Keloid Scars – Causes, Treatment & Prevention

My name is Ioannis Goutos, I’m a
consultant plastic surgeon and both my NHS and private practice is based in London. My areas of expertise include burn care, scar management as well as
body contouring. If you would like to arrange a consultation please feel free
to get in touch. There are various different classification
system for scars. The system that I most frequently use in my practice relates to
the amount of collagen that is present within the scar. If an individual goes through an uneventful wound healing and scaring process he or she is going to end up with what we called a normotrophic scar. In other words this scar
contains the normal expected amount of collagen. If for any reason there is less
collagen within the scar then we call this an atrophic scar and this normally
has a depressed appearance. On the other end of the spectrum if there are excessive amounts of collagen within the scar then this is called hypertrophic
and it normally appears to be elevated. Keloid scars which exhibit very protuberant growth or at the very extreme spectrum of hypertrophic scars. A hypertrophic scar typically manifest
itself as a raised red lumpy scar whose dimensions remain within the confines of the original injury. They tend to resolve successfully through a process called scar maturation and they’re very frequently seen in younger individuals
who have had an injury including burns. Keloid on the other hand represent the
extreme end of hypertrophy in scars. They tend to have significant dimensions
either vertically or horizontally and they have a rather unpredictable natural evolution. Since they do not regress successfully on their own and very
frequently need treatment by a specialist Genetic predisposition is a very strong
risk factor for the development of keloid scars a nearly 50% of patients
that attend my keloid management clinic have a positive family history.
Additionally patients with Afro-Caribbean type skin are 15 to 20
times more prone to developing keloid scars. Hormonal upsurges including
pregnancy, puberty and endocrine disorders including hyperthyroidism do
put you at higher risk of developing scars. Very interestingly it has been
recognized over the last two decades that uncontrolled hypertension can
contribute to greater severity of keloid scars. Furthermore areas of the body that
are subject to more tension or stress for example the chest, the shoulders and
the suprapubic area are more prone to be developing keloid scars. One of the hallmarks of diagnosing a
keloid scar is its unpredictable natural evolution. What we very
frequently see in clinical practice is that keloid scars can develop even after
years following the original insult to the skin. Patients with keloid scars can
develop particularly troublesome symptoms of pain, itch and can suffer with very low self-esteem due to the unsightly appearance of these
scars. Furthermore areas of the body that are subject to more tension or stress
for example the chest, the shoulders and the suprapubic area are more prone to be developing keloid scars. There are two separate groups of
procedures that can be offered to keloid patients but can achieve different
objectives. The first group of interventions that can be really helpful
for keloid scars aim to replace a bulky keloid scar with a fine symptom-free
scar. By far the best way to achieve this is by performing what we call an extralesional excision of the scar and then half post-operative radiotherapy. Second group of choices that is available aims to reduce the bulk of the existing scar and
improve the symptoms and there is a wide range of agents that can be used
including the injection of steroids, 5-fluorouracil, the topical application
of steroid tape as well as cryosurgery. So the exact details of the keloid
management plan will need to be delineated in the context of a
consultation with a specialist plastic surgeon and preferably within a
multidisciplinary team if you feel that our team can help please feel free to
get in touch What can I do to prevent getting a
keloid scar. This is by far one of the commonest questions that I am asking my scar management clinics. At the first thing that I encourage my patients to do
is to help me identify any precipitating factors that may have towards scarring.
This for example includes acne or folliculitis which is inflammation
around the hair follicles. These conditions need to be treated early by a specialist. The second measure that can be taken is
to try and avoid any preventable injury to the skin for example tattoos or
piercings especially in individuals that are known to have a propensity to form keloid
scars. Additionally if you sustained an accident or if you have surgery please
do inform your doctor that you are at high risk for keloid scars so that the
right adjunctive measures can be taken to minimize your keloidal risk Every operation that involves an incision through the skin will result in scarring. Nevertheless there are a number of measures that your qualified surgeon can
take in order to minimize the risk of unfavorable scarring. This includes
meticulous planning and the placement of incisions that respect the natural
creases within the skin. The closure of the wound with appropriately chosen
tension-relieving techniques and also the appropriate aftercare which includes
dressings and wound support adjuncts. If you’re a particularly high risk or
unfavorable scarring then you should be seeking advice from a qualifying plastic
surgeon who specializes in scar management

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