From our previous website’s article collection. Dates, prices and treatment information reflect the original publication period.
Quick Answer: A keloid is pathological scar tissue that extends beyond the original wound margins; unlike a hypertrophic scar, it grows past the wound edges and does not regress spontaneously. The combination of intralesional triamcinolone and 585/595 nm pulsed dye laser is the most effective treatment approach. A post-treatment recurrence prevention protocol is mandatory for high-risk locations and populations (Fitzpatrick IV–VI, ear/chest/shoulder, genetic predisposition).Keloids represent one of the most challenging scar types encountered by plastic surgeons and dermatologists. Developing after surgeries, piercings, or infections that were expected to heal well, a keloid can significantly impair quality of life through both aesthetic concerns and symptoms such as itching and pain. At Abel Beauty, multi-step protocols centred on each patient's individual risk profile are applied for keloid treatment.
Difference Between Keloid and Hypertrophic Scar
Although these two conditions are frequently confused, their treatment approaches and recurrence risks differ considerably.
| Feature | Keloid | Hypertrophic Scar |
|---|---|---|
| Wound boundary | Exceeds it (invasive growth) | Does not exceed it |
| Spontaneous regression | Does not regress | May partially regress over 2–3 years |
| Growth | May continue for months to years | Stops after 6 months |
| High-risk locations | Ear, chest, shoulder, back | Over joints, trunk |
| Genetic predisposition | Strong (autosomal dominant) | Less pronounced |
| Itching/pain | Frequent and pronounced | Moderate |
| Treatment response | Resistant; high recurrence risk | Better response |
Mechanism of Keloid Formation
At the root of keloid development lies the overactivation of the TGF-β1 (Transforming Growth Factor beta-1) signalling pathway seen in normal wound healing. This drives fibroblasts into uncontrolled proliferation and collagen production. Type I and III collagen expression in keloid tissue may be 20 times higher than in normal skin. Keloid fibroblasts are resistant to apoptosis; consequently, growth does not halt spontaneously.
High-Risk Locations and Populations
Not all wounds produce keloids. Conditions carrying elevated risk include:
- Location: Earlobe (10–20% rate following ear piercing), anterior chest (especially sternum), shoulder and deltoid region, upper back
- Skin tone: Fitzpatrick IV–VI, particularly individuals of Afro-Caribbean and Asian descent; rare in Fitzpatrick I–III
- Family history: First-degree relative with keloid → risk increases 5–10-fold
- Age: Highest incidence between ages 10 and 30
- Wound type: Wounds under tension, infected wounds, second-degree burns with prolonged healing
Treatment Protocol Comparison Table
| Treatment | Mechanism of Action | Efficacy | Recurrence Rate |
|---|---|---|---|
| Triamcinolone injection | Fibroblast apoptosis induction, collagen degradation | 50–70% | 50–55% |
| 5-Fluorouracil (5-FU) | Inhibits fibroblast proliferation | 45–65% | 40–50% |
| Steroid + 5-FU combination | Synergistic effect | 65–80% | 30–40% |
| Pulsed dye laser (585/595 nm) | Vascular targeting, TGF-β reduction | 57–83% | 25–35% |
| Steroid + PDL laser (combination) | Optimal synergistic protocol | 80–90% | 15–25% |
| Bleomycin injection | DNA synthesis inhibition | 70–85% | 20–30% |
| Cryotherapy | Tissue necrosis + fibrolysis | 50–75% | 40–50% |
| Radiotherapy (brachytherapy) | Fibroblast inhibition | 70–90% | 10–15% (surgery + RT) |
| Surgical excision (alone) | Removes the lesion | Palliative | 45–100% (without adjuvant!) |
Combined Protocol: Steroid + Laser — the Most Effective Approach
Current evidence-based medicine data show that the combination of intralesional triamcinolone (10–40 mg/mL, every 3–4 weeks) with pulsed dye laser or Nd:YAG laser achieves the highest complete response rates. The Abel Beauty protocol:
- Initial assessment (lesion size, vascularity, firmness, symptoms)
- Triamcinolone 10 mg/mL intralesional injection (every 3–4 weeks, 3–4 sessions)
- PDL or Nd:YAG laser session every 4–6 weeks (concurrent or alternating)
- Response assessment with volumetric measurement of the lesion at each session
- Addition of 5-FU or bleomycin if response is absent or insufficient
Surgical Keloid Treatment: Not a Standalone Solution
Surgical excision alone carries a 45–100% recurrence risk in keloid; it should therefore never be used as a stand-alone treatment. Surgery is considered only in the following situations:
- Large lesions unresponsive to pharmacological treatment
- Locations causing functional impairment (over joints)
- Must always be combined with adjuvant therapy (radiotherapy or steroid)
Recurrence Prevention Strategies
Preventing recurrence after treatment is an integral part of keloid management:
- Pressure therapy: Especially for ear and chest keloids; customised pressure garments or ear pressure devices are used for 23 hours a day for 6–12 months.
- Silicone gel/sheet: At least 12 hours a day for 3–6 months. Normalises the collagen matrix and reduces transepidermal water loss.
- SPF 50+ sunscreen: UV exposure can trigger new keloid formation.
- Tension reduction: Tension-free sutures and silicone tapes should be used throughout wound healing.
How to Reduce Keloid Risk in Wound Care
A proactive approach is essential in high-risk individuals:
- Relaxed skin tension lines (RSTL) should be respected in surgical planning
- Wound infection should be avoided; antiseptic care must be maintained meticulously
- No tension over the suture line; intradermal suturing technique when necessary
- Silicone gel should be started immediately after wound closure
- For ear piercing in high-risk individuals, the lower edge of the lobe should be preferred; cartilage must never be pierced
Keloid Management at Abel Beauty: Izmit and Kocaeli
Abel Beauty carries out multidisciplinary assessment for keloid treatment, creating an individualised treatment plan for each patient. At the initial consultation, VAS itch/pain score, dimensional measurement, and photographic documentation of the lesion are performed. Treatment response is recorded at every session. Remote video consultations are also available for patients travelling from Kocaeli and surrounding provinces.
Frequently Asked Questions
Can a keloid come back? Because keloid susceptibility is a genetic and constitutional trait, new wounds in the same individual may give rise to new keloids. However, with appropriate preventive measures and treatment, the risk of recurrence can be significantly reduced.
Is keloid treatment painful? Discomfort related to injection pressure in firm tissue may be felt during intralesional injections. Topical anaesthesia is used to improve comfort.
Can keloids be treated in children? Steroid doses must be carefully adjusted in children; wherever possible, conservative approaches (silicone, pressure) should be prioritised. Parental consent must be obtained for cases requiring laser or injections.
This article is for informational purposes only. Please consult a qualified physician for treatment decisions.
