For people with darker skin pigments keloid scarring can be an ugly fact of life. A keloid is an overgrowth of scar tissue at a site of injury. Keloids can occur from trauma, burns, surgical incisions, lacerations, piercings, and even tattoos. In extreme cases keloids can even form after a simple abrasion to the skin. Imagine scraping your elbow or knee and forming a a large painful keloid scar afterward! Again, this is an extreme example but this can happen. The good news is that keloids are treatable. The bad news is that it’s not always an easy fix and in many cases it requires multiple treatments and/or procedures.
Not all unsightly or dark scars are keloids. A widened scar is simply that, a scar which has stretched or expanded because it is over a moving joint (such as the knee or elbow) or because it’s in an area of tension. Most widened scars are not keloids therefore they won’t be treated the same way keloids are treated.
In a keloid scar the collagen which helps repair the cut skin edges grows too much and the scar will appear swollen, hard, and sometimes painful. Because a keloid is first and foremost an inflammatory reaction one of the first-line treatments is a steroid injection. Kenalog steroid is injected directly into the keloid scar and after a few weeks the scar will appear flatter and lighter in color. If this injection is repeated every month then in most cases the patient will see a significant improvement in the keloid scar.
In an ideal situation the keloid shrinks and softens after kenalog injections. Often as it shrinks I am able to excise the keloid and re-close the incision. Patients who have very bad or large keloids sometimes require a single dose of radiation therapy after excision to prevent the keloid from recurring. This single dose of radiation has been very effective in preventing or slowing recurrence but it is only necessary for large or refractory keloid scars.
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