A steroid is injected directly into the scar. This can help soften and then shrink hard scars. Keloids and hypertrophic scars often soften after this treatment. This can help reduce the size of scars by freezing the top skin layers. The freezing causes the skin to blister. Laser resurfacing. This treatment uses high-energy light to burn away damaged skin. Laser resurfacing may be used to reduce wrinkles and refine hypertrophic scars.
Punch grafts. These are small skin grafts to replace scarred skin. The surgeon uses a small tool to make punch a small hole in the skin and remove the scar. Then the scar is replaced with a small piece of unscarred skin. Punch grafts can help treat deep acne scars. Surgical scar revision. This is surgery to remove the entire scar and rejoin the skin. A new scar will form. The goal of this surgery is to create a less obvious scar.
Surgical scar revision is often done on wide or long scars, scars that healed in an abnormal way, or scars in very visible places. Radiation therapy. This is not used often. It's used mainly for scars that are resistant to other treatments. Abnormal scars sometimes form after a wound has healed. There are many different types of scars, including:. These are thick, rounded, irregular groups of scar tissue.
They grow at the site of a skin wound. But they can be much larger than the wound itself and expand outside of the area of the initial wound They often look red or darker in color, as compared to the nearby normal skin. Keloids are formed from collagen that the body makes after a wound has healed.
These scars may appear anywhere on the body. But they are more common on the chest, back, shoulders, and earlobes. They occur more often in darker-skinned people. Keloid scars may occur up to 1 year after the original skin injury.
Treatment for keloid scars varies. There is no one simple cure. It's common for these scars to come back after treatment. Often more than one treatment is needed. Treatment may include:. Steroid injections. Steroids are injected directly into the scar tissue. This helps to reduce the itching, redness, and burning feelings that these scars may produce.
Sometimes the injections help to decrease the size of the scar and soften the scar tissue. The main side effects are skin discoloration and a sunken area of skin at the injection site atrophy. The scar is frozen off. Pressure therapy. A type of pressure appliance is worn over the scar area. These may be worn day and night for up to 4 to 6 months. It's not clear how well this treatment works. Silicone dioxide. This is applied in the form of a gel or pad. This can help soften and decrease the redness of keloids.
If the keloid scar does not get better with other treatments, then surgery may be done. One type of surgery directly removes the scar formation with a cut incision. Stitches help close the wound. Sometimes skin grafts are also used to help close the wound. This means replacing or attaching skin to an area that is missing skin. Skin grafts are done by taking a piece of healthy skin from another area of the body called the donor site and attaching it to the needed area.
Unfortunately, even after surgery keloids can come back again. And sometimes even larger keloids are created. Laser surgery. Scars may be treated with a variety of different lasers, depending on the underlying cause of the scar. Lasers may be used to smooth a scar, remove the abnormal color of a scar, or flatten a scar. Most laser therapy for scars is done together with other treatments. These include steroid injections, special dressings, and bandages.
Multiple treatments may be needed, regardless of the first type of therapy. Pulse dye laser is a good choice for keloids. This can be used for scars that don't respond to other treatments. Hypertrophic scars are similar to keloid scars.
But they don't grow as big as keloid scars and remain within the area of the original injury. They may also respond better to treatment. Hypertrophic scars may also look red, and are often thick and raised. They often start to develop within weeks after the skin injury. These scars may get better on their own. Genetic studies on keloid. J Natl Med Assoc. Scar contractures, hypertrophic scars, and keloids. Facial Plast Surg. Current progress in keloid research and treatment. J Am Coll Surg.
A review of the biologic effects, clinical efficacy, and safety of silicone elastomer sheeting for hypertrophic and keloid scar treatment and management. Dermatol Surg. On the nature of hypertrophic scars and keloids: a review. Plast Reconstr Surg. Randomized controlled trial to determine the efficacy of paper tape in preventing hypertrophic scar formation in surgical incisions that transverse Langer's skin tension lines. Prospective comparison of octyl cyanoacrylate tissue adhesive Dermabond and suture for the closure of excisional wounds in children and adolescents.
Arch Dermatol. Chuangsuwanich A, Gunjittisomrarn S. J Med Assoc Thai. New combination of triamcinolone, 5-fluorouracil, and pulsed-dye laser for treatment of keloid and hypertrophic scars. Agbenorku P. Alster TS. Improvement of erythematous and hypertrophic scars by the nm flashlamp-pumped pulsed dye laser. Ann Plast Surg. Treatment of keloid sternotomy scars with nm flashlamp-pumped pulsed-dye laser.
Prevention and treatment of keloids with intralesional verapamil. Bleomycin in the treatment of keloids and hypertrophic scars by multiple needle punctures. Bleomycin tattooing as a promising therapeutic modality in large keloids and hypertrophic scars. Evaluation of various methods of treating keloids and hypertrophic scars: a year follow-up study.
Br J Plast Surg. The effects of onion extract on hypertrophic and keloid scars. J Wound Care. Experience with difficult keloids. Graham GF. Clin Plast Surg. Layton AM. A review on the treatment of acne vulgaris. Int J Clin Pract. Management of scar contractures, hypertrophic scars, and keloids. Otolaryngol Clin North Am. O'Brien L, Pandit A. Silicon gel sheeting for preventing and treating hypertrophic and keloid scars. Cochrane Database Syst Rev. McIntyre L, Baird M. Pressure garments for use in the treatment of hypertrophic scars—a review of the problems associated with their use.
International clinical recommendations on scar management. Pulsed dye laser treatment on burn scars. Alleviation or irritation? Fitzpatrick RE. Treatment of inflamed hypertrophic scars using intralesional 5-FU. Atiyah BS. Nonsurgical management of hypertrophic scars: evidence-based therapies, standard practices, and emerging methods. Aesthetic Plast Surg. Yamamoto T.
Bleomycin and the skin. Br J Dermatol. Antifibrogenic effects of liposome-encapsulated IFN-alpha2b cream on skin wounds in a fibrotic rabbit ear model. J Interferon Cytokine Res. Khoosal D, Goldman R. Vitamin E for treating children's scars. Does it help reduce scarring?
Can Fam Physician. Effect of Mederma on hypertrophic scarring in a rabbit ear model. Pilot study evaluating topical onion extract as a treatment for postsurgical scars. Safety and efficacy of local administration of Contractubex to hypertrophic scars in comparison to corticosteroid treatment. Results of a multicenter, comparative epidemiological cohort study in Germany.
In Vivo. Pharmacological modulation of wound healing in experimental burns. New innovations in scar management. This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference.
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Get Permissions. Read the Issue. Sign Up Now. Aug 1, Issue. Management of Keloids and Hypertrophic Scars. B 8 , 23 Intralesional corticosteroid injections for prevention and treatment of keloids and hypertrophic scars are a practical first-line approach for the family physician. B 9 , 22 Silicone elastomer sheeting is a noninvasive, but time-intensive, first-line option for prevention and treatment of keloids and hypertrophic scars.
B 8 , 26 , 31 Pressure dressings or garments are effective for prevention of hypertrophic scars, especially in burns. B 10 , 27 , 31 When first-line treatments for keloids and hypertrophic scars fail, combination therapy surgery, silicone sheeting, and corticosteroid injections is an effective second-line option. B 12 , 13 , 17 — 19 , 28 , 30 — 33 Limited clinical trials have failed to demonstrate lasting improvement of established keloids and hypertrophic scars with onion extract topical gel e.
Keloids Hypertrophic scars Keloids Remain confined to border of original wound Extend beyond border of original wound Arise in any location; commonly occur on extensor surfaces of joints Commonly occur on the sternal skin, shoulders and upper arms, earlobes, and cheeks Regress with time Grow for years Fewer thick collagen fibers Thick collagen Scanty mucoid matrix Mucoid matrix Flatten spontaneously in time Remain elevated more than 4 mm Appear within one month Appear at three months or later Less association with skin pigmentation More common in darker skin types Adapted with permission from Jackson IT, Bhageshpur R, DiNick V, Khan A, Bhaloo S.
Table 1 Hypertrophic Scars vs. Cheeks are a common location for keloids, often secondary to acne. Figure 1. Figure 2. Read the full article. Get immediate access, anytime, anywhere. Choose a single article, issue, or full-access subscription. Earn up to 6 CME credits per issue. Purchase Access: See My Options close.
Best Value! To see the full article, log in or purchase access. More in Pubmed Citation Related Articles. Email Alerts Don't miss a single issue. Sign up for the free AFP email table of contents. Navigate this Article. Remain confined to border of original wound. Extend beyond border of original wound.
Arise in any location; commonly occur on extensor surfaces of joints. Fewer thick collagen fibers. Flatten spontaneously in time. Remain elevated more than 4 mm. Appear within one month. Appear at three months or later. Less association with skin pigmentation. More common in darker skin types.
Preventive silicone sheeting as postsurgery care. Multiple preparations available; tolerated by children. Expensive; should be avoided on open wounds; poor study designs. Patient acceptance and safety. May cause hypopigmentation, skin atrophy, telangiectasia. May cause hyperpigmentation, irritation. Case study May cause hyperpigmentation, wound ulceration. First-line treatment. Useful on small lesions; easy to perform.
May cause hypopigmentation, pain. Inexpensive; available in family physician's office. Requires multiple injections. May cause discomfort, skin atrophy, telangiectasia. Silicone elastomer sheeting. Expensive; poor study designs. Pressure dressing 24 to 30 mm Hg worn for six to 12 months. Difficult schedule; poor adherence.
Second-line and alternative treatment. Z-plasty option for burns. Immediate postsurgical treatment needed to prevent regrowth.
|Keloid before and after steroid injection||Acosta et al 29 conducted a prospective clinical trial with patients aged 1—14 years. However, further preclinical and clinical trials are needed to establish safety and efficacy of this kind of administration. Effectiveness of intralesional triamcinolone in the treatment of keloids in children. During the follow-up period, they detected signs of recurrence in 46 npp steroid profile 91 keloids that were treated with intralesional TAC injections. J Midwifery Reprod Health.|
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|Steroid injection to reduce scar tissue||They also often result in severe emotional distress [ 2 ]. Corticosteroids suppress inflammation and mitosis while increasing vasoconstriction in the scar. It can take some scars more than a year after surgery to look better. Author information Copyright and License information Disclaimer. Intralesional corticosteroid injections for prevention and treatment of keloids and hypertrophic scars are a practical first-line approach for the family physician. Perilesional linear atrophy and hypopigmentation after intralesional corticosteroid therapy: report of two cases and review of the literature. The Lindberg award.|
|Keloid before and after steroid injection||This dose of steroid is substantially more than the stat dose we plan to use in our study and requires multiple visits and repeated injections. In theory, this injection will prevent any scar formation before treatment is started. It also may try to reorient the scar so that its edges look more like the normal lines and creases of the skin. Case study International clinical recommendations on scar management. This content is owned by the AAFP. TAC combined with verapamil was proved to be effective with statistically significant overall improvements of scars over time and long-term stable results.|
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