Keloid Disorder is a chronic skin conditions that requires a comprehensive treatment plan and approach. Most keloid lesions need more than one modality of treatment. Approach to treatment of keloid should be a step by step non-surgical treatment plan for every patient. This plan should take into consideration the location, size and thickness of the keloid as well as the associated symptoms and all prior treatments. Some keloids can be treated with cryotherapy alone, others need to be injected with steroids first and, if they do not respond to this treatment, cryotherapy is used in the second stage. If all these fail, one may need to even incorporate chemotherapy, as a step to gain control over the process. Although keloids are difficult conditions to treat, the good news is that everyone with keloids can be helped in one form or the other. Treatment process takes time. Each cycle of treatment results in some improvement in the appearance and size of the treated keloid. In most patients, treatment needs to be repeated several times to achieve best results.
INTRALESIONAL STEROID INJECTIONS:
An easy and common method of treating keloidal lesions is to inject them with steroids. Steroid injections work for a minority of patients, specially those with very few and thin keloid lesions. Steroid injections are often repeated every few weeks. There is no clinical evidence that higher doses of steroids are better, therefore, the dose of injected steroids should be kept the lowest possible. There is, however, strong evidence that higher doses of steroid do cause side effects, both locally at the site of injection causing skin atrophy and fat necrosis, and systemic side effects, such as rise in blood sugar (among diabetics) specially when repeated every few weeks.
The fundamental approach to treatment of keloids is to destroy the keloid tissue with a method that results in the least chance of recurrence. Cryotherapy is one such treatment that can destroy the keloid tissue. It is also the safest method, as it does not involve any medications. Cryotherapy works best on bulky keloids such as ear and large keloidal tumors. Success of cryotherapy is for the most part "operator dependent". Incorrect application of cryotherapy often does not lead into any results. As such, patients should ask their physicians about their past experience with cryotherapy. Simple spraying of liquid nitrogen from a spray can, a commonly practiced technique is simply not going to work.
INTRALESIONAL CHEMOTHERAPY INJECTIONS:
Certain chemotherapy drugs have shown various degree of efficacy in treatment of keloidal lesions. Choice of drugs, the dosage as well as side effects have all to be taken into consideration before initiating such treatments. Very painful chest wall keloids respond best to intra-lesional chemotherapy.
Surgery and removal of the keloid from the skin does result in immediate improvement in the appearance of the skin, however, the risk of recurrence after surgery is near 100%, making the situation often worse by re-growth of an even bigger keloid at the site of surgery.
Radiation therapy as an adjunct to surgery can cause regression of some, but not all keloids. Radiation, however, can cause fibrosis and very dense skin reaction at the site of treatment. Chronic infections and skin abscess formation are among other long term complications of recurrent keloids after radiation therapy. Long term carcinogenic and other risks of radiation therapy may not justify using radiation in the treatment of keloids that by nature, are benign skin conditions.