Skin Conditions, General | December 16, 2014 | Author: The Super Pharmacist
Keloid scarring is a condition that can be very challenging to treat successfully because the mechanisms that cause it are not yet fully understood by the medical community. As a result, there are several evidence-based options available to the patient. The best therapeutic option will depend on a number of different factors, including the underlying conditions that may have contributed to the keloid developing; the size and location of the keloid; whether the patient has a history of recurrent keloids; and the physician’s recommendations and capabilities. A recent comprehensive review indicated that a combination of different therapies may be the best approach for treating the condition. This has been supported by a number of other studies that have examined combinations of the following therapies. In general, these studies have found that combining two or more therapies consistently provides better clinical outcomes than using standalone treatments.
Various bandages and occlusive (airtight) dressings have been applied with success to keloid scarring as both preventative and palliative therapies. These treatments are preferred by some physicians because they have minimal side effects, although their prescription is dependent on whether they are practical for the patient’s condition. The primary dressings used in treating keloid scarring include silicone gel and compression earrings. Silicone is applied either in sheets impregnated with gel, or else a topical application of the gel that is secured with an occlusive bandage. Compression earrings are applied after keloids have been removed from the earlobes and are worn 24 hours a day until the patient’s physician advises otherwise. Both methods have good rates of success as well as prevention of recurrent scars.
One of the primary treatments for treating keloid is the administration of Intralesional steroid injections, in which triamcinolone is directly delivered percutaneously to the skin lesions.
Typically, injections are administered every two to six weeks until improvement is seen. This method is designed to directly treat scarring while minimising any systemic side effects of the medication.
Reviews generally support intralesional injections efficacy in treating the majority of keloid scars., .
Side effects of this method include widened blood vessels near the skin (called telangiectasias) and subcutaneous atrophy, or depressions in the skin at the site of the treatment, although both can heal on their own. Alternatives to intralesional steroid injections are currently under investigation. One recent study investigating the effects of interferon injections found promising results when compared to outcomes using steroids. Another study examined bleomycin injections and found that they may be more successful than steroid injections. These budding areas of research are in their infancy and results should be treated cautiously at this stage.
Laser therapy has been used to treat hypertrophic scars since the late 1990s with very good results, but there is less evidence supporting their application in treating keloid scars. There are a number of different laser therapies available, including pulsed dye lasers (PDL), intense pulsed light (IPL) and carbon dioxide fractional lasers. There is not yet a broad consensus in the research literature supporting one type over another for treating keloids, although recent research suggests that PDL is the most promising avenue.
Combining intralesional injections with IPL therapy has been shown to provide better clinical outcomes than intralesional injections only.
Surgically removing keloid scars is one of the oldest techniques for treating the condition.
Though while it is generally successful initially, surgery often results in a very high rate of recurrence; in some cases the recurrent scar is bigger than the first one. Recurrence is preventable, however. Combining surgical removal with additional therapy such as intralesional injections, topical dressings and radiotherapy has been shown to significantly reduce the rate of recurrence following surgery.
Radiation therapy is typically prescribed as an adjunct treatment of keloid scars to surgery. While some concerns about the safety of radiation therapy persist, a retrospective study found that there was little causal relationship between carcinoma and postoperative radiation therapy used for keloid scarring. Several studies have determined that radiation therapy combined with surgery is a highly effective treatment that prevents recurrence.
Cryotherapy typically involves the application of liquid nitrogen at low temperatures to treat keloid scarring, and has been applied as a stand-alone or adjunct treatment. Several studies have reported that success rates of cryotherapy are mixed, and this may be due to the timing of the application as well as other factors., Cryotherapy has been shown to be effective as an adjunct treatment for intralesional steroid injections. One potential side effect is hypopigmetation, or the loss of skin colour due to melanin depletion.
As with many other conditions, preventative care is one of the most successful ways to treat keloid scarring. Preventative care is applied most successfully when the patient is made aware of their risk factors for developing a condition. There are a number of risk factors for keloid scarring.
Family History. The first and most important is having a family history of keloids; heredity plays a major factor in the probability of developing chronic conditions.
Blood Type. There is also evidence that having blood type A increases a person’s risk factor level for developing keloid scarring, although the underlying reasons are not entirely understood.
Age. Younger persons are more prone to keloids, particularly those between the ages of 10 and 30. This may be due to changing molecular structures as we age, and it is associated with the risk of keloids related to body piercings between these ages.
Skin Pigment. There is some evidence that having darker skin pigments can increase the likelihood of developing keloids, but there has not yet been a comprehensive clinical trial investigating this phenomenon, so it is difficult to say with certainty that it is in fact the case.
Pregnancy. Finally, being pregnant can cause an increased risk of developing keloids, presumably because of elevated levels of oestrogen during pregnancy.
Persons who have elevated risk factors for keloids can take preventative steps such as avoiding body piercings, cosmetic surgery and tattoos. Additionally, combining preventative treatments such as intralesional steroids or radiation therapy following medically necessary surgeries will minimize the risk of developing keloids as a result.
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