Laser and Steroid Treatments for Keloids: What to Do Next?

Depression after treatment of keloids with laser and corticosteroids?

Dear Doctor, I have developed small keloids on my chin and chest due to acne, and I have been receiving regular steroid injections at the dermatology department for many years.
Two years ago, I moved and switched to a teaching hospital, where I have been returning for follow-ups every three months.
Six months ago, after a keloid specialist personally administered an injection, the keloid located between my breasts, which is about 0.5 cm in diameter, became bruised with a light yellow color and showed slight indentation.
After discussing this with the doctor, I was advised to undergo laser treatment followed by another steroid injection.
After two treatments, the two keloids on my chest, as well as the one between my breasts, have developed noticeable indentations, particularly the lesion between my breasts, where I can distinctly feel the bone when pressing down (in contrast to the skin on the other side, which feels more elastic).
The edges of the indentations appear pale white.
Should I continue with the treatment, or should I consider switching hospitals or doctors? I have been asked to take photos before each injection; should I request these photos for comparison and further inquiry? Thank you for your response.

Xiong kou you dong, 40~49 year old female. Ask Date: 2021/07/07

Dr. Wu Yuxin reply Dermatology

I apologize, but current medical regulations prohibit online diagnoses in this manner.
If it is inconvenient to visit a hospital or clinic due to the pandemic, you may consult a dermatology clinic that offers telemedicine services, which can provide you with the necessary diagnosis and treatment according to regulations.

Reply Date: 2021/07/07

More Info

Keloids, or hypertrophic scars, can be a challenging condition to manage, especially when they arise from acne or other skin injuries. Your experience with steroid injections and laser treatments is quite common among patients dealing with keloids. Let's break down your situation and explore the options available to you.

Firstly, it's important to understand that keloids are formed due to an overproduction of collagen during the healing process. They can be raised, firm, and often extend beyond the original wound site. Treatments typically aim to reduce the size of the keloid, flatten it, and alleviate any associated symptoms such as itching or discomfort.

Steroid injections, like the ones you've been receiving, are a standard treatment for keloids. They work by reducing inflammation and collagen production in the scar tissue. However, the results can vary from person to person, and multiple sessions may be necessary to achieve the desired outcome. In your case, it seems that while the steroid injections have been somewhat effective, they have also led to some undesirable side effects, such as the formation of depressions in the skin.

The addition of laser therapy is another common approach. Laser treatments can help to flatten keloids and improve their appearance by targeting the blood vessels and collagen in the scar tissue. However, as you've experienced, laser treatments can sometimes lead to changes in skin texture, such as the depressions you mentioned. This is not uncommon, and it can be a frustrating aspect of treatment.

Given your current situation, where you have developed noticeable indentations in the skin, it’s essential to have an open discussion with your dermatologist or the keloid specialist. Here are some considerations for your next steps:
1. Continue Treatment or Seek a Second Opinion: If you feel that the current treatment plan is not yielding satisfactory results or if the side effects are concerning, it may be worth seeking a second opinion. A different dermatologist may offer alternative treatment options or a different approach to managing your keloids.

2. Document Your Progress: Requesting photographs of your keloids before and after treatments can be very helpful. This documentation allows you to visually track changes over time and can provide valuable information for discussions with your healthcare provider. It can also help you assess whether the treatments are effective or if adjustments are needed.

3. Discuss Alternative Treatments: There are various treatment options for keloids, including silicone gel sheets, cryotherapy, and even surgical removal in some cases. Each option has its own benefits and risks, and your dermatologist can help you weigh these based on your specific situation.

4. Consider Combination Therapy: Sometimes, a combination of treatments can yield better results. For example, combining steroid injections with laser therapy or using silicone sheets after laser treatment may help improve the overall appearance of the keloids.

5. Monitor for Changes: Keep an eye on any new changes in your keloids or surrounding skin. If you notice increased pain, redness, or any other concerning symptoms, it’s crucial to address these with your healthcare provider promptly.

In conclusion, managing keloids can be a complex process that often requires patience and persistence. Open communication with your healthcare provider is key to finding the most effective treatment plan for your unique situation. If you feel uncertain about your current treatment, don't hesitate to seek a second opinion or explore alternative therapies. Your comfort and satisfaction with the treatment outcomes should always be a priority.

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