Keloids & Treatment

By: Michael Appleman


Keloids are raised, reddish nodules that develop at the site of the burn injury. After the burn wound has occurred to your skin, both the skin cells and connective tissue cells (fibroblasts) begin multiplying in order to repair the injury. A burn scar is made up of 'connective tissue'. The connective tissue is gristle-like fibers deposited in the skin by the fibroblasts to hold the wound closed. With keloids, the fibroblasts continue to multiply even after the wound is filled in. As a result the keloids project above the surface of the skin and form large mounds of scar tissue.

Keloids may form on any part of the body. The most likely place for a keloid to be found is the upper chest, shoulders and upper back. Symptoms include pigmentation of the skin, itchiness, redness, unusual sensations and pain.

Keloids may be prevented by wearing pressure garments over the burn injury site. The pressure garments are worn for months to years after the initial healing of the burn wound. The garments are worn for 23 of 24 hours each and every day. Once a keloid has formed, you should speak to your doctor about possible removal. The treatments to choose from for removal of Keloids are as follows:

   Removal with conventional surgery - This unreliable technique requires great care, and keloids that return after being removed may be larger than the original. Keloids return in more than 45% of people when they are removed surgically. Keloids are less likely to return if surgical removal is combined with other treatments.
   Dressings- Studies have shown that moist burn wound coverings made of silicone gel sheets reduced the size of keloids over time. It is said that this treatment is safe and painless.


   Compression- This involves using a bandage or tape to apply continuous pressure 24 hours a day for a period of six to 12 months. Compression can cause a keloid to become smaller. For keloids that form at the site of an ear piercing, a clip known as a Zimmer splint usually reduces keloid size by at least 50% after one year of compression. Zimmer splints that look like earrings are available.
   Steroid Injections- Steroid Injections with triamcinolone acetonide or another corticosteroid medicine typically are recurring at intervals of four to six weeks. This treatment has been found to reduce the size of the keloid and the irritation. You should always remember that these type of injections are uncomfortable.
   Cryosurgery - This freezing treatment with liquid nitrogen is repeated every 20 to 30 days. It can cause a side effect of lightening the skin color, which limits this treatment's usefulness.
   Laser Therapy - Laser therapy is an alternative to conventional surgery used to remove keloids. There is no good evidence that keloids are less likely to recur after laser therapy than after regular surgery.
   Radiation Therapy - Radiation therapy is controversial. This is because radiation has been found to increase the risk of cancer. Radiation treatments have been found to reduce scar formation when it is used immediately after the initial surgery. That means the radiation therapy should be done during the time a surgical wound is healing. You must remember that you will be at risk of cancer due to the radiation.
   Experimental Treatments - One experimental treatment that has shown promise is injecting keloid scars with medicines that were developed to treat autoimmune illnesses or cancers. Before having any of the experimental treatments, you should speak with your doctor, weigh the pros and cons and decide if you should have the treatment or not. Remember that the drugs used in the experimental treatments, are various types of interferon and chemotherapy agents 5-fluorouracil and bleomycin.

You should understand that at this time there is no completely satisfactory treatment for keloids. Keloids have been found to recur. When that occurs the keloid may be larger than the keloid that was removed. In order to discourage this from happening, surgeons have combined scar removal and steroid injections or radiation therapy. After removal you may again need to wear pressure garments for up to one year. Many burn survivors who suffered keloids have needed repeated surgeries every few years.

Always speak with your doctor and family members. Weigh out the pros and cons of each treatment and then decide what is best for you.