Keloid Scarring Treatment

Non Surgical Treatments for Keloid Scars

The application of mechanical pressure by compression devices is advocated in the treatment of keloid scars. Pressure may theoretically break up collagen bundles and soften the keloid mass; however, therapy must be instituted for long periods (>23 h/d for 6 mo) before significant effect can be achieved. Unfortunately, many regions of the head and neck are not amenable to pressure application. Silicone sheeting is used to decrease the irritation and pruritus associated with keloids. The proposed mechanism of action involves maintenance of scar hydration and inducement of a subsequent decrease in cytokine release, resulting in less collagen deposition. Certain authors report great success in keloid regression with this modality. Unfortunately, the general opinion on silicone sheeting does not support significant reduction in the dimensions or pigment characteristics of keloids, although silicone sheeting can be very effective in decreasing pruritus.

See>>> silicone gel sheeting for keloid scars

Various therapies, including nitrogen mustard, tetroquinone, antihistamines, retinoic acids, zinc, vitamin A, vitamin E, and verapamil, have been used with varying degrees of success.

Interferon (IFN) therapy is used because of its ability to reduce collagen synthesis in dermal fibroblasts. Granstein et al. reported a 30% reduction in keloid height after intralesional injections of IFN-gamma 3 times weekly for 3 weeks. As with other treatment modalities, some recurrences are to be expected. IFN has adverse effects, including low-grade fevers, a flu-like illness for 48-72 hours after injection, and pain on injection.

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J Plast Reconstr Aesthet Surg. 2006;59(7):693-9. Epub 2006 Feb 21. 

Intra-lesional injections of collagenase are ineffective in the treatment of keloid and hypertrophic scars.
Kang N, Sivakumar B, Sanders R, Nduka C, Gault D.
Mount Vernon Hospital, Northwood, Middlesex HA6 2RN, UK.

The treatment of keloid and hypertrophic scars remains difficult. Enzymatic digestion of keloid scars has been previously proposed as an effective treatment strategy for reducing the volume of keloid scars. To test this, we administered intra-lesional injections of pure collagenase (between 600 and 4500 units for each scar) into the keloid and hypertrophic scars of seven human volunteers (five keloid and two hypertrophic scars). Five patients (three keloid and two hypertrophic) received more than one injection of collagenase.

The treatment resulted in a temporary reduction in scar volume for three of the patients with keloid scars. However, scar volumes for these three patients returned to the same (or greater) levels after 6 months of follow-up. Treatment with collagenase produced no change in scar volume for the two patients with hypertrophic scar. Side effects were numerous and severe including; pain, swelling, blistering, ulceration and ecchymosis at the site of injection. One patient required admission to hospital for 48h after the first injection.

Maximum length of follow-up was 6 months. None of the seven patients completed the study and returned for final follow-up at 2 years. This pilot study suggests that treatment of keloid and hypertrophic scars with intra-lesional injections of collagenase is ineffective.

Int J Dermatol. 2005 Sep;44(9):777-84. Related Articles, Links
Treatment of keloids and hypertrophic scars with dermojet injections of bleomycin: a preliminary study.
Saray Y, Gulec AT.
Department of Dermatology, Baskent University Faculty of Medicine, Ankara, Turkey. yaseminsaray@hotmail.com

BACKGROUND: Numerous treatment modalities have been used to treat keloids and hypertrophic scars, but the optimal treatment has not been established. OBJECTIVE: The aim of this study was to determine the efficacy and safety of intralesional jet injection of bleomycin as therapy for keloids and hypertrophic scars that are unresponsive to intralesional steroid injection.

METHODS: The study included 14 patients with 15 keloids or hypertrophic scars that had not responded to a minimum of three intralesional injections of triamcinolone acetonide. Multiple jet injections of 0.1 ml of bleomycin (1.5 IU/ml) were administered to each lesion, with injection sites spaced 0.5 mm apart. Injections were repeated each month. Scar height was measured, and scar pliability and erythema were scored at baseline and then monthly during the treatment and follow-up periods. Patients' self-assessments of subjective symptoms (pruritus and pain) were also scored. Clinical improvement was defined primarily on the basis of scar height reduction (percentage reduction from baseline), and was classified using the following scale: complete flattening (100%), highly significant flattening (> 90%), significant flattening (75-90%), moderate flattening (50-75%), and minimal flattening (< 50%). Pre- and post-treatment mean values for scar height, scar pliability, erythema, pruritus and pain were statistically compared.

RESULTS: The number of sessions required to successfully treat the lesions ranged from two to six. Eleven lesions (73.3%) showed complete flattening, one (6.7%) showed highly significant flattening, two (13.3%) showed significant flattening, and one scar (6.7%) showed moderate flattening. The mean scar height was significantly lower, and the mean scores for scar pliability and erythema were significantly better at the end of treatment (P < 0.001, P < 0.001 and P < 0.001, respectively). The mean scores for pruritus and pain also improved significantly (P < 0.001 and P = 0.01, respectively). The observed side-effects were hyperpigmentation (four lesions) and skin atrophy (three lesions). No recurrences were noted during follow up (mean duration of 19 months).

CONCLUSIONS: Intralesional jet injection of bleomycin is an effective and safe method of treating keloids and hypertrophic scars that are unresponsive to intralesional steroid therapy

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Dissolves scar tissues and releases the aminoacids and other components in them for the reproduction of fibroblasts which give rise to new connective tissues and glycosaminoglycans -the molecules that deeply moisturize, firm skin and give it strenght and capacity to withstand over-stretching. It also replenishes the lipid barrier of the skin and triggers the regeneration of damaged cells while preventing and removing acne scars, keratosis, psoriasis scales and all types of skin blemishes.

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