Keloid Scar: All you need to know

What is a Keloid scar?

Keloid scars are abnormal scars that can occur after a skin injury. Keloid scar growing is a natural process followed by wound healing. These scars tend to appear slowly over months beyond the initial wound. Keloids progress to form thick, firm scars that are tough to heal, because of which causes significant emotional and physical distress in patients when left untreated.

Keloid scars are not harmful or cancerous if left untreated. Since they can be of cosmetic concern to the patient, it’s better to get keloid scar treated.

Keloid scars are often confused with hypertrophic scars. However, both conditions are different. While keloid scars develop over months, hypertrophic scars develop over a few weeks. Unlike keloid scars, hypertrophic scars can fade away on their own if left untreated.

Signs and Symptoms of Keloid scar

A keloid scar may develop after months of an injury and be marked by the following symptoms:

• Thick, irregular scarring, typically on the earlobes, shoulders, cheeks, or middle chest
• Red or pink shiny, hairless, lumpy, raised skin after the injury
• Soft to a firm or rubbery textured scar
• Itchiness on the patch of skin
• Discomfort or irritation due to the lump while clothing

What causes a keloid scar?

Keloid scar reason is theorised to occur due to an imbalance between increased collagen and extracellular matrix synthesis. This occurs due to the following reasons:

• Any unwanted wound or injury
• If you have gone through any cosmetic surgery
• If you have inked or pierced your body.
• Inflammation due to popping acne can also increase the chance of keloid scar

Medical treatments for keloid scar removal

The therapies and treatments for the removal of keloid scar include:

1. Occlusive dressings

Silicone gel sheeting (SGS) is a commonly used occlusive dressing applied on the wound to reduce the risk of excessive keloid scar formation. SGS is theorised to seal and hydrate the wound. This dressing creates a moisture-retaining environment that prevents dehydration of the outer layer of the skin, which subsequently limits the formation of excessive tissue and collagen in the skin.

2. Compressive therapy

Compression or pressure therapy is used after surgical excision to prevent the recurrence of ear keloids. Compression treatments are performed using elastic wrap bandages and custom pressure pads. It is reported that ear keloids treated with compression therapy after surgery reduce the chances of the reappearance of scar to 70.5 to 95%. The therapy shows the best result when applied appropriately.

3. Intralesional steroids

Intralesional steroids are used as first-line treatment by many physicians. Typically, triamcinolone, a corticosteroid, is injected at a concentration of 2.5mg to 20mg for facial keloids and 20mg to 40mg for non-facial keloids. This therapy has been shown to reduce keloid recurrence to an average of 50 per cent after surgical excision and also reduce scar volume.

4. Imiquimod 5% cream

Imiquimod, 5% cream, is the keloid scar cream used successfully to treat basal cell carcinoma and human papillomavirus-related warts. It is a promising treatment after surgery for the removal of keloid scars.

5. Intralesional and topical 5-fluorouracil (5-FU)

5-FU can also effectively reduce excessive tissue growth and collagen synthesis.

However, following this treatment, there is a 21 to 35 % chance that keloid can reoccur after three months.

6. Interferons

Interferon alpha-2b and interferon-gamma can also be used as a treatment of keloid scare to suppress collagen synthesis and keloid scar contraction.

7. Bleomycin

Bleomycin, isolated from Streptomyces verticillus bacteria, is also used as a treatment for both keloids and hypertrophic scars.

8. Surgery

It can be removed with surgery, also. However, the scar may reoccur even after surgery, with a reoccurrence rate of 45-100%.

9. Radiation therapy

Radiation therapy is the most effective therapy in addition to surgery to reduce keloid scar. However, the patients undergoing radiation therapy may experience erythema, desquamation, and transient changes in pigmentation.

10. Cryotherapy

It is the freezing therapy used applied on keloids to reduce scar volume and recurrence. However, exposure to low temperatures can induce vascular damage, resulting in cell anoxia, cryonecrosis, and coagulative necrosis.

11. Pulsed-dye laser (PDL)

PDL is an advanced laser therapy that improves the appearance of keloid scars.

12. Laser-assisted drug delivery (LADD)

LADD is also an advanced laser technology that allows applied medicine to penetrate in the skin for keloid scar removal effectively.

Effective home remedies for keloid scar removal

You can get rid of keloid scars at home with these effective remedies:

1. Include Vitamin D in your diet

Vitamin D-rich foods to your diet or as a supplement can slow the progression of tissue fibrosis and inhibit collagen synthesis in a keloid scar.

2. Aspirin

One study on keloid scar treatment reports that aspirin can/ reduce keloid scar formation by inhibiting scar-forming immune cells from entering wounds.

You can mix the powdered aspirin tablets with water to form a paste, then apply them to the affected area. It is an effective remedy at home to reduce scar pigmentation and size. However, you should discontinue using it in case of an allergic reaction.

3. Papaya

In another study, the Papain enzyme in raw papaya fruit was found to increase collagen degradation, thus, it can be effectively used as a home remedy for the treatment of keloid scar.

4. Garlic

Incorporating garlic in a diet or applying garlic extract on keloid scar is also reported to reduce scar size and skin pigmentation. Besides, it can also be used as a remedy for fungal infections, leishmaniasis, skin aging, and skin rejuvenation.

Read more- Health benefits of garlic

5. Honey

Honey is another natural remedy to reduce the size of keloid scars. The fatty acids in honey such as palmitic acid, stearic acid, oleic acid, linoleic acid, and octadecanoic acid interfere with tissue formation in a keloid scar. Therefore, applying raw honey regularly to the affected area can help you get rid of keloid scars.

6. Onion

Onion extracts can also improve keloid scars and hypertrophic scars. You can apply onion extract on the affected area several times a day to get rid of the keloid scar.

What are the preventive measures for keloid scar?

The preventive measures to avoid keloid scars include:

• The treatment for it may be hard and the scar might reappear even after the treatment. Therefore, occlusive dressing with a silicon gel sheet as well as compression therapy with elastic wrap bandages, and custom pressure pads is the best preventive measure to avoid the outbreak of keloid scar.
• Maintain hygiene and clean your wound till it heals
• Avoid any unwanted cosmetic surgery, tattoos, and piercing
• Avoid exposing your wound to the sun as it may cause hyperpigmentation on the scar.

Conclusion

Keloid scars are harmless yet abnormal scars that can appear while a wound is healing. If left untreated, it can grow large, becoming a cosmetic concern. People with these scars may undergo emotional and physical distress which can degrade their quality of life. These scars can be easily treated with medical interventions such as surgeries and radiation therapies. Besides, you can also get them treated effectively at home with extracts of papaya, garlic, onion, and honey and by applying aspirin.

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