Steroid Injection for Keloid or Hypertrophic Scars

What is a keloid scar?

A keloid scar is a thick raised scar. It can occur wherever you have a skin injury, but usually forms on earlobes, shoulders, cheeks or the chest. If you are prone to developing keloid scars, you may develop them in multiple areas. A keloid scar is different from that of a hypertrophic one.

A hypertrophic scar stays within the bounds of the original wound and can fade over time without treatment.

Causes

Experts do not completely understand what causes keloid or hypertrophic scars, but most agree it is likely a dysfunction of the wound-healing process. Collagen is a protein found throughout the body and is key to wound healing, but when the body produces too much of it, keloid scars can form.

Keloid scar growth may be triggered by any sort of skin injury – an insect bite, acne, an injection, body piercing, burns, hair removal, and even minor scratches and bumps. Sometimes keloid scars form for no obvious reason.

Steroids are often used as a treatment for smaller scars. However, in larger scars (or if injections are not effective), then a combination of surgical excision and steroid injections may be required.

The steroid is injected into the bulkiest part of the keloid scar at an angle. The needle will be inserted inside the scar tissue at tiny, spaced intervals to spread the steroid throughout the scar.

During treatment the scar tissue may temporarily look paler. It will sting and feel tense for a few seconds.

The injection needs to be repeated at intervals of 3 to 6 weeks for developing keloid scars (until it is stabilized), or monthly for 3 to 6 months on existing ones.

Corticosteroids reduce the production of collagen and proteins that form fibrous scar tissue as well as inhibit inflammatory factors. This activity causes keloid scars to soften and become flatter.

Evidence of Benefit
Although some medical experts assert that steroid injections cannot completely eliminate keloid scars, most others indicate that they are effective and, in some cases, can completely resolve a keloid scar.

Studies repeatedly show that using steroid injections, in combination with other therapies, significantly increases the overall effectiveness of this type of treatment.

Outcomes are significantly better if treatment is administered soon after the wound develops.

Once you have considered all the information that I will discuss with you in more detail in clinic, you can of course decide not to have steroid treatment and choose to live with the scar.

Complications are infrequent and usually minor. However, no treatment is without risk, and it is important that you are aware of the possible complications.

All the risks will be discussed in detail with you at your consultation. However, if you have further questions or concerns, do not hesitate to discuss them with me.

Possible adverse side effects include:

  • Hypopigmentation or hyperpigmentation: It is possible that the scar may become lighter or darker than the surrounding tissue. Hypopigmentation may be reversible with time (up to one year), but it could be permanent.
  • Skin/fat atrophy: This occurs when scars become very thin and looks like a depression in the skin. This can occur following large amounts of steroids and/or injection in the surrounding normal tissue, which is likely to be permanent.
  • Cushing’s syndrome: This unlikely syndrome can develop if too much steroid is used but is very rare, given the small dose that is usually injected.
  • Pain on injection: Injections normally sting but can be improved with local anaesthetic or topical numbing creams. As the keloid scars soften, treatment becomes easier and less tender.
  • Recurrence: Steroid injections need to be repeated if there is any sign of recurrence.

A plaster is applied if there is a small amount of bleeding. This can be removed the same day, and you can resume normal activities.

Before you leave the clinic, you will be given a follow up appointment for 3 weeks’ time, when we can perform further injections as required.

Scar Advice
I recommend that you massage the incisions, using small circular motions at least twice a day for 5 minutes. You can use any moisturising cream of your choice and apply firm pressure until it blanches.

The scars will also benefit from silicone scar gel (ScarAway® or Kelo-Cote®) twice a day, which will soften and fade them, as well as applying sunblock for 12 months to provide sun protection.

The ScarAway® can be purchased from Healthcare Pharmacy at Governors Square in Grand Cayman.

This is a minimally invasive procedure, and you can return to work and full activities on the same day.

Depending on the indications, steroid injections are sometimes covered by healthcare insurance, although most patients are required to contribute a copay. This is normally 20% of the cost of the procedure.

For self-funding patients, surgical fees are a combination of the consumables and the surgeon's fee. A quotation for the steroid injection will be given during the clinic appointment.