and Managing Hypertrophic Scars: A Patient's Journey

Improving keloids?

Hello, Doctor: About three years ago, I developed a bump in my genital area, which, when squeezed, oozed pus.
It then became a red, swollen hard lump that often itched.
Since it was in a private area, I thought it was a gynecological issue and delayed seeking help for a year until I finally mustered the courage to visit a gynecology clinic.
The gynecologist diagnosed it as a keloid and performed surgical excision in May of last year, prescribing steroid pills afterward and advising me to use POLYXAL scar gel once the wound healed.

Two to three months post-surgery, I noticed the wound felt hard to the touch, and I suspected that the stitches might not have been completely removed during the suture removal.
I pulled out the remaining stitch ends myself, which was painful and caused some bleeding.
Afterward, I felt that the scar gel did not improve the situation, so I stopped applying it.
The keloid gradually grew over time, accompanied by unbearable itching, especially at night!
In April of this year, I switched to a different gynecology clinic, where the doctor prescribed an anti-itch medication for me (indicated for skin itching and urticaria) and advised me to see a specialized surgeon instead of continuing with gynecology.
The doctor mentioned that keloids are prone to recurrence after excision and recommended steroid injections as a better treatment option, providing me with a referral to the general surgery department at Chang Gung Memorial Hospital.
Later, the general surgeon referred me to the plastic surgery department, where the plastic surgeon advised against surgery, stating that it would not be covered by insurance and that if the keloid recurred post-surgery, it could enlarge the wound.
The recommendation was to try monthly steroid injections.
Since I experience daily itching, the doctor informed me that the current treatment could only alleviate symptoms and not cure the condition, aiming to reduce redness and flatten the area.
However, steroid injections might cause skin indentation, and if I was concerned about the appearance of the scar, I should have the keloid excised and then promptly receive steroid treatment.
I have only received the first injection this month.
I would like to inquire about the initial cause of the bump.
I do not have keloids in other areas, and I only discovered my predisposition to this condition because of the one in my vulvar area.
I have a history of allergies, keratosis pilaris, and I am allergic to Painil and Ibuprofen.
Whenever I get bitten by mosquitoes, the wounds always develop blisters and become red, swollen, and itchy, taking a long time to heal.
I tend to pop the blisters.
Is this related to my keloid predisposition? Additionally, can I continue to apply POLYXAL scar gel or the anti-itch medication (indicated for skin itching and urticaria)? I still experience persistent itching every night.
Thank you, Doctor, for taking the time to respond.
Wishing you peace and well-being!

Niming, 20~29 year old female. Ask Date: 2016/05/05

Dr. Wu Yuxin reply Dermatology

1.
I cannot answer the question about the initial cause of acne.

2.
The wounds from mosquito bites that develop blisters and become red, swollen, and itchy take a long time to heal and are unrelated to keloid predisposition.

3.
POLYXAL scar gel or anti-itch medication can be applied continuously.

Reply Date: 2016/05/05

More Info

Hypertrophic scars, also known as keloids, can be a challenging condition for many patients, particularly when they develop in sensitive areas such as the genital region. Your journey, as you described, highlights the complexities of diagnosis and management of such scars.
Initially, the development of a pimple-like lesion that became inflamed and eventually formed a hard, itchy mass is indicative of a possible inflammatory response, which can lead to hypertrophic scarring. The fact that you have a history of allergic reactions and keratosis pilaris may suggest a predisposition to abnormal healing responses, which can contribute to the formation of keloids or hypertrophic scars. Keloids are characterized by an overproduction of collagen during the healing process, leading to raised, thickened scars that can be itchy and uncomfortable.

The treatment pathway you have followed is quite common. After the initial diagnosis of keloids, surgical excision is often considered; however, as you have experienced, keloids have a high tendency to recur after surgical removal. This is why adjunct therapies, such as corticosteroid injections, are frequently recommended to help manage symptoms and reduce the likelihood of recurrence. Corticosteroids work by reducing inflammation and collagen production, which can help flatten the scar over time.

Your experience with the POLYXAL scar gel and the subsequent lack of improvement is not uncommon. While silicone-based gels and sheets are often recommended for scar management, their effectiveness can vary from person to person. It’s essential to continue using them as directed, especially if they are recommended by your healthcare provider, as they may still provide some benefit over time.

Regarding the ongoing itching and discomfort, it is crucial to manage these symptoms effectively. The topical anti-itch medication prescribed by your new gynecologist may help alleviate some of the discomfort. However, it is essential to ensure that any topical treatments you use do not irritate the area further. Always consult with your healthcare provider before continuing or changing any medication regimen.

As for your concerns about the relationship between your allergic tendencies and the development of keloids, there is some evidence to suggest that individuals with atopic conditions (like allergies and eczema) may be more prone to developing keloids. This could be due to an exaggerated inflammatory response during the healing process.
In summary, your journey with hypertrophic scars is multifaceted, involving both physical and emotional challenges. It is essential to maintain open communication with your healthcare providers, including dermatologists and plastic surgeons, to explore all available treatment options. Regular follow-ups and possibly a multidisciplinary approach may provide the best outcomes in managing your condition.
Lastly, continue to monitor your symptoms and report any changes to your healthcare provider, as they can help tailor your treatment plan to your specific needs. Remember, while keloids can be persistent, there are various strategies to manage and improve their appearance and associated symptoms.

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