When you have a client or a patient that has keloids, rest assured that you have all the right tools to help them out. These angry looking, raised, red scars are unsightly and can be uncomfortable and distressing both physically and mentally. In order to treat them, it is important to understand them, how they are formed, and what options are available for you to apply.
You don’t have to be a dermatologist to successfully take care of Keloid, but you will need some key information, so we also suggest you attend the talks on keloids at SCALE 2019 Music City.
Scars are the byproducts of injuries to the skin. At its most basic a scar is a mark, or differentiation, on the skin where an injury occurred. Such injuries can be as small as a paper cut or as large as a deep wound. Scars can present as fine lines, pits, or raised areas. Of those raised areas there are hypertrophic scars and then there are keloids. The difference in the two comes down to the eventual disposition of the scar itself. Initially similar, over time hypertrophic scars will eventually become pale and flat. Keloid treatment will not fade over time and in order for them to diminish or disappear they require treatment.
Keloids are visually very distinct. They are red to purple, raised, and large relative to the surrounding skin. They can be incredibly uncomfortable (itchy or outright painful) and make the surrounding area feel tight. Frequently the scars grow bigger than the original wound ever was and, when big enough, can end up restricting movement and interfering with normal life. This does not necessarily cause any type of serious medical issue, as much as it is an inconvenience and annoyance, but that all depends on the severity of the discomfort. However, keloids frequently have serious cosmetic implications.
A very large keloid can make a person quite self conscious, as can scars that are in highly noticeable and visible places. Sun exposure can make keloids look worse. These scars are particularly prevalent for people with skin of color, as noted by the Skin of Color Society:
They occur rarely in Caucasians and are more prevalent in those of South Asian ancestry and especially African sub-Saharan ancestry. They bear no relation to the depth of skin color, however the precipitating injury can be as minor as an insect bite or acne pimple or as extensive as surgical (even ear-piercing) wounds. The tendency in Africans is so pronounced that a number of African cultures have incorporated scarification (deliberate scaring) patterns into tribal or religious rights of passage, such as the onset of puberty.
There is one warning sign that could indicate a serious health issue, contrary to all other contemporary understanding of keloid scars – if they don’t stop growing, a dermatologist should take a look. Keep in mind that a scar like this can grow for months and even years, but sometimes it may, in fact, have a cancer growing in it. In the case of suspicion, it should be biopsied.(Source).
What Causes Keloids
When the dermis layer of the skin is wounded, the body responds by producing new collagen, which acts to bind and mend the skin. This granulation of new tissue is what causes the scar and, in many cases, the scar will simply fade away over time. In the case of keloids, though, they grow instead.
As noted above, keloids can be triggered by any type of injury to the skin, including those that seem relatively insignificant. This includes such things as acne scars, ear piercings, scratches, vaccination sites and chickenpox. They can also appear at the sites of more significant trauma areas like surgical incisions, cuts and burns. In fact, “According to the American Osteopathic College of Dermatology, an estimated 10 percent of people experience keloid scarring. Men and women are equally likely to have keloid scars. Other risk factors include being pregnant and being younger than 30. Keloids tend to have a genetic component, which means you’re more likely to have keloids if one or both of your parents has them. According to one study, a gene known as the AHNAK gene may play a role in determining who develops keloids and who doesn’t. The researchers found that people who have the AHNAK gene may be more likely to develop keloid scars than those who don’t.” (Source).
Keloid Treatment Options
Traditionally these scars have been treated depending on how large and how old the scar is. The range of treatments include surgical removal to steroid injections, silicone pad application (yes this works) to laser therapy or cryotherapy.
According to Global News Wire, the market to treat these scars will exceed $3.7 billion, growing by 10% in the next 7 years. This presents an enormous market opportunity for those of us in the cosmetic and aesthetic fields, as well as the dermatologists that see most keloid scar patients now.
The trick, as pointed out in Practical Dermatology, is how complex keloids really are when it comes to finding a treatment that uses a one-size-fits-all approach. Keloids are “hard to treat, largely because of their unpredictable nature, high recurrence rate, and the dearth of consistently effective treatments. The pathogenesis of keloids is poorly understood, and we don’t understand why certain patients are more susceptible than others. We also do not know why keloids are more common on certain skin sites, such as the ears, chest, and back… There are no FDA-approved drug treatments for keloid scars. A device that delivers superficial radiation, the Sensus SRT-100, is FDA approved for keloid removal. Other available options include excision (with or without repair), steroid injections, intralesional 5-Fluorouracil (5-FU), radiation therapy, imiquimod, silicone gel or silicone sheeting, pressure devices, botulinum toxin injections, cryotherapy, and lasers.”
Most of these treatment options are non-invasive. The simple elegance of laser treatment and cryotherapy, and the surprising efficacy of botulinum toxin, make keloids a problem that can be addressed in most professional settings by educated providers.