Steroid Injections for Scar Management: What You Need to Know

The doctor only administers a small amount of steroids each time and says that too much cannot be given at once, but I haven't seen any results?

Hello, Doctor.
I would appreciate it if you could take the time to respond to my questions.
Thank you.
My family has a tendency to develop hypertrophic scars, and I am no exception.
My mother had a postoperative 3D hypertrophic scar that measured 10 cm in width and 4.5 cm in thickness, which makes me very concerned.
Last year, after my uterine fibroid surgery, I applied silicone sheets until October 19, 2016, and it has been six months.
I continue to use them, but the hypertrophic scar is still protruding about 2.5 mm.
I consulted a plastic surgeon, and the doctor said, "With your level of scarring, you don't need injections; steroids shouldn't be administered too frequently.
If it remains the same after three months, come back." The doctor only administered a small amount this time, and I feel it had no effect.
Later, I went for another visit and asked the doctor, "Are you concerned that too much injection will cause it to sink?" The doctor felt the scar and said, "No, it's already quite soft; you don't need injections, and you don't need to come back next time." I feel that it is better to address the scar while it hasn't grown too large, rather than waiting for significant changes that would require more time and effort to manage.
However, this doctor believes that the scar does not require treatment, and the nearby nurse's chatter distracted the doctor, preventing effective communication.
Additionally, my gynecologist administered steroids during the surgery, and the wound initially looked very nice.
Recently, I was shocked to see the changes in my scar: "Why has your scar grown so quickly?! I recommend going to a plastic surgeon; you can get steroid injections now." The doctor asks you: 1.
Does the 2.5 mm thick hypertrophic scar need treatment? 2.
Why shouldn't steroids be injected in large amounts at once? (But the amount this doctor administered really didn't seem to have any effect.) Thank you, Doctor.

JULIA, 40~49 year old female. Ask Date: 2016/11/01

Dr. Wu Yuxin reply Dermatology

1.
It depends on the situation, as keloids are primarily an aesthetic concern.
If they are not painful or itchy, treatment may not be necessary.
2.
There should be an appropriate amount, as physicians have their professional considerations, which are not solely based on the patient's feelings.

Reply Date: 2016/11/01

More Info

Understanding steroid injections for scar management is crucial, especially for individuals prone to hypertrophic scars or keloids, as you mentioned in your case. Let's address your concerns systematically.

1. Is the 2.5mm thick hypertrophic scar in need of treatment?
Hypertrophic scars, which are raised and can be itchy or painful, often require intervention if they cause discomfort or if their appearance is distressing to the patient. In your case, a 2.5mm thick scar is relatively mild, but the decision to treat it should consider several factors, including your personal feelings about the scar, its location, and any symptoms you may be experiencing. If the scar is not causing you any discomfort and you are not particularly bothered by its appearance, it may not require immediate treatment. However, if you notice that the scar is becoming more prominent or if it is causing you anxiety, it may be worth discussing further treatment options with your healthcare provider.

2. Why can't steroids be injected in large quantities at once?
Steroid injections, particularly corticosteroids, are commonly used to manage hypertrophic scars and keloids due to their anti-inflammatory properties. However, there are important considerations regarding the dosage and frequency of these injections:
- Risk of Atrophy: One of the primary concerns with injecting steroids is the risk of skin atrophy, which can occur if steroids are injected in high doses or too frequently. Atrophy refers to the thinning of the skin, which can lead to a sunken appearance at the injection site. This is particularly concerning in cosmetic areas where the aesthetic outcome is paramount.

- Diminished Returns: Injecting too much steroid at once may not only increase the risk of side effects but can also lead to a phenomenon known as "diminished returns," where the effectiveness of the treatment decreases with higher doses. This is why many practitioners prefer to start with a lower dose and assess the response before considering additional treatments.

- Monitoring Response: By administering a smaller dose initially, your physician can monitor how your scar responds to the treatment. If the scar shows improvement, they can then decide whether to continue with additional injections. This approach minimizes the risk of complications while allowing for effective management of the scar.

In your case, it seems that the initial steroid injection during your surgery was intended to prevent excessive scarring. However, the subsequent assessment by your plastic surgeon indicated that further treatment may not be necessary at this time. It’s essential to maintain open communication with your healthcare providers. If you feel that your concerns were not adequately addressed during your visits, consider seeking a second opinion or asking for a more detailed explanation of the treatment plan.

In conclusion, while your scar's thickness of 2.5mm may not necessitate immediate intervention, it is essential to monitor its progression. Steroid injections can be an effective treatment for hypertrophic scars, but they must be administered judiciously to avoid complications. If you have ongoing concerns about your scar, do not hesitate to advocate for yourself and seek further clarification or alternative treatment options. Your comfort and satisfaction with your treatment plan are paramount.

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