Effective Keloid Management

• Keloid treatment should be personalized based on size, location, age of the scar, and patient factors including skin type and treatment goals.
• Steroid injections remain the gold standard first-line treatment with success rates of 50-80%, particularly effective for newer, smaller keloids.
• Non-invasive options like silicone therapy and pressure treatment offer safe, accessible management approaches with minimal side effects.
• Advanced treatments including laser therapy, cryotherapy, and radiation are available for resistant cases, though they require specialist expertise.
• Combination approaches yield significantly better outcomes than single treatments, with recurrence rates reduced by up to 80% when multiple modalities are used together.
• Treatment success depends heavily on consistent follow-up care and preventative measures to manage both physical symptoms and psychological impact.

Keloid Treatment Options Beyond Removal: Comprehensive Care

Keloid scars represent a challenging dermatological condition that affects many Londoners seeking treatment options beyond surgical removal. These raised, often uncomfortable scars extend beyond the original wound boundaries and can cause both physical discomfort and psychological distress. At Skin Surgery Clinic London, we understand that keloid removal isn’t always the preferred or most appropriate treatment approach for every patient. Fortunately, numerous effective non-surgical and minimally invasive keloid treatment options exist that can significantly improve appearance, reduce symptoms, and prevent recurrence.

This comprehensive guide explores the full spectrum of keloid treatments available in London, from steroid injections and silicone therapies to pressure treatments and advanced technologies. Whether you’re dealing with a newly formed keloid or have been struggling with persistent scarring for years, understanding these treatment modalities can help you make informed decisions about your care. Our London-based specialists offer personalised treatment plans that often combine multiple approaches for optimal results.

Table of Contents

• Understanding Keloids: Causes, Symptoms and Challenges
• Steroid Injections: First-Line Treatment for Keloid Scars
• Silicone-Based Therapies: Non-Invasive Keloid Management
• Pressure Therapy: How Compression Treats Keloid Scars
• Advanced Options: Laser, Cryotherapy and Radiation Treatments
• Which Keloid Treatment Works Best for Different Cases?
• Combination Approaches: Maximizing Keloid Treatment Success
• Living with Keloids: Psychological Support and Future Innovations

Understanding Keloids: Causes, Symptoms and Challenges

Keloids are abnormal scar formations that develop when the body’s healing process goes into overdrive. Unlike normal scars, keloids grow beyond the boundaries of the original wound, creating raised, often reddish or purplish tissue that can continue to expand over time. These distinctive scars most commonly appear on the chest, shoulders, earlobes, and cheeks, though they can form anywhere on the body following injury, surgery, acne, or even minor skin trauma.

Several factors increase keloid susceptibility, including:

• Genetic predisposition (family history of keloids)
• Darker skin tones (particularly those of African, Asian, or Hispanic descent)
• Age (most common between 10-30 years)
• Hormonal factors (often worsen during pregnancy or puberty)

Keloids present unique treatment challenges because of their tendency to recur, sometimes growing back larger than before treatment. They can cause physical symptoms including tenderness, pain, itching, and restricted movement when located near joints. Many patients also experience significant psychological impact due to their appearance, particularly when keloids are visible on the face or other exposed areas.

Understanding the nature of keloids is essential for effective treatment planning. At our London clinic, we conduct thorough assessments of each keloid’s characteristics—including size, location, age, and previous treatment history—before recommending appropriate interventions.

Steroid Injections: First-Line Treatment for Keloid Scars

Intralesional corticosteroid injections remain the gold standard first-line treatment for keloid scars in London and worldwide. This minimally invasive approach involves carefully injecting a potent anti-inflammatory steroid medication, typically triamcinolone acetonide, directly into the keloid tissue. These injections work by suppressing inflammation, reducing collagen synthesis, and inhibiting the growth of fibroblasts—the cells responsible for excessive scar formation.

The treatment protocol typically involves:

• Initial assessment to determine suitability
• Application of topical anaesthetic if needed
• Precise injection of the steroid into different parts of the keloid
• Repeat treatments at 4-6 week intervals
• A course of 3-5 sessions for optimal results

Most patients experience noticeable improvements after steroid injections, with keloids becoming flatter, softer, and less symptomatic. Studies show success rates of 50-80%, with younger, smaller keloids responding most favourably. The treatment can significantly reduce itching and discomfort, often within days of the first injection.

While generally safe, potential side effects include skin thinning (atrophy), hypopigmentation (lightening of the skin), telangiectasia (visible blood vessels), and temporary pain at the injection site. Our London specialists carefully calibrate the concentration and volume of steroid used to minimise these risks while maximising effectiveness.

For patients concerned about keloid removal in London, steroid injections offer a less invasive alternative that can be highly effective, particularly when combined with other treatment modalities as part of a comprehensive management plan.

Silicone-Based Therapies: Non-Invasive Keloid Management

Silicone-based treatments represent one of the most accessible and non-invasive approaches to keloid management. These treatments work through several mechanisms, including hydration of the stratum corneum, regulation of fibroblast production, and reduction of collagen deposition. Two primary forms of silicone therapy are widely used in London clinics:

Silicone Gel Sheets: These flexible, reusable sheets are applied directly to the keloid and secured with medical tape or bandages. For optimal results, they should be worn for 12-24 hours daily for at least 2-3 months. The occlusive environment created by the sheets helps normalise collagen production and improve scar hydration. Many patients appreciate that these sheets can be trimmed to fit specific keloid shapes and sizes.

Silicone Gels and Creams: These topical formulations offer greater convenience, especially for facial keloids or those in visible areas. The gel dries to form an invisible, breathable sheet that protects the scar while delivering the therapeutic benefits of silicone. Application twice daily is typically recommended for at least 8-12 weeks.

Clinical studies demonstrate that silicone therapy can reduce keloid height, improve flexibility, decrease redness, and alleviate symptoms like itching and discomfort. Success rates vary between 34-80% depending on keloid age, size, and patient compliance. The treatment is particularly effective for newer keloids and as a preventative measure following surgery.

The primary advantages of silicone-based treatments include:

• No pain or discomfort during application
• Suitable for home use with minimal professional supervision
• Virtually no side effects beyond occasional skin irritation
• Cost-effective compared to other treatment modalities
• Can be used alongside other treatments in combination protocols

At our London clinic, we often recommend silicone therapy as part of a comprehensive keloid management plan, either as a standalone treatment for mild cases or in conjunction with more intensive interventions for severe or resistant keloids.

Pressure Therapy: How Compression Treats Keloid Scars

Pressure therapy represents one of the oldest and most established methods for treating keloid scars. This approach utilises sustained compression to flatten keloids and prevent their recurrence through several biological mechanisms. The constant pressure reduces blood flow to the scar tissue, decreases collagen production, and encourages collagen fibres to align more naturally.

Pressure therapy typically involves:

• Custom-fitted pressure garments or devices that apply 24-30 mmHg of pressure
• Consistent wear for 12-23 hours daily
• Treatment duration of 6-12 months for optimal results
• Regular adjustments as the keloid changes shape and size

This treatment modality is particularly effective for keloids in areas that can be easily compressed, such as earlobes (using pressure earrings), chest, and limbs. For example, specialised pressure earrings have shown success rates of up to 90% in preventing earlobe keloid recurrence after surgical excision.

The primary challenge with pressure therapy is patient compliance, as the devices must be worn consistently for extended periods. However, modern pressure garments are increasingly comfortable and discreet, making long-term use more feasible. Our London specialists work closely with patients to ensure proper fit and provide strategies for incorporating pressure therapy into daily routines.

While pressure therapy alone can be effective for some keloids, it is most commonly used as part of a multimodal approach. For instance, combining pressure therapy with surgical excision or steroid injections significantly reduces recurrence rates compared to either treatment alone. This makes it an important component of comprehensive keloid management, particularly for high-risk areas or patients with a history of keloid recurrence.

Advanced Options: Laser, Cryotherapy and Radiation Treatments

For keloids that prove resistant to conventional treatments, several advanced therapeutic options are available at specialised London clinics. These sophisticated interventions target keloid tissue through different mechanisms and may be particularly beneficial for complex or recurrent cases.

Laser Therapy: Various laser modalities have shown promise in keloid treatment. The pulsed dye laser (PDL) specifically targets blood vessels within the keloid, reducing redness and inflammation while improving overall appearance. The fractional CO2 laser creates microscopic treatment zones that stimulate collagen remodelling and improve scar texture. Typically, a series of 3-6 treatments spaced 4-6 weeks apart is recommended. Laser therapy is particularly effective for flattening smaller keloids and reducing associated symptoms like itching and pain.

Cryotherapy: This technique involves freezing the keloid tissue with liquid nitrogen, causing cellular destruction and subsequent healing with more normal collagen patterns. The procedure is performed by applying the cryogen directly to the keloid for several freeze-thaw cycles. While effective for smaller keloids, particularly those on the face and earlobes, cryotherapy may cause temporary blistering and hypopigmentation, which can be more noticeable in darker skin tones. Multiple sessions spaced 3-4 weeks apart are typically required.

Radiation Therapy: Used primarily as an adjunct to surgical excision, radiation therapy inhibits fibroblast proliferation and collagen synthesis. Low-dose, superficial radiation is delivered to the keloid site, typically within 24-48 hours after surgical removal. This approach significantly reduces recurrence rates, particularly for high-risk keloids such as those on the earlobes, sternum, or shoulders. While highly effective, radiation therapy requires careful consideration due to the theoretical risk of carcinogenesis, making it most appropriate for severe, recalcitrant keloids where other treatments have failed.

5-Fluorouracil (5-FU): This antimetabolite medication can be injected into keloids, either alone or in combination with corticosteroids. 5-FU works by inhibiting fibroblast proliferation and is particularly useful for keloids that have become resistant to steroid injections. Treatment typically involves weekly injections for 8-12 weeks, with studies showing improvement rates of 45-78%.

These advanced treatment options require specialised expertise and equipment, highlighting the importance of seeking care at a dedicated skin surgery clinic with experience in complex keloid management.

Which Keloid Treatment Works Best for Different Cases?

The effectiveness of keloid treatments varies significantly based on multiple factors, making personalised assessment crucial for optimal outcomes. Our London specialists consider several key variables when recommending treatment approaches:

Keloid Characteristics:

• Size and Age: Smaller, newer keloids (less than 12 months old) typically respond better to conservative treatments like silicone therapy and steroid injections, with success rates of 70-80%. Larger, older keloids often require more aggressive combination approaches.
• Location: Earlobe keloids show excellent response to surgical excision followed by pressure therapy (85-90% success). Chest and shoulder keloids are notoriously difficult to treat, with higher recurrence rates (50-70%) and often require multimodal approaches.
• Previous Treatments: Keloids that have recurred after previous interventions may require more intensive approaches, such as excision with adjuvant radiation or combination therapies.

Patient Factors:

• Skin Type: Patients with darker skin tones (Fitzpatrick types IV-VI) must be carefully assessed for treatments that might cause hypopigmentation, such as cryotherapy.
• Age: Younger patients often experience more aggressive keloid growth but may also respond better to certain treatments like steroid injections.
• Treatment Goals: Some patients prioritise symptom relief (itching, pain) over cosmetic improvement, influencing treatment selection.

Comparative Effectiveness:

• For symptomatic relief (itching, pain): Steroid injections provide the quickest results (70-80% improvement within 2-3 sessions)
• For flattening raised keloids: Combination of surgery with radiation shows the highest success rate (85-95% for appropriate candidates)
• For improving flexibility and texture: Silicone therapy combined with massage shows gradual improvement over 3-6 months
• For preventing recurrence: Pressure therapy following excision reduces recurrence rates by 50-60% compared to excision alone

Treatment effectiveness must also be balanced against potential side effects, cost considerations, and the patient’s ability to adhere to treatment protocols. Our London clinic provides comprehensive assessments to determine the most appropriate treatment pathway for each individual case, with regular monitoring to adjust approaches as needed based on response.

Combination Approaches: Maximizing Keloid Treatment Success

The complex nature of keloid formation often necessitates a multifaceted treatment approach. Combination therapies have consistently demonstrated superior outcomes compared to single-modality treatments, particularly for challenging cases. At our London clinic, we develop personalised combination protocols based on the specific characteristics of each keloid and the individual patient’s needs.

Several evidence-based combination approaches have shown particular promise:

Surgical Excision with Adjuvant Therapy: Surgical removal alone results in recurrence rates of 45-100%. However, when combined with immediate post-surgical interventions, outcomes improve dramatically. Options include:

• Excision followed by intralesional steroid injections (reduces recurrence to 20-40%)
• Excision with immediate radiation therapy (reduces recurrence to 5-20%)
• Excision with pressure therapy (particularly effective for earlobe keloids)

Multi-Drug Injections: Combining different injectable medications can enhance effectiveness while reducing side