Despite what is written and claimed by many health care professionals, the treatment of keloids remains unsatisfactory. In fact most individuals will claim that the keloids are worse after any procedure. Many different types of treatments have been developed to treat keloids. Some have been partially effective but the majority do not work in all individuals.
The most common treatments for keloids include:
Steroids: The use of topical and oral steroids has no role in the treatment of keloids. For steroids to be effective, they have to be injected into the keloid. Cortisone, most commonly kenalog (10mg/ml) is injected into the keloid. The keloid does not immediately shrink and takes time. This time period may vary anywhere from 4-12 weeks. In some cases, the keloid will soften up and shrink. Some individuals require multiple steroid injections spaced over a period of 4- weeks. About 30-50% of individuals show no response. For those who do respond, the scar will be less conspicuous, flat and not obvious.
Steroids & Surgery: Some physicians administer steroids every 4-6 weeks and let the keloid soften up. Following this they either excise the keloid with surgery or use laser to remove the keloid. In any case, a compression dressing is always applied to prevent the regrowth of the keloid.
Laser: The pulsed-dye laser has been tried to treat keloids and has been partially successful at treating the smaller lesions. Laser is safe and fast but most individuals require multiple sessions. Some individuals also develop worsening of their keloids after laser. Laser therapy is also expensive.
Cryotherapy: Cooling or freezing the keloids has been tried out for the very small lesions. The cryotherapy does work in some keloids and makes them flat. However, many individuals show no response to cryotherapy.
Radiation: Some physicians administer radiation therapy over a few weeks. In those who do respond, the results can be dramatic. However, radiation treatment for keloid therapy is not always successful. Some physicians combine steroids followed by radiation therapy
Chemotherapy: Some individuals just want the keloids out and have opted for chemotherapy drugs. Fluorouracil injections into the keloids have been tried out and worked well in some cases. The injections are also painful and irritating.
Silicone splints: In burn individuals, silicone splints have routinely been applied followed by compression garments. The splints are worn for many months and some data do indicate that this treatment works. However, this is not a universal finding and may individuals still develop keloids. Most individuals quickly tire out wearing compressive splint dressings for long periods.
Interferon: Injections of interferon have also been used to treat keloids. The interferon is injected 2-3 times a week for a few months. Some individuals do show a decrease size in keloids but many individuals show no response. In addition interferon also has some side effects which include:
- general fatigue
- a flu like syndrome
Interferon is expensive and does not work in everyone.
Today, we have no cure for keloids. The best way to avoid keloids is to avoid any unnecessary elective surgery, avoid trauma or body piercing.