Effective Treatments for Keloids: Long-Term Solutions and Risks of Steroid Injections

Keloid

Hello, I have a keloid on my chest that measures approximately 10 cm in length, 3 cm in width, and 0.5 cm in thickness.
It often feels itchy, and when it itches, the area of the keloid expands, becoming red and swollen.
I have previously visited a dermatologist for steroid injections, which helped it gradually diminish.
However, after a period without injections, it slowly became red and swollen again.
Is there a permanent solution for keloids? Also, what are the potential effects on the body from continuously receiving steroid injections, even if the dosage is low? Thank you for your response.

doodoo, 30~39 year old female. Ask Date: 2000/12/05

Dr. Zheng Lizhen reply Dermatology

The formation of keloids is related to individual constitution and various external factors.
External factors such as infections, burn scars, and foreign bodies can easily lead to the development of hypertrophic scars.
Due to the involvement of individual constitution, there is currently no definitive method for prevention.
Local steroid injections have shown good results, but pain is a significant drawback, and a small percentage of women may experience menstrual cycle disruptions.
Other treatment options include cryotherapy, topical retinoids, radiation therapy, and silicone sheets.
In terms of prevention, it is important to avoid unnecessary surgeries, minimize injuries, treat acne promptly, and refrain from getting ear piercings.

Reply Date: 2000/12/05

More Info

Keloids, or hypertrophic scars, are raised areas of scar tissue that form at the site of an injury or incision. They can be itchy, painful, and may expand beyond the original wound site, as you've experienced. The treatment of keloids can be challenging, and while steroid injections are a common approach, they may not provide a permanent solution.

Steroid Injections and Their Efficacy:
Steroid injections, particularly corticosteroids, are often used to reduce inflammation and flatten keloids. They work by inhibiting collagen synthesis and reducing the proliferation of fibroblasts, which are the cells responsible for scar formation. While these injections can lead to a reduction in size and symptoms, such as itching and redness, the effects are often temporary. As you noted, keloids can recur after treatment, especially if the underlying factors that contribute to their formation are not addressed.

Long-Term Solutions:
There are several long-term treatment options for keloids, but each comes with its own risks and benefits:
1. Surgical Removal: This involves excising the keloid surgically. However, there is a significant risk of recurrence, and in some cases, the new scar may become a keloid itself.

2. Cryotherapy: This method involves freezing the keloid with liquid nitrogen. It can be effective in reducing the size of keloids, especially when combined with steroid injections.

3. Laser Therapy: Laser treatments can help flatten keloids and improve their appearance. Different types of lasers may be used, and multiple sessions are often required.

4. Silicone Gel Sheets: These are applied to the keloid and can help flatten and soften the scar over time. They are a non-invasive option and can be used in conjunction with other treatments.

5. Radiation Therapy: This is sometimes used after surgical removal to prevent recurrence. It can be effective but carries risks, including potential long-term side effects.

6. 5-Fluorouracil (5-FU) Injections: This chemotherapy agent can be injected into the keloid to help reduce its size and prevent recurrence.

Risks of Long-Term Steroid Use:
While steroid injections can be effective, long-term use can lead to several side effects, including:
- Skin Atrophy: Prolonged steroid use can thin the skin, making it more susceptible to injury and bruising.

- Tissue Damage: Repeated injections can cause damage to the surrounding tissue, leading to changes in skin texture and color.

- Hormonal Effects: Although the doses used in keloid treatment are generally low, systemic absorption can occur, leading to potential hormonal imbalances.

- Infection Risk: Any injection carries a risk of infection, particularly if proper sterile techniques are not followed.

Conclusion:
In summary, while steroid injections can provide temporary relief and reduction in keloid size, they are not a permanent solution. A combination of treatments may be necessary to achieve the best results. It is essential to consult with a dermatologist or a specialist in scar management to discuss the most appropriate treatment plan for your specific situation. They can help you weigh the risks and benefits of each option and monitor your progress to minimize the chances of recurrence.

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