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Keloid & Hyperthrophic scar treatment

Keloid & Hypertrophic scar treatment

There are multiple treatment options for ear keloid treatment including surgical and non-surgical options. There are factors involved in suitable treatment for each individual patient such as the size of the keloid, the area where the keloid is located and patient preference etc.

At the London keloid scar clinic, we have highly experienced doctors in keloid treatment who will examine and discuss the suitable treatment for each individual patient.

All Keloids are not the same and should be treated differently. Our experience Keloid specialist doctors will consider the factors involved in choosing a treatment plan for the most effective and prevent Keloid recurrence as below and discuss the treatment plan with you.

  1. Locations: Keloid at certain areas could be a more aggressive and higher chance to grow back such as the chest and cheeks. Whereas Keloids at the ear and abdomen reoccur less accordingly to studies. Therefore, the keloids at the chest and cheeks should be treated with a more aggressive treatment protocol.
  2.  The number of keloids: Multiple Keloids should be treated with oral medication together with other non-surgical options. 
  3. Size of keloid: Small keloids usually should be treated with non-surgical op, whereas large keloids may need cryotherapy or surgical options.
  4. Stage of keloid: treatment at an early stage of keloid ( first few months old) is usually more effective and has less chance of recurrence. Very old/mature keloids are also easier to treat.
  5. Family history: patients, who have close relatives who have a keloid, have a higher risk of keloid recurrence. 
  6. Gender: Male patients have a higher recurrent rate of keloid. 
  7. Previous treatments.: Keloids that reoccur post-surgery are more difficult to treat and need more aggressive treatment protocol 
  8. Finance and budget 
  9. Patient’s ability to attend regular and consistent treatment sessions and patient lifestyle.

Choices of keloid & hypertrophic scar treatment

  1. Non-surgical treatments
  2. Surgical treatments with post-surgical treatment to prevent keloid reoccur.
  3. LCC signature triple therapy of keloid removal, steroid and chemotherapy local injections and Hydrocolloid dressing or compression therapy.

After a full medical consultation where the doctor will check your medical history and examine your keloids, the treatment options will be discussed and the best treatment option for you. The doctor will explain the procedure, aftercare as well as possible complications. You will be given opportunities to ask all the questions you have before you proceed with the treatment.

Treatment option 1


Non Surgical Treatments

  1. Corticosteroid injection into the scar tissue. The common use steroid for keloid is Triamcinolone acetonide 40 mg/ml. It is recommended for first-line treatment. The steroid effects are suppression of inflammation, vasoconstriction, inhibit collagen formation, degradation of collagen and decrease of growth factor. Hence, the treated scar shrinks and flattens.  The injection is best done every three weeks until the scar is completely flat. A local anaesthetic will be offered to help with the discomfort of the injection.

As the maximum result of injection will be at three weeks after, we usually recommend having the injection every three weeks until the keloids are completely flat. Then patients can observe if the keloid grows back or not. Top-up injections may be needed if the keloid grows back. The risk of recurring keloids depends on many factors including the severity of the keloid itself.

Procedure:

  1. You will have a detailed medical consultation and examination by our experienced doctor prior to the treatment.
  2. A topical or local anaesthetic may be applied/injected to help reduce the discomfort of the injection prior to the steroid injection.
  3. Steroids will be injected into the scar tissue.
  4. The treated areas will be covered with plasters which should be kept on for at least one hour.
  5. A review appointment will be scheduled for one month after the treatment.

It is recommended you should have an injection for three weeks until the keloid is completely flat. Then you can observe if the keloid grows back or not. If it starts to grow back, you may need to have the steroid injection to maintain the flattening effect. Depending on the severity of the keloid, it may not grow back or you may need the maintenance injection every few months or years.

After the treatment

You may experience some discomfort in the treated areas over the next few days. Mild swelling of the scars can be expected the next day. Then the scar will gradually flatten down and over the next four weeks, you will see the maximum result from the injections.

There are many factors involved in the chance of keloid recurrence including severity, location etc. However, on average 70% of our patients have been successfully treated without recurrence of the keloids.

Risks and complications

Common risks and complications are just temporary for steroid injection including local side effects like discolouration, thinning of the skin and depression in the treated area and around the area. It is very rare that it becomes a permanent effect. However, if you have large keloids that need large amounts of steroid injection, it may cause some systemic side effects although it’s rare.

More Non Surgical Treatments

Chemotherapy injection

It is locally in the scar tissue, not in blood vessels. The common and least side effects chemotherapy drug used for keloid is Fluouracil 50 mg/ml or as known as 5-FU. Other drugs Vincristine and Docetaxel are usually used as the second and third line as a higher chance of pain or allergy. The medication helps stop keloid cells from dividing and killing the keloid tumour cells. It’s more effective when combined with steroid injection according to many research studies. At our clinic, we have researched the most effective and safe combination ratio of the 5-FU and steroids. The injection is best done every three weeks until the scar is completely flat. A local anaesthetic will be offered to help with the discomfort of the injection. 

Verapamil injection into the scar.

Verapamil appears to inhibit collagen production and inhibit inflammation. It can be used combined with Steroid injection for the maximum effect. The injection is best done every three weeks until the scar is completely flat. A local anaesthetic will be offered to help with the discomfort of the injection.

Botulin Toxin

Botulinum toxin injection locally into and around the scar. It can help reduce the size of keloid and tension, less itching and reduce sebaceous gland secretion. The medication is injected directly into the scar and around the scar to reduce tension. 

Corticosteroid cream 

The topical cream is beneficial for flattening small keloids, helping soften and flatten large keloids and helping prevent the keloid regrow and suppress the itchiness and pain from keloids.

Radiation therapy

We are able to refer our patients for Radiation Therapy if needed.

Hydrocolloid patch occlusion therapy

This technique has been used as an occlusive therapy alternative to the use of silicone sheets in our outpatient clinic. It significantly helps reduce itchiness and pain and softens the keloid and hypertrophic scar. 

Asiaticoside oral supplement for keloid treatment

The pathogenesis of keloid still remains elusive. However, transforming growth factor (TGF)-β, a potent profibrotic factor that stimulates collagen synthesis in keloid, is the focus of keloid research. Asiaticoside inhibit TGF-β1-induced collagen type I and PAI-1 expression. Therefore, it helps flatten the keloid. This supplement is recorded parts in patients who have multiple keloids. 

Pressure therapy

We offer pressure earrings for Keloid at ears. The treatment aims to reduce blood supply to the areas. Hence treat and prevent keloid growing back. 

Treatment option 2


Surgical Removal

Usually, surgical removal is recommended when the keloid is large and doesn’t respond to non-surgical treatments. However, the doctor will discuss with the patients which method is best suitable. The surgical keloid removal is included below.

  1. Excise and stitches 
  2. Shaving 
  3. Cryotherapy with Liquid nitrogen freeze. 

As after the removal, keloid has a high chance of it could regrow, our keloid specialist doctors will advise the methods to prevent the recurrence of keloid including a course of injection of steroids and 5-FU or Radiation therapy. 

Treatment option 3


THE LCC SIGNATURE COMBINATION TREATMENT FOR EAR KELOID.

We understand that steroid injections alone are not an effective treatment for large keloid nodules. Therefore, keloid removal is highly recommended. The main aim is to get rid of the keloid tissue immediately as most large keloid nodules do not flat down easily with steroid injection alone or may need a number of sessions of steroid injections to flatten them down. This could take many years of monthly injections.

The very high success rate of our signature treatment created by our expert, Dr Salinda Johnson, stems from her research and experience of treating thousands of ear keloid patients. It features a combination of the treatments below.

STEP 1. KELOID REMOVAL

Pre-treatment instruction:

  • Avoid taking blood thinning medication, food and supplements for two days prior the
    treatment includes alcohol, ibuprofen, Vitamin C, E, St Johns’s wort in order to help prevent the risk of bleeding.
  • Ensure eating food normally before the treatment. This will help prevent the risk of fainting during the treatment from low blood sugar.
  • Prepare time to spend at the clinic at least 2 hours.

Procedure:

The keloids around the area will be disinfected with an antiseptic solution. A local anaesthetic injection will be administered to numb the area. You may feel slight discomfort during the injection.

However, the anaesthetic will immediately numb the area and the numbness will last up to 4 hours. Keloids will be removed by the specific shaving method or excision & stitches that aim to remove all the keloid tissue or as much keloid as possible yet preserve the natural shape of your ears.

The specific electro-surgical machine that the doctor uses will shave the keloid whilst stopping any bleeding at the same time. Therefore, there will be very minimal bleeding and it should be painless. Please note: the keloid removal will not necessarily cure the keloid.

Steroid injection: Immediately after the removal, the specific steroid for keloid will be injected into a certain part of the wound. The antibiotic ointment will be applied and the wounds will be then covered with plaster.

After the treatment:

  • A specific wound care kit will be provided
  • Antibiotic tablets will be provided to prevent infection
  • A follow-up appointment will be arranged four weeks after the treatment
  • An emergency telephone number will be given.
  • A clinic nurse will contact you one or two days after to check how you are and answer any questions you may have

STEP 2. PREVENTATIVE MEASURES FOR KELOID RECURRENCE

Once you come back for a follow-up appointment with the doctor at four weeks after your keloid removal, the doctor will examine the wounds and if they’ve healed well, the doctor will start the keloid recurrent prevention.

A course of a minimum of 5 steroid injections into the treated area every 2-4 weeks apart. The doctor will advise how often you will need to come back for further injections.

SILICONE SHEETING: Silicone sheets are thought to work by increasing the temperature, hydration, and oxygen tension of the occluded scar, causing it to soften and flatten. This technique should be avoided on open wounds but can be applied as soon as the skin heals. To be effective, sheets must be worn over the scar for 12 to 24 hours per day for two to three months. 

“My team share my passion for the aesthetics industry and only through this passion are we able to provide our patients with a truly outstanding experience.”

Dr Salinda Johnson

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