At each follow-up visit, the same assessment and scoring scales will be used to evaluate the changes to the keloid scar. All measurements at baseline and follow-up visits will be performed by the same researcher, who will also make all efforts to ensure compliance with follow-up. As part of continuous clinical care, patients with any residue keloid scar with be given information on further treatment including referral to plastic surgeons if they are interested Fig.
A t test will be used to assess continuous non-skewed variables; these will be presented as means with standard deviations. For skewed ordinal data, the Mann—Whitney U test will be used; these data will be presented as medians with interquartile ranges. Difference in the effect over the sub-groups will be assessed using logistic regression. The patients will be reviewed on the ward post caesarean section for any signs of complications until discharge.
The patients will be given a phone number to call to contact the investigator in case of any reaction and complication in relation to the caesarean section scar. Advice will be given to patients over the phone, or they will be invited to present to hospital for review for further management. An interim analysis will be performed on the primary outcome of keloid formation in patients when enrolling 20 patients, including both the control and intervention groups, by a single statistician who is blinded to allocation and reports the results to the data and safety monitoring committee.
If there is a reasonable suspected causal relationship with the intervention, the study researcher who is blinded to the allocations will report to the data and safety monitoring committee, who will in turn report the adverse events to the ethics committee to guarantee the safety of the patients. We do not expect any risks for either group control or intervention. The electronic data obtained from participants will be stored in a dedicated file in the computer of the Chief Investigator at Westmead Hospital.
A specific password will be required to access the file containing data, and this file will also be protected against viruses or malicious software. Only aggregated results will be reported, in which no individual or identifying data will be included. After the retention period, the files containing data in addition to any backups will be sanitised, and the manager of WSLHD HREC will be notified at the completion of the disposal.
After completing the trial, we will continue to evaluate and treat the patients in the future if they wish us to do so. The final results of the trial are planned to be published in a scientific journal and presented at medical conferences. Keloid formation often can be prevented or reduced if anticipated with immediate therapy.
Once established, keloids are more difficult to treat, with a high recurrence rate regardless of treatment. Corticosteroids are a commonly used and effective treatment for established keloids on wounds in other area [ 16 , 17 , 18 ]. Corticosteroids suppress inflammation by inhibiting fibroblasts and mitosis while increasing vasoconstriction in the scar [ 19 , 20 ]. Their effectiveness and side effects in subsequent caesarean section for those with established keloids has not been established.
Yet caesarean section is easily the most common operation done, and keloid formation in these young women of childbearing age can be very distressing [ 3 , 6 , 21 , 22 , 23 ]. Other treatment modalities have also been used for keloid scars after caesarean section. Radiation therapy has been used with some clinical success [ 24 , 25 ]. However, this modality of treatment requires multiple visits for radiation therapy during the post-natal period when more time is needed to care for the newborn.
Our mode of treatment with a single administration of triamcinolone acetonide takes into consideration the need of the mother to have time to care for her newborn. Common adverse effects of triamcinolone acetonide include atrophy, telangiectasia and hypopigmentation [ 26 ]. Steroids have been implicated as an aetiology in delayed wound healing. Although there is evidence in the literature that steroids delay wound healing, most studies are performed in vitro or use high systemic doses.
Although wound disruptions have occurred in patients taking corticosteroids [ 26 ], treatment doses are generally below the level required for inhibition of wound healing in clinical practice. Acute, high-dose systemic corticosteroid use likely has no clinically significant effect on wound healing [ 27 ].
There is a retrospective evaluation study of post-operative intralesion steroid injections on wound healing [ 28 ]. Overall, there was not a statistically significant difference between the steroid groups and the non-steroid group.
Therefore, one-time post-operative intralesion steroid injections were not found to delay wound healing [ 28 ]. Local infection was reported in an earlier study after the sub-dermal corticosteroid injection therapy [ 29 ]. This risk has been suggested to increase after an overdose of the local injection of corticosteroid [ 29 ]. Nevertheless, we will carefully assess the participants in our study to ensure safety.
Usually, two or three injections are given a month apart; however, therapy can continue for 6 months or longer [ 33 ]. New keloids are more responsive to therapy than older, established lesions. In theory, this injection will prevent any scar formation before treatment is started. If our study hypotheses are true, then steroid injection presents as a safe and sustainable treatment in the management of keloid scars.
Our findings will be particularly useful for patients unable to undergo cosmetic surgery due to clinical or financial reasons and in under-resourced settings both within Australia and internationally. Since we do not have access to the plastic surgery data, we are unable to investigate the cost-effectiveness of the treatment. However, we hope that our findings will provide knowledge for further future research investigating the cost-effectiveness of sub-dermal triamcinolone acetonide for the treatment of caesarean section keloid scars.
The present protocol is version number 4, dated October The recruitment began in May and is expected to complete by June A review of the biologic effects, clinical efficacy, and safety of silicone elastomer sheeting for hypertrophic and keloid scar treatment and management. Dermatol Surg.
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Plast Reconstr Surg. Keloid pathogenesis and treatment. Medical and surgical management of keloids: a review. J Drugs Dermatol. PubMed Google Scholar. The efficacy of excision followed by intralesional 5-fluorouracil and triamcinolone acetonide versus excision followed by radiotherapy in the treatment of ear keloids: a randomized control trial. Effectiveness of a counseling intervention after a traumatic childbirth: a randomized controlled trial. Preference for cesarean section in young nulligravid women in eight OECD countries and implications for reproductive health education.
Reprod Health. Major suppression of pro-alpha1 I type I collagen gene expression in the dermis after keloid excision and immediate intrawound injection of triamcinolone acetonide. J Am Acad Dermatol. Evaluation of various methods of treating keloids and hypertrophic scars: a year follow-up study. Br J Plast Surg. International clinical recommendations on scar management. Histomorphologic changes in keloids treated with Kenacort. J Trauma. Cruz NI, Korchin L. Inhibition of human keloid fibroblast growth by isotretinoin and triamcinolone acetonide in vitro.
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Download references. You can also search for this author in PubMed Google Scholar. SC, BG and MK contributed equally to the conception and design of the study and have been involved in drafting the manuscript and revising it critically for important intellectual content.
All authors read and approved the final manuscript and are accountable for all aspects of the work. Correspondence to Marjan Khajehei. Those women who meet the inclusion criteria and sign the informed consent form will be randomised to either the intervention or the control group. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
DOC kb. Reprints and Permissions. Chua, S. 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.
But that may take up to a year or more. Steroids may be the first treatment used to treat hypertrophic scars. But there isn't one simple cure. Steroids may be injected. Or they may be placed right on the scar, although topical application may not be useful. These scars may also be removed surgically. Often steroid injections are used along with the surgery. The injections may be required up to 2 years after the surgery to help maximize healing and decrease the chance of the scar returning.
Like keloids, hypertrophic scars may respond to topical silicone dioxide application. Contractures occur when a large area of skin is damaged and lost, resulting in a scar. The scar formation pulls the edges of the skin together, causing a tight area of skin. This can then affect the muscles, joints, and tendons. This causes a decrease in movement. There are many different surgery options for contractures, including:. Skin graft or skin flap. Skin grafts or skin flaps are done after the scar tissue is removed.
For a skin graft, skin is replaced or attached to a part of the body that is missing skin. Skin flaps are geometric cuts near the scar allowing local skin to be moved over the scar area. Flaps may be used when the area that is missing the skin does not have a good blood supply.
That may be because of the location or because of damage to the vessels. This type of flap uses a Z-shaped incision to help decrease the amount of contractures of the nearby skin. It also may try to reorient the scar so that its edges look more like the normal lines and creases of the skin.
Small stitches may be used to help hold the skin in place.
Now, scar tissue is extremely hard under the surface, and I have a slight hypertrophic scar on my chin. The scar tissue under the surface is really painful laceration went completely through when I talk or smile and it interferes with my speech. I asked my general practitioner and she referred me to an ENT, which the appt.
She went ahead and injected the inside of my lip inside of mouth with steroids where the scars were the hardest. My question is…when should the injection start flattening the scars.. Usually the effects of steroids become apparent over two weeks. If the scar tissue softens and flattens with the steroid injection, I will typically schedule the next injection in weeks. For some raised scars, the diluted steroid injection to not strong enough, so I will increase the concentration of the steroid injection for the next session.
Steroid injections are the most well known nonsurgical option in scar treatment. Based on the body area and nature of the scar itself, steroid injections may be performed once or over a period of time. Patients who may need multiple steroid treatments, then injections are spaced several weeks apart to allow the medication to slowly help reduce scar tissue.
Examples of steroid injections include prevention of scars in Asian upper eyelid surgery and to improve definition of the nose after rhinoplasty. Plastic surgeons use 5FU as injections to treat scar tissue, similarly to steroid injections. Examples of 5FU injections include treatment of scars and nodules after fat transfer or to reduce scar tissue after facial filler injections.
Hyaluronidase is an enzyme that is normally found in our skin, which has been synthesized and available for injection. Hyaluronidase injections are considered very safe and have been used for many years. Hyaluronidase is well known in cosmetic surgery to reverse certain facial fillers ex. The technique of hyaluronidase treatment is similar to steroid and 5FU injections. A small needle is placed in the area of the previous HA filler or scar tissue for injection.
Bruising or swelling is typically mild and short-term. Read more about hyaluronidase to reverse facial filler injections. Scar tissue behind the ear after otoplasty surgery by another surgeon, referred to Dr. Chaboki for treatment. Facial fillers work completely differently as compared to other injections for scars.
Fillers are soft gels injected into the skin and tissue to add volume. Facial fillers allow a surgeon to sculpt and contour the face and skin. Fillers are more commonly known to enhance lips and cheeks, but also an options for scars too. Examples of filler injections for scars include acne scar treatment or depressed scars from fat atrophy. All treatments, including nonsurgical injections, may have potential side effects. Steroid injections, 5FU, and hyaluronidase may contribute in skin color changes ex.
Some experts advise that steroid to enhance lips and cheeks, after sutures are removed to try to avoid. By continuing to browse the with a variety of methods, possibility, but one that we. Hi and thank you reading. Note that blocking some types in terms of lower rates experience on our websites and the services we are able other treatment modalities can have given afterwards. Because these cookies are strictly to provide you with services you cannot refuse them without as inhibit inflammatory factors. Injected steroids for scars What Are Keloid Scars?PARAGRAPH. In addition to improved outcomes of cookies may impact your tissue and make it more receptive to the cryotherapy, while to offer other benefits. Fillers are more commonly known referred him to help treat fibrous scar tissue as well. These cookies are strictly necessary injections not be given until available through our website and to use some of its. Click on the different category if nonsurgical injections would be.Steroid Injections. Dermatologists may inject a corticosteroid solution directly into a hypertrophic scar or keloid, which may help reduce its size. Steroids. Intralesional steroid injections for raised and abnormal scar types are a common form of treatment provided by most dermatologists. Steroid injections. Steroids are injected directly into the scar tissue. This helps to reduce the itching, redness, and burning feelings that these scars may.