Keloid Scar Treatment: Guidelines for Care and Choosing the Right Approach

A keloid scar is a condition in which the skin produces excessive collagen tissue after an injury or surgery, resulting in a raised scar that extends beyond the original wound boundary. Keloids are often firm, pink, red, or dark in color and may cause itching, pain, or discomfort.

• Hypertrophic scar: Raised above the original wound but does not extend beyond the wound boundary.
• Keloid: Raised and expands beyond the original wound boundary, continuing to grow even months or years later.

1. Genetics
   People with a family history of keloids are more likely to develop them.
2. Body location
   Keloids commonly occur on the chest, shoulders, behind the ears, and upper back, where the skin is under tension.
3. Age
   Teenagers and younger people have a higher chance of developing keloids due to increased collagen production in the skin.
4. Skin type
   Individuals with darker skin tones, including Asians and Africans, are more prone to keloids compared to those with lighter skin.

1. Topical medication and silicone sheets – Mostly effective for prevention rather than treatment.

• Silicone gel sheets: Help compress scars, reduce elevation, and decrease collagen overproduction.
• Scar-reducing creams: Contain ingredients that help reduce excessive tissue formation, such as onion extract and vitamin E.

2. Intralesional steroid injection

• The most commonly used drug is Triamcinolone acetonide.
• Helps reduce inflammation and collagen overproduction.
• Requires repeated injections every 4–6 weeks, 5–10 sessions depending on the scar type.
• Possible side effects include skin thinning and white patches.

3. Surgical removal of keloids

• Suitable for large keloids or when other treatments are ineffective.
• Should be combined with steroid injections and silicone-based therapies to reduce recurrence.
• Involves excising the entire keloid mass and carefully suturing to minimize tension.

4. Laser therapy

• Picosecond or Fractional CO2 lasers help reduce redness and improve keloid thickness.
• Multiple sessions are required for visible results.

• Proper wound cleansing.
• Avoid scratching or picking at the wound.

• Reduces wound tension.
• Lowers the risk of keloid formation in high-risk individuals.

• Small keloids may be treated with injections or topical agents alone.
• Larger keloids may require surgery combined with other therapies.

• For facial or neck keloids, non-invasive options such as laser or steroid injections are often preferred to avoid additional scarring.

• If one method is ineffective, adjustments or combination therapies may be required.

• Treatment usually requires time and repeated sessions.
• Prevention is more important than treatment, especially for individuals prone to keloids.

There are multiple methods for treating keloid scars, including silicone gel, steroid injections, laser therapy, and surgical excision. The choice of treatment depends on the type of keloid, aesthetic goals, and medical advice. Proper wound care from the beginning remains the key factor in preventing new keloid formation.