Keloid Scar

As wounds heal, collagen is laid down to give strength and as it matures much of the collagen is resorbs leaving just the collagen of a fine scar. However, in 2% of Caucasians and 11% of Africans and Asians, the collagen does nor resorb. Instead, it continues to grow. It can be considered to have become a benign tumour. It is red, raised, itchy and painful. This is a keloid. Most occur after injury or surgery.

In a few people, the injury is so minor that no one knows where the keloid came from. Maybe it was a scratch or a spot that set it off. Acne can be a real problem for keloiders, leaving keloids growing all over the back and chest. Some areas of the body are more prone to them than others. The centre of the chest and the tip of the shoulder are the worst. Fortunately, the face is fairly safe, but the neck is getting tricky.

A similar, milder version of the keloid is the Hypertrophic scar. These scars are more common and we see them in Irish and Scottish Celtic skin. We associate hypertrophic scars with red hair. Red hair, red scars. The wound over heals like the Keloid, but after a month or two settles spontaneously to become a reasonable scar.

The treatment of these very difficult scars requires determined treatment delivered by a determined doctor. We have silicone gel and Icon laser for early problems.

Established keloids require other treatments. Steroid injections into the scar itself work well, but the dosage and frequency are important. If the steroid leaches into normal tissue, it can cause this tissue to atrophy leaving a depression and red capillaries. We often see patients, who say they have had steroid injections, but it hasn’t worked. We can use the same steroid injections and make it work. You need skill and determination on both sides.

Radiotherapy, usually combined with surgery is a good treatment, but one needs a keen radiotherapist, delivering very superficial treatment.

It is so much better to avoid the problem.

The Cadogan Clinic has just introduced the Bilhi genetic test, which can determine from a saliva sample whether you might be one of these poor scar formers. This is the only clinic in the UK where this is available.  A positive result probably would not stop the proposed operation taking place, but it would mean that we would be ready to commence The Cadogan Scar management in order to reduce the consequences.

The first line of treatment is the application of silicone sheet or more commonly silicone gel.

The next line is the Icon laser treatment and later steroid injections and radiotherapy.

We are often proactive and arrange for the superficial radiotherapy immediately after surgery well before any collagen is laid down.

Related Treatments:

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Of course, we use the very latest technology. But our real skill is in knowing how and when to use it to suit each individual patient.

MR BRYAN MAYOU, FOUNDER

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