Why some scars do not look pretty?

As part of a nomal healing process, the body forms a scar after an invasive medical or surgical procedure, after tattoos and piercings and after ordinary events, such as insect bites and trauma from scratching. When the body fails to heal properly, there is an abnormal proliferation of scar tissue. This results in a raised formation of fibrous scar caused by excessive tissue repair. The resultant abnormal scar is called a keloid.

Keloid is a common presenting complaint in a medical practice. Managing and preventing keloids is a formidable challenge because of incomplete understanding of how keloids are formed. There is no good way to prevent or treat them as they seem to recur in certain percentage of the population. This leaves patients and physicians quite frustrated.

Keloids have been recognized since antiquity. The term keloid was chosen based on the Greek word for crab claw (“cheloid”). Main complaints from patients vary from unsightly look to itching and pain at the site of the keloid. The most common anatomical sites for keloids include the chest, shoulders, earlobes, upper arms, and cheeks.

Keloids are more common in dark-skinned persons. It is estimated to be between four to 16 per cent among blacks and Hispanics. Keloids occur with equal frequency in men and women. Younger patients are affected more often, with an age range of 10 to 30 years. A genetic predisposition to keloids has been described.

There is no good treatment available to take care of keloids. There are multiple treatment options but they can be expensive and recurrence rates are high. Therefore, prevention is important. Patients with a family history of keloids should avoid ear piercing, and those with a personal history should avoid elective surgical procedures unless absolutely necessary.

Injection of steroids is the most effective and widely used treatment for keloids. In one study there was a symptomatic improvement in 72 per cent of patients and complete flattening of the keloid in 64 per cent. However, the long-term cure rates remain uncertain. Recurrence rate can be 50 per cent or more.

Surgical removal of keloids generally results in recurrence of lesions, with rates ranging from 40 per cent to 100 per cent. In fact the regrowth of keloid may be larger.

Radiation therapy has been shown to effectively reduce the recurrence rate of keloids. Recurrence rates were substantially reduced to 14 per cent. But there are side effects to radiation therapy. This includes redness of the skin, inflammation, swelling and ulceration. Radiation therapy is not easily available.

Silicone gel has been approved by the U.S. Food and Drug Administration as an effective addition to keloid removal and as prophylaxis to prevent abnormal scarring following surgical incisions. Silicone gel can be applied to the scar after the incision has healed. The entire scar should be covered for 12 to 24 hours a day to get good results. If used correctly, silicone gel has been shown to induce more rapid healing.

Some researchers have reported pressure therapy following removal of the keloid to be effective. Laser therapy has not been found to be effective and its cost is prohibitive. There is a long list of therapies which have been tried without great success.

The bottom line is there is no ideal therapy for treating keloids. This is because we do not understand the mechanism behind abnormal healing of tissues in some. Combination therapy helps. For example, silicon gel to be applied to the scar after the keloid has been surgically removed.

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