Keloid and hypertrophic scars are abnormal scar formations — keloids extend beyond the original wound boundary, hypertrophic scars stay within. Both are common in Latin, Black, and Asian skin. Treatment is multimodal and ongoing.
Differentiating the two
- Keloid: grows beyond original wound, often expanding over years
- Hypertrophic: stays within wound boundary, may flatten over 1–2 years naturally
Keloids are more aggressive and recurrence-prone. Treatment philosophy is the same but keloids need more vigilant maintenance.
Step 1: Intralesional steroid (triamcinolone)
First-line treatment. Injection of corticosteroid directly into the scar every 4–6 weeks for 3–6 sessions. Flattens and softens the scar. Side effect: skin atrophy if overdosed.
Conservative dosing essential. Atrophy from overdose creates depressed area that's harder to address than the original scar.
Step 2: Laser
Vascular laser reduces redness and hyperemia driving scar activity. Fractional non-ablative or CO₂ for texture and pigmentation. Picosecond for hyperpigmented surrounding tissue.
Multi-modal laser approach addresses different aspects (color, texture, surrounding pigmentation).
Step 3: Silicone sheets / pressure
Daily silicone sheet wear (24/7 ideal) for 3–6 months reduces scar mass. Compression garments for body keloids.
Underrated but evidence-based. Compounds with intralesional + laser.
Surgical excision (with caution)
Risk: keloid often recurs larger if simply cut out. Surgical excision must be combined with intralesional steroid + radiotherapy or other adjunctive treatment. Lima offers experienced plastic-surgical management for severe cases.
When to consider: very large keloids, functional impairment, careful multimodal post-op plan.
Prevention is the best treatment
If you're keloid-prone, avoid elective procedures that cause skin trauma in keloid-prone areas (chest, shoulders, ear lobes). Pre-treatment with silicone and prophylactic intralesional steroid post-procedure can prevent keloid formation.
Genetic predisposition + body location are the main risk factors. Family history matters.
Specific body location considerations
- Chest/shoulders: highest keloid recurrence rate
- Ear lobes: common from piercings; pressure earrings effective
- C-section scars: often hypertrophic; aggressive prevention regimen
- Acne keloids: aggressive acne control essential
Trip planning
Keloid management is ongoing. Multi-trip strategy:
- Initial trip: first intralesional + laser + silicone protocol setup
- Trips 2-4: serial intralesional spaced 4-6 weeks apart
- Annual maintenance: as needed for recurrence prevention
Frequently asked questions
Will my keloid go away?
Significant improvement realistic; complete elimination uncommon.
What about cryotherapy for keloids?
Yes, intralesional cryotherapy is one option in difficult cases.
Are there topical treatments?
Silicone gels, pressure earrings. Limited monotherapy effect.
What about radiotherapy after surgery?
Reduces recurrence rate dramatically. Considered for high-risk surgical excision.
Can I prevent keloids during piercings?
If keloid-prone, avoid piercings at high-risk sites. Use pressure earrings post-piercing.
What about acne keloids?
Aggressive acne control + intralesional + topical regimen.
How does Asian/Korean keloid management differ?
Similar principles. Some cultures use traditional remedies that may have evidence base.
Bottom line
Multi-modal protocol: intralesional steroid + laser + silicone/pressure. Ongoing maintenance pattern for keloid-prone patients. Surgical excision only with careful adjuvant plan. Lima offers experienced multi-modal management at meaningful cost savings.