#keloid - how to treat?

Keloids represent a type of scar caused by an abnormal reaction to trauma with an excessive tissue response and production of collagen with fibrosis. 

Keloids are firm, rubbery lesions or shiny, fibrous nodules, and can vary from pink to fleshy, red or dark brown in colour. A keloid scar is benign and not contagious, but sometimes accompanied by severe itchiness, pain, and changes in texture. In severe cases, it can affect movement of skin. Genetics plays an important role on keloids predisposition. Keloid scars are seen 15 times more frequently in highly pigmented ethnic groups than in Caucasians 

Unfortunately, treatment options are limited and results may not be satisfactory. They include:

1. first line: cryotherapy, intralesional injections of steroids, silicone ointments under compression and radiotherapy (in trained hands).
2. second line: excision followed by compression therapy and monthly injections of triamcinolone.
3. Vascular pulsed dye lasers might decrease redness (at least in theory), but all lasers, even the non ablative ones, involve energy delivered to the dermis. Energy is converted to heat and carries a risk of scarring, and thus keloids. Therefore, although described as a therapeutic option, lasers can be risky and must be used very carefully for such purpose.