Chronic and Severe Keloids: Struggles with Treatment and Management - Dermatology

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Keloids are a challenging dermatological condition characterized by the overgrowth of scar tissue at the site of an injury. They can be particularly distressing for patients, both physically and emotionally, especially when they are large, itchy, or painful, as in your case. Chronic and severe keloids can significantly impact a person's quality of life, and managing them often requires a multifaceted approach.

From your description, it seems that you have been dealing with a keloid on your chest for over a decade, which has grown significantly and continues to expand despite various treatment attempts, including steroid injections, botulinum toxin injections, cryotherapy, and surgical excision. The persistent nature of your keloid and the associated symptoms of itching and pain can understandably lead to frustration and anxiety about future implications, such as during pregnancy.


Understanding Keloids
Keloids form as a result of an abnormal healing response, where the body produces excessive collagen in response to skin injury. This process can be influenced by several factors, including genetics, skin type, and the location of the injury. Keloids are more common in individuals with darker skin tones and can occur after various types of skin trauma, including acne, surgical scars, or even minor injuries.


Treatment Options
1. Intralesional Steroid Injections: While you have already tried this, it is worth noting that repeated injections can sometimes help flatten the keloid over time. The effectiveness can vary, and some patients may require a combination of treatments.

2. Cryotherapy: This method involves freezing the keloid tissue, which can help reduce its size. However, as you mentioned, it may not have been effective in your case.

3. Surgical Excision: Surgical removal of the keloid can be effective, but there is a risk of recurrence, and in some cases, the keloid may return larger than before. This is particularly concerning for keloids that have a history of aggressive growth.

4. Radiation Therapy: Post-surgical radiation therapy has shown promise in reducing the recurrence rate of keloids. This treatment involves delivering low doses of radiation to the area after surgical excision to prevent regrowth.

5. Silicone Gel Sheets or Dressings: These can be applied to the keloid to help flatten it over time. They are often used as a preventive measure after surgery but can also be used for existing keloids.

6. Laser Therapy: Certain types of lasers can help reduce the redness and thickness of keloids. This treatment may be used in conjunction with other therapies.

7. Newer Treatments: Emerging therapies, such as the use of 5-fluorouracil (5-FU) injections, have shown some effectiveness in treating keloids. Additionally, some studies are exploring the use of platelet-rich plasma (PRP) and other biological therapies.


Considerations for Pregnancy
Your concerns about pregnancy and keloid expansion are valid. Hormonal changes during pregnancy can indeed affect keloid behavior, often leading to increased growth. It is essential to discuss your plans for pregnancy with your healthcare provider, who may recommend a tailored approach to managing your keloids during this time.


Seeking Specialized Care
Given the complexity of your case, it may be beneficial to consult with a dermatologist who specializes in keloid treatment or a plastic surgeon with experience in scar management. They can provide a comprehensive evaluation and develop a personalized treatment plan that considers your medical history, the characteristics of your keloid, and your future plans, including pregnancy.


Conclusion
Living with chronic keloids can be incredibly challenging, and it is essential to explore all available treatment options while also considering the psychological impact of this condition. Support groups or counseling may also be beneficial to help you cope with the emotional aspects of living with keloids. Remember, you are not alone in this struggle, and there are healthcare professionals who can help you navigate these challenges.