A keloid is an atypical type of scar more commonly occurring in darker complected individuals such as blacks, Hispanics and Indians though it is seen in all races including even the Irish and Scandinavians. They are elevated, hard scars that usually extend beyond the original wound margins and can continue to grow, sometimes slowly and other times quite rapidly. Not only are they aesthetically displeasing but they are usually associated with unpleasant symptoms such as pain, itching and burning.
Various options are available for their treatment including steroid injections, pressure dressings, topical silicone – gel or solid form, surgical excision, lasers, radiation treatments and intralesional chemotherapy injections. Serial (repeated) steroid injections and surgical removal with repeated steroid injections are the two most common therapeutic approaches used though ultimately, because of such varied responses, treatment needs to be individualized in order to maximize effectiveness and minimize untoward outcomes.
Of critical importance for the long term success in the treatment of keloids is patient compliance – adhering closely to instructions and recommendations including showing up at follow up appointments. These growths are often difficult to and have a high rate of recurrence particularly in certain areas. By not maximizing the odds for success, the risks for failure increase.
At the top of the list of areas that are very difficult to treat and get excellent, aesthetically acceptable long term results is the chest. It has a very high rate of recurrence despite various aggressive treatments. The permanent scars can be quite noticeable, displeasing and larger in area compared to the initial lesions, usually as a consequence of the side effects of steroid injections. However, the resolution of the painful, annoying symptoms associated with the keloids make them a more than an acceptable price to pay.
Occasionally and somewhat against the odds, treatment results can be outstanding in this area as seen in this patient of mine (photos). She had more than a five year history of painful, burning and itching keloids of her chest which she wanted to definitively address. They had been initially treated by her dermatologist a few years previously but with only partial, short term improvement. Her risk factors were very high – African-American AND a very strong family history of multiple and aggressive keloid growths.
After discussing the various therapeutic options, it was elected to proceed with monthly intralesional Kenalog (steroid) injections tailored precisely to her responses, carefully balancing aggressiveness and effectiveness of treatment with minimization of local side effects. After almost a year of sessions, there was a complete resolution of the keloids and associated symptoms and with essentially no side effects. To date, they have not recurred.
It would be nice if everyone had similar results in this area.
For more information on keloids and their treatment or to schedule a consultation with me, please call my office at (480) 451-3000.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona