Keloid / Hypertrophic Scars
What are Keloid Scars?
Keloid scars represent an exaggerated healing response by the body. It usually presents as a scar that is red, firm and protrudes from the skin. They can occur after surgery or trauma, or may develop spontaneously; often after an acne cyst. They may arise anywhere on the body, but they are most common on the shoulder, upper chest, back and earlobes (secondary to ear piercing). At times, these scars can be itchy or painful. Other than earlobe keloids, surgical removal is not recommended as it often results in a recurrence of the scar that is larger than the original lesion. The goal of the treatment is to soften and flatten the scar, improve the symptoms of pain and itching and improve the overall appearance of the scar.
What are Hypertrophic Scars?
Hypertrophic scars, also known as rolling scars, are raised red scars that are filled with collagen. These scars occur when the body produces too much collagen during the acne healing process. These scars have a wave-like appearance resulting in bands of tissue deep within the skin.
What Is The Difference Between Hypertrophic Scars and Keloid Scars?
While keloid scars and hypertrophic scars are very similar, there is one big difference between the two scars. Keloid scars continue to grow after the healing process has completed. Hypertrophic scars do not grow beyond the site of injury. Both scars are benign and non-contagious.
Keloid Scar Treatment Options
Intralesional Cortisone Injections
Softening and flattening of the scar tissue is most often achieved with a series of injections directly into the scar. A special device called a ligmaject is used to inject the kenalog as it provides some mechanical advantage to the injection, allowing the medication to penetrate and spread thoroughly throughout the scar. Kenalog an anti-inflammatory that is also very effective in reducing or eliminating symptoms of pain, irritation or itching. Although many people request surgical revision to remove the keloid scar, the scar tissue will almost ALWAYS recur even larger, so it is strongly discouraged.
Vascular Laser – Vbeam (Pulsed Dye) or Vasular (IPL) Lasers
Reduction of the redness associated with the scars is obtained by a series of vascular laser treatments. These are non-ablative lasers that do not disrupt the surface of the skin. The wavelength of laser is selectively absorbed by hemoglobin in red blood cells. This constricts the blood vessels and reducing the redness. Additionally, the heat energy from the laser can stimulate collagen remodeling leading to some mild softening and flattening of the scar tissue.
Silicone Gel Dressing
Silicone gel dressings have been shown to help assist in softening and flattening scar tissue and prevent recurrence. This treatment is not effective independently for thick keloids. However, when used in conjunction with other treatments it prevents the scars from becoming elevated once they have become flat. We have some silicone scar patches that can be applied nights and used for several weeks or months or a topical product can also be applied nightly to prevent further elevation of the scar.
Ear Lobe Keloids
These are the only type of keloid scars that are amenable to surgical revision with the Ultrapulse Co2 Laser. After administering a local anesthetic, a surgical blade removes the bulky scar and then the laser systematically treats base, flattening until it is flush with the surface of the skin. Although no sutures are required, the area will need to crust and scab and will likely take two to three weeks to heal completely. Immediately following the removal, kenalog injections will be initiated to prevent recurrence and will need to be repeated every three to four weeks for three to six treatments.
In approximately two to three weeks when the area has healed after the removal, a topical Rx imiquimod (Aldara or Zyclara) will need to be applied three to five nights per week. This is an immune stimulating medication that promotes the activation of immune cells that in turn encourage healing of the scar and prevents recurrence. This provides a dramatic, often life-changing improvement in one treatments.
Fractional Laser Resurfacing
The Ultrapulse Co2 SCAAR FX Laser is the newest technology that has been shown to effectively treat scars, particularly keloid and burn scars. The laser creates micro columns of thermal energy by penetrating through the scar tissue, breaking down the tight bands associated with scars and improving the texture and tone. The procedure is similar to aerating your lawn. The heat created with the laser channels helps to soften the scar tissue while simultaneously stimulating collagen regeneration and repair below. Immediately following the procedure while the channels are still open, kenalog will be applied and massaged into the scar. Some pain is associated with this laser as it does penetrate through the surface of the skin.
Hypertrophic Scar Treatment Options
Surgery is not a recommended treatment for hypertrophic scars. This is due to the risk of worsening the existing scars and creating more severe scarring. Most treatments are minimally invasive for these kinds of scars.
These injections work similarly to the injections used to treat Keloid scarring. Cortisone injections are a popular treatment option for improving the appearance of hypertrophic scars. These injections are effective in reducing the signs of hypertrophic scars such as inflammation and redness. Alleviating these signs enhances the appearance of these scars significantly.
Cosmetic procedures such as chemical peels, skin bleaching, and microdermabrasion are effective in improving the overall appearance and prominence of hypertrophic scars. These treatments gently remove the top layers of the skin and improve mild surface irregularities, such as these scars. Multiple treatments are often required in order for treatment to be as effective as possible.
Much like surface treatments, laser treatments remove the top layers of damaged skin, improving the appearance of the skin. These treatments also stimulate the production of collagen, which stimulates the natural healing process of the skin. Because lasers are so precise, only the damaged skin is treated, leaving the healthy tissue untouched.