Keloid and Hypertrophic Scars

Abnormal scarring can be a very troublesome problem and can occur as a result of trauma, skin piercing, or surgery - basically anytime the skin is broken. Keloids or hypertrophic scars occur can occur in any skin types but are more common in African American and Hispanic skin types. A previous history of keloids speaks to an increased risk, but the risk is not one-hundred percent. For patients who experience these conditions, there are many possible treatments but none that have proven to be effective in all cases. Often several treatments must be combined to get optimal results.

While additional research must be done, it appears that keloids and hypertrophic scars are not separate entities but on a continuum with one another. Hypertrophic scars are raised scars which remain in the line of the scar. Keloids are also raised but extend outside of the discrete scar. In order to minimize the risk of either, great care must be used in wound closure to ensure that no tension exists on the wound.

If a person suffers from a keloid or hypertrophic scar, there are several options for repair. Direct excision is always an option though this solution alone will almost certainly result in a recurrence of the process. Topical or injection therapies offer good adjuncts to surgical excision to help prevent recurrence. Though no treatment has shown 100% efficacy at preventing recurrence, several are used with good results depending on physician preference. Intralesional steroid injections, often with kenalog, is a useful tool not only to help prevent recurrence but also to help decrease keloids that are present. Additional therapies with the chemotherapy drug 5-FU directly into the lesion and imiquimod applied to the top of the excised area can be helpful in decreasing recurrence rates. Several studies have been done with the application of silicone sheeting for several hours a day for several days to months after surgical excision of a keloid with very favorable results. The mechanism of action is not entirely known but thought to be related more to the moisturizing effect on the wound than the silicone itself.

For keloids which are particularly troublesome, large, or recurrent, a short course of radiation therapy after excision can be beneficial. Because of the potential side effects of radiation, this therapy is reserved for particularly troublesome cases but can be very useful in the right circumstances.

source: ezinearticles.com