A keloid is an area of irregular fibrous tissue that forms at the site of an injury or previous scar. Though keloid scars are not usually harmful to your health, they can cause both uncomfortable physical symptoms and cosmetic concerns. At California Dermatology Care, we are proud to be offering the most extensive array of procedures for keloid and hypertrophic scar reduction in the Bay Area. Our board-certified dermatologists can examine your condition and work with you to determine the most suitable method of treatment.
What are Keloids? How Do They Differ from Normal Scars?
When the skin is damaged, fibrous tissue called scar tissue forms over the wound to repair and protect the injury. In some cases, the body produces excess collagen during the healing process, resulting in extra scar tissue that forms smooth, hard growths known as keloids. They differ from normal scars as keloids usually extend beyond the edges of the injury site and are characterized as raised, ridged lumps or darkened areas of skin. Keloids are more severe than hypertrophic scars, which are characterized as thickened, wide and often raised scars that, unlike keloids, do not usually extend beyond the wound site.
Though they are not usually dangerous, keloid scars can create prominent cosmetic concerns that affect your appearance and confidence. For some patients, they can also cause discomfort, tenderness, itchiness or irritation. At California Dermatology Care, Dr. William Ting and his team of expert dermatologists offer various treatment methods to eliminate keloids scars and restore a smoother, natural-looking texture to the skin. Very rarely, dermatofibrosarcoma protuberans (DFSP), a rather uncommon malignant skin tumor can mimick appearance of keloid scars and thus all keloids or abnormal appearing scar tissues should be evaluated by one of our expert dermatologists or dermatology physician assistants at California Dermatology Care.
Symptoms of Keloid Scars
Keloids can form anywhere on the body. They tend to develop on the neck, shoulders, chest, backs and ears. Ear keloids are especially common and can be difficult to treat. They may take several weeks or months to develop fully. The symptoms of a keloid scar may include:
- A localized pink, red or flesh-colored area of skin
- A lumpy, ridged or raised area of skin
- An injury site that grows larger with scar tissue over time
- An itchy patch of skin
Keloid scars can generally be prevented if you consult a dermatologist or a physician assistant supervised by a board-certified dermatologist at the formation of a new injury. Sun protection, skin massaging and the application of a silicone gel or sheeting can help protect a fresh scar. However, when a keloid scar forms, medical treatment is usually the most reliable and effective method of removal.
What Causes Keloid Scars?
Most types of skin injuries can lead to keloid scarring. The most common wounds that trigger this issue include:
- Acne scars
- Ear piercings
- Chickenpox scars
- Surgical incision sites
- Vaccination sites
Who Is At-Risk of Developing Keloids?
Men and women are equally likely to develop keloid scars. Risk factors for experiencing this problem include:
- Darker skin tone
- Asian descent
- Latino descent
- Under the age of 30
Types of Treatment for Keloid Scars
At California Dermatology Care, we offer various treatment modalities to help correct keloid scars. Based on an in-depth examination of your skin type and the current condition of your scar, our dermatologists can recommend the most appropriate method of removal to ensure you achieve optimal results. Additionally, some but not all keloid scar treatments may be covered by your health insurance provider, so it is important to check with our medical providers and/or billing office to review your insurance policy before embarking on a specific treatment plan.
Superficial radiotherapy (SRT?) utilizing SRT-100TM by Sensus Healthcare, is the most revolutionary new modality for keloid and hypertrophic scar. This FDA-approved therapy is among the most effective procedures to treat even the toughest keloid. While SRT-100TM can be used to treat keloid without incision utilizing a protocol of one SRT session per week for 4 weeks in a row, SRT modality has the highest success rate (in excess of 90%) when it is performed once daily, 3 days in a row, preferably within 24 hours of surgical excision of the original keloid skin tissue. Most treated patients will experience concurrent reduction or itching and pain associated with keloids. SRT has much greater safety margins compared to traditional orthovoltage radiation therapy as SRT involves typically one thousand times less energy, no associated radioactivity or scattered radiation. Side effects associated with SRT for keloids are usually minimal and may include pigmentary changes in the treated area. SRT for keloid is typically covered by most PPO insurance carriers (subject to typical copay, deductible and coinsurance) and Medicare though preauthorization may be required. Any residual keloid tissue after SRT can be further flattened with intralesional 5-fluorouracil/cortisone injection at later date. Dr. Ting and the clinical team at California Dermatology Care is among the first dermatologists in California and West Coast to administer this state-of-the-art technology for keloid and arguably may be among the most experienced medical clinics in the nation in administering SRT for keloids.
Cryoshape is yet another innovative keloid scar treatment modality available at California Dermatology Care led by Dr. William Ting. Cryoshape utilizes cold temperature to destroy the keloid tissue from within, a controlled medical process known as cryonecrosis.
During treatment, a handheld cryoprobe delivers liquid nitrogen directly into the keloid to freeze unwanted scar tissue. This results in the cellular destruction of the keloid and cuts off its blood supply, causing it to shrink and disappear. Local anesthesia is used to ensure a comfortable procedure, and a vast majority of patients experience a significant reduction in keloid size after just one treatment. Treatments also minimize any itching or pain associated with keloids. Appointments can typically be completed in under an hour, but procedure lengths will vary depending on the size and number of keloids being treated. Patients can return home immediately afterward.
The advantages of the Cryoshape modality include the ability to treat multiple keloid scars in one outpatient session with no surgical excision required. Additionally, any residual keloid tissue left after Cryoshape tends to respond better to conventional therapies such as intralesional steroid rejection, which can be used as a follow-up treatment for improved results. The downsides of Cryoshape include it not being covered by any insurance carriers, though it may be submitted to pre-tax HSA/FSA accounts. There may also be some minor side effects after treatment, such as temporary pain or discomfort that typically subsides on its own. Some wound fluid drainage from liquefied keloid tissue can also occur for the first few days, requiring daily dressing changes for one week. Some patients, especially those with darker or ethnic skin tones, may also experience minor pigmentary changes in areas treated with Cryoshape. During your consultation, Dr. Ting and the team at California Dermatology Care will discuss all of this and more to help decide if this treatment is right for you.
Cryoshape is proven to be a highly effective procedure for keloid scarring with a success rate of about 70% at California Dermatology Care, although this may be lower in skin areas previously treated with radiation therapy. Drs. Ting and Freeny and our clinical team are among the first dermatologists in the Bay Area to offer this groundbreaking modality for keloid scar tissues. During your upcoming consultation, our providers will review your skin care needs and recommend the right approach for achieving your treatment goals.
review your skin care needs and recommend the right approach for achieving your treatment goals.
INTRALESIONAL 5-FU/STEROID INJECTIONS
Intralesional steroid injection is the traditional, most widely performed method of keloid scar removal. Since this procedure can be customized to your needs, the type and strength of steroid injected will depend on the degree and maturity of your keloid scar. The cortisone injection may be performed alone or in combination with a potent anti-proliferative medication called 5-fluorouracil to provide significantly greater flattening effect of keloid tissues.
While intralesional steroid injection is typically covered by most insurance carriers (subject to typical copay, deductible and coinsurance), the use of adjunctive intralesional 5-fluorouracil is considered elective. For optimal results, multiple injections may be required, and treatments may be repeated as necessary every four to eight weeks until satisfactory flattening of keloid scar tissue is achieved. Intralesional steroid injections with or without 5-FU can be used safely with few significant side effects, although disadvantages of this treatment option include some pain or discomfort associated with numerous injections, the risk of skin atrophy (which is usually temporary), pigmentation changes, the development of fine blood vessels in the surrounding areas of treated skin and a lack of efficacy for some patients. While cortisone injections are usually covered by most insurance carriers (subject to typical copay, deductibles and coinsurance), the use of adjunctive intralesional 5-fluorouracil is considered elective.
Often in combination with medical treatment, supplementary techniques can help to enhance the results of your procedure. Based on your condition, our dermatologists can design a personalized at-home regime for addressing the keloid scar and protecting the injury site. This routine may include:
- Sun protection
- Scar massage
- Silicone gel or sheeting
- Prescription-strength topicals such as imiquimod or 5-fluorouracil
GenesisPlus Advanced Laser Therapy
This procedure is highly suitable for patients seeking to treat hypertrophic scars or to further smooth out skin texture and skin tone of already flattened scar tissues after utilizing above mentioned modalities. The GenesisPlus system can help to accelerate scar remodeling, minimize redness and enhance cosmetic results. This treatment also works to soften and relax the tension in scars, improving mobility for patients with uncomfortable physical symptoms. For patients with hypertrophic scars, Dr. Ting may recommend a series of four to six GenesisPlus Advanced Laser Therapy sessions, often in combination with vascular lasers and/or intralesional steroid injection.
Vbeam Prima/Perfecta and Excel V Vascular Laser Therapy
Prominent redness or purplish hue associated with keloid scar tissue presents as much of aesthetic challenge as the contour irregularity of the scar tissues. By reducing reddish skin tone of the keloid tissues with combination of the advanced vascular lasers at California Dermatology Care, Dr. Ting and the clinical team can help you minimize unwanted visual attention drawn to the keloid or hypertrophic scar tissues. Advanced vascular lasers such as Vbeam Prima and Excel V lasers targeting different absorption wavelengths of hemoglobin can dramatically improve the cosmetic appearance of these reddened scar tissues via series of laser treatment sessions and thus improve one’s sense of self-esteem and confidence. In your upcoming consultation, providers at California Dermatology Care will assess contour and skin tone irregularity of your keloid or hypertrophic scars as well as the maturity of the scar tissues to put together a treatment plan that addresses your priorities.
Schedule Your Consultation Today with Dr. William Ting and the clinical staff at California’s Leading Dermatology Clinic
Dr. William Ting and the clinical staff at California Dermatology Care (CDC) are highly experienced medical dermatology specialists with a passion for creating effective and lasting results. They adopt the latest technology and most advanced techniques to remove keloid scars and restore a natural-looking texture to the skin. At the forefront of their work is their commitment to the long-term health of his patients; they take every measure to ensure your skin is nourished and protected against harmful sources, such as sun exposure, to secure your future wellbeing.
Aligning with this focus, Dr. Ting leads a team of friendly, professional and caring dermatologists and experienced dermatology physician assistants who are dedicated to helping you feel more confident about your health and external appearance. Serving the residents of San Ramon, Livermore, Hercules and beyond, Dr. Ting has helped countless men and women treat keloid scarring and achieve better skin health. If you are concerned about the development of a keloid scar and would like to learn more about your treatment options, contact California Dermatology Care by texting (925) 328-0255 or email firstname.lastname@example.org to schedule your consultation today.
*Patient education matters to us. The information on this page has been reviewed by the board-certified dermatologists of California Dermatology Care. If you have any questions about our procedures or treatments, please get in touch with us today.