White Substance in Keloids: Causes and Treatments Explained - Dermatology

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Keloids, or hypertrophic scars, are raised areas of scar tissue that form at the site of an injury. They can be particularly challenging for individuals who are predisposed to developing them, as they can grow larger than the original wound and may cause discomfort or aesthetic concerns. The white substance you observed within your keloid after steroid injection could be attributed to several factors, including the body's metabolic processes, the effects of the steroid treatment, or even the presence of residual material from the injection itself.

When corticosteroids are injected into a keloid, they work by reducing inflammation and suppressing the overproduction of collagen, which is a key component in scar formation. However, the injection can also lead to localized changes in the tissue, which may result in the formation of a white, cyst-like substance. This substance is not uncommon and can be a combination of necrotic tissue, metabolic byproducts, and possibly some residual steroid that has not been fully absorbed by the body.

The appearance of this white material could be mistaken for a pimple, cyst, or pus, but it is essential to differentiate between these possibilities. In your case, the nurse suggested that it might be residual steroid, which is plausible, especially if the injection was administered a couple of months prior. Steroids can sometimes crystallize or form deposits if they are not fully metabolized or absorbed, leading to the formation of these white substances.

If the white substance was indeed squeezed out and appeared as a round, white mass, it could be a sebaceous cyst or a similar structure, but given your history of steroid injections, it is more likely related to the treatment. It’s important to note that while keloids can be treated with steroids, the results can vary, and some individuals may experience complications such as the formation of these substances.

In terms of treatment, if the white substance is causing you concern or discomfort, it would be advisable to consult with your dermatologist or healthcare provider. They may recommend further evaluation, which could include imaging studies or a biopsy to rule out any other underlying conditions. If it is determined to be a benign process related to the steroid treatment, your doctor may suggest monitoring it or possibly removing it if it becomes bothersome.

In addition to steroid injections, other treatment options for keloids include silicone gel sheets, cryotherapy, laser therapy, and surgical excision. Each of these treatments has its own set of benefits and risks, and the choice of treatment often depends on the size, location, and characteristics of the keloid, as well as the patient's personal preferences and medical history.

In conclusion, the white substance you observed in your keloid may be related to the metabolic processes following steroid injection or residual steroid itself. It is essential to follow up with your healthcare provider for a thorough evaluation and to discuss the best course of action for your specific situation. Keloid management can be complex, and a tailored approach is often necessary to achieve the best outcomes.