KELOIDS & HYPERTROPHIC SCARS

keloid and Hypertrophic Scar Treatment 

Keloids and hypertrophic scars are exuberant forms of scar formation due to abnormal wound healing responses to trauma, inflammation, burns etc. The condition rarely occurs spontaneously in predisposed individuals.

Etiology and Pathogenesis:

1. Injury - hemostasis --inflammation --- excessive synthesis of collagen by fibroblasts -- 
2. keloid Transforming growth factor-B (TGF-B) is highly expressed in keloidal tissue
3. Seen primarily in the black population

Clinical Presentation:

1. Raised, pink-to-purple papules that are often painful, pruritic, or both. The overlying epidermis is typically smooth.
2. May be disfiguring as it grows beyond the initial tissue injury into adjacent tissue.
3. Recurrence after surgical removal is common and may be larger, more extensive.

Treatment and Management:

1. Prevention is key! Surgical scars should not cross joints. Avoid mid chest incisions. Skin lines should be followed during the surgery.
2. Occlusive dressings - silicone gel sheets and dressings, non-silicone occlusive sheets. III. Compression therapy
3. Intralesional corticosteroid injections
4. Intralesional mesotherapy with special cocktails to inhibit fibroblast proliferation.
5. Topical corticosteroids, scar gels under occlusion.
6. Excision with I/L steroids with occlusive dressings.
7. Other options: Radiation therapy, laser therapy etc.
8. Intralesional injections with chemotherapeutic agents for keloids and hypertrophic scars has also been tried on quite successfully.

PEARLS & PITFALLS:

1. Keloids & hypertrophic scars are difficult to manage.
2. They can be easily prevented by early recognition and prompt treatment in high risk patients.
3. Therapeutic options are numerous but no single modality is the best.
4. Recurrence is possible after any procedure.
5. Keloid treatment is a long treatment where the dermatologist is unable to quote the exact number of treatment sessions. The patient must discuss keloids’ treatment cost in Chandigarh in advance.
6. Long term follow up with an observation period of at least 2 years is necessary to effectively reduce the possibility of recurrence and predict the success of the keloids treatment.