Keloid Scar Removal with Steroid Injections

Keloid scars are a common but distressing condition for those who develop them. Unlike typical scars, which often fade and improve over time, keloids can continue to grow and remain raised, often causing itching, pain, and cosmetic concerns. Among the various treatments available, steroid injections are the gold standard and have gained significant attention for their effectiveness in managing keloid scars. 

What Are Keloid Scars?

Keloids are raised, thickened areas of skin that form at the site of an injury. Unlike normal scars, which eventually flatten and become less noticeable, keloids extend beyond the original trauma area and can continue growing even after the wound has healed. They may form after surgery (and stitches), burns, piercings, acne, or even minor cuts. Keloids can affect any part of the body but are most commonly seen on the chest, shoulders, earlobes, and upper back.

The development of keloid scars is linked to an overproduction of collagen during the healing process. Normally, collagen is produced to repair damaged tissue, but in the case of keloids, the body produces too much, leading to the formation of these dense, rubbery, and often itchy or painful bumps.  Typically, keloids form when the trauma of the injury has the dermal layer of the skin – the second layer which contains your collagen.

Why Do Keloids Form?

The exact cause of keloid formation is still not entirely understood, but several factors are believed to play a role:

• Genetics: Keloids tend to run in families, and certain ethnic groups, particularly individuals of African, Asian, and Hispanic descent, are more prone to developing them.
• Skin Tension: Areas of the body with high skin tension, such as the chest and shoulders, are more susceptible to keloid formation.
• Inflammation: Prolonged inflammation at the wound site may contribute to abnormal collagen production, increasing the likelihood of keloid development.
• Hormonal Factors: Some research suggests that hormonal changes, particularly during puberty or pregnancy, may increase the risk of keloid formation.

Understanding Steroid Injections for Keloid Scars

One of the most widely used and effective treatments for keloid scars is steroid (corticosteroid) injections. Steroids have powerful anti-inflammatory properties, and when injected directly into the keloid, they can reduce inflammation, suppress collagen production, and shrink the scar. This makes steroid injections a popular choice for treating keloids that are raised, thickened, and causing discomfort.

How Steroid Injections Work

Steroid injections involve administering a corticosteroid, typically triamcinolone acetonide, directly into the keloid. Brand names for the drug include Cortisone and Kenalog.  The injection works by:

1. Reducing Inflammation: Inflammation plays a crucial role in the development and growth of keloid scars. Steroids help decrease the inflammatory response, which can stop or slow down the excessive production of collagen.
2. Suppressing Collagen Production: Collagen is the protein responsible for skin strength and elasticity. In keloids, an overproduction of collagen leads to thick, raised scars. Steroid injections inhibit the cells responsible for producing collagen, thereby preventing further thickening of the scar.
3. Promoting Scar Softening: Over time, steroid injections help to soften the keloid tissue, making it less rigid and more pliable. This can improve the texture and appearance of the scar.
4. Reducing Symptoms: Keloids can be itchy, painful, and sensitive to touch. Steroid injections help alleviate these symptoms, making the scar less uncomfortable.

The Treatment Process

The process of treating keloid scars with steroid injections typically involves several sessions spaced out over weeks or months, depending on the size and severity of the scar. Here is a step-by-step overview of what to expect:

1. Initial Consultation: A healthcare provider will assess the keloid and discuss treatment options. If steroid injections are deemed appropriate, the provider will explain the procedure, including potential risks and benefits.
2. The Injection Procedure: During the actual procedure, the healthcare provider will use a fine needle to inject the steroid directly into the keloid. The procedure is usually quick and performed in an outpatient setting. Some patients may experience mild discomfort during the injection.
3. Repeat Sessions: Keloid scars often require multiple injections for optimal results. Sessions are typically scheduled every 4 to 6 weeks, and the total number of injections depends on how well the keloid responds to treatment. Larger or more stubborn keloids may require additional sessions.
4. Post-Injection Care: After the injection, patients may experience mild redness, swelling, or tenderness at the injection site. These side effects usually subside within a few days. Patients should follow any aftercare instructions provided by their healthcare provider, such as avoiding excessive sun exposure or applying moisturizing creams to the area.

Effectiveness of Steroid Injections

Steroid injections are one of the most effective treatments for keloid scars, but their success varies from person to person. Some of the factors that influence the effectiveness of the treatment include:

• Dose: The dosing of the injected steroid can affect the success of treatments.  If the dose is too low, improvement may not be seen.  If the dose is too high, side effects may occur.

• Scar Age: Newer keloids tend to respond better to steroid injections compared to older, more established scars.
• Scar Size: Smaller keloids may shrink more significantly with treatment than larger ones.
• Scar Location: Keloids in areas of high skin tension, such as the shoulders or chest, may be more resistant to treatment.

In many cases, steroid injections can flatten and shrink the keloid by up to 50-80%. However, complete eradication of the keloid is rare, and some patients may experience recurrence over time. Combining steroid injections with other treatments, such as laser therapy or surgical removal, can enhance results and reduce the likelihood of recurrence.

Side Effects and Risks

While steroid injections are safe, they can have side effects, particularly when used over an extended period. Some of the potential side effects include:

• Skin Thinning: Repeated steroid injections can cause the skin to become thinner and more fragile, particularly in sensitive areas.
• Pigment Changes: Some patients may experience changes in skin pigmentation, with the treated area becoming lighter or darker than the surrounding skin.
• Atrophy: In rare cases, the tissue around the injection site may atrophy, leading to a sunken or indented appearance.

Patients should discuss the potential risks with their healthcare provider before starting treatment to ensure they fully understand the benefits and potential drawbacks.

Alternative and Complementary Treatments

While steroid injections are highly effective for many patients, they may not be suitable for everyone. For patients who do not respond well to steroids or experience significant side effects, alternative treatments are available. These may include:

• Laser Therapy: Laser treatments can help reduce the redness and thickness of keloid scars.
• Surgical Removal: In some cases, keloids may be surgically removed, though this carries an elevated risk of recurrence unless combined with other treatments.
• Silicone Sheets: Applying silicone gel sheets to the keloid can help flatten the scar and reduce its size over time, especially in cases where the keloid is very new.

Conclusion

Steroid injections offer a promising solution for individuals struggling with keloid scars, helping to reduce their size, alleviate discomfort, and improve their appearance. While the treatment is not a cure-all and may require multiple sessions, it can be an effective part of a broader strategy for managing keloid scars. By working with an experienced healthcare provider, patients can explore the most appropriate treatment options for their specific needs, helping them achieve the best possible outcomes in the management of keloid scars.