Keloid is undoubtedly a big fear of anyone who has any kind of surgery. Having an ugly scar can compromise the outcome of any surgery, especially if it is aesthetic.
Although keloid is a specific scar type, many patients think they have keloids, as there is a lay understanding that any non-ideal scar is a keloid.
This is not true. Keloid is a raised, thick scar, usually accompanied by itching or pain. It has a strong genetic component, most often affecting blacks and Asians. Most of the time, it begins to itch and get high after 3 weeks to 3 months of surgery. It does not regress on its own without treatment, becoming tall and thick permanently.
Often confused with keloids, the hypertrophic scar is a type of scar that resembles a keloid, but is not as intense and regresses on its own over time, often flattening after 6 to 16 months of surgery.
Other unsightly scars labeled keloid are enlarged, atrophic (low relief) or retracted scars. All of them do not have high relief, although they are aesthetically undesirable.
Keloid is formed by an uncontrolled production of collagen. This exaggeration in production causes the scar, instead of flat, to be raised and invade the skin, exceeding the original limits of the lesion.
Keloid treatments aim to reduce collagen production or decrease collagen accumulation. Silicone based creams or plaques, as well as scar area compression and corticoid creams are some examples.
Once in formation, when the relief is already high, these treatments do not help much. Corticosteroid injection is most effective in trying to stall growth or minimize keloids. Sometimes reaches to even involution.
Lasers are still under development and may be an alternative, although they still do not show solid results in keloid regression.
Once well developed, tall and wide, there is no treatment that makes the keloid greatly reduced. Surgery becomes the best treatment.
In fact, surgery removes the problem and starts a new scar from scratch. Its advantage is that it allows an attempt to control the new scar. If nothing is done the keloid will surely return. Therefore, some treatment is required after surgery.
Beta therapy is a type of radiotherapy for the skin. It reduces the activity of fibroblast, the cell responsible for collagen production. This reduces the chance of it returning. Injection of corticosteroids at the wound edge after removal of the keloid is also a good alternative to add to the treatment.
Beta-therapy should be started on the day after surgery, usually requiring 10 sessions. Follow-up of healing should be done at least for the first 4 months, in case of a tendency of keloid return, a new corticosteroid injection is made.
This is the most effective keloid treatment these days, but it is no guarantee of success. Even so, sometimes the keloid returns. Fortunately, most cases have a satisfactory result.
Another question to consider is whether the keloid can be completely removed. Due to its location and size, some surgeries may be required to minimize the problem and it cannot always be eliminated.
Dangerous keloid scar removal tutorials can cause necrosis - TomoNews (April 2024)
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