Keloid Assesment & Keloid Management

Summary: Several treatment options are available for scarring correction. Choosing between them will depend on the type of lesion, and the opinion of a specialist.

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Accurate wound assessment is essential for diagnosis and for starting, monitoring, and evaluating a treatment strategy for wound management.

The origin and course of scar development are important-is the scar getting better or worse? A successful treatment will depend on:

1. Site (anatomical location of the scar)

2. Symptoms (pain, itching, etc)

3. Severity of functional impairment (such as joint mobility)

4. Implications (how much is the patient disturbed?)

A colour photograph of the lesion at each consultation provides a reference to evaluate the progress of treatment since changes occur reallyslowly. The presence of a positive familiar history, previous keloid scarring in the same or other body sites, low response to treatment or reappearance of scarring, certain body locations (such as the center of the chest), large size, prolonged inflammation, and severe symptoms are associated with abnormal scarring.

Actual ways of treating problematic Scarring

A simple treatment can be offered with 3 courses of action-noninvasive treatment, invasive treatment, and leave alone management. Noninvasive options include use of compression methods (such as pressure garments with or without gel sheeting); static and dynamic splints; acrylic casts; masks and clips; application of a variety of oils, lotions, and creams; antihistamine drugs; hydrotherapy; and psychosocial assistance and advice.

We already reviewed silicon sheeting. Massage therapy is often advocated but it shows no evidence of benefit. Further below we will analyze why a topical cream made with the ONLY natural substance that functions as a complete and balanced solution for the protection, repair, renewal and moisturizing of skin of a little creature that produces it and bubbles it onto its skin may provide great improvements to those suffering from scars and a welcome product for those wanting to prevent scars before surgery or before and after scar revision procedures, as it signals the body that it is being cured and does not need to respond by inflammaging the area.

Invasive treatments include surgical excision and resuture. Generally, revision should be considered only if the surgeon thinks that better conditions for wound healing can be achieved than on the first time (less inflammation, better technique). Intra lesional corticosteroid injection is widely used but it can lead to complications (fat atrophy, dermal thinning, and pigment changes). Other treatments that have been tryed with variable results include injections of fluorouracil, interferon gamma, and bleomycin, radiotherapy, laser therapy, and cryosurgery.

Leave alone management - Most scars are best left without invasive treatment for a year to mature before any diagnosis is made on their appearance. Monitoring (wait and watch) will allow further assessment of appearance, symptoms, and psychological impact, and reassurance is important. Some scars are best left alone in the long term. Informed, shared decision making with patients may help reduce inappropriate claims for treatment.

When such management plans are applied to specific scar types, certain patterns can be observed:

Treatment of widespread scars is mainly by revision surgery to narrow the width of the scar. Revised scars in anatomical sites subject to high tissue mobility such as limbs can benefit from splinting.
Atrophic scars have been improved with chemical peels, cutaneous laser resurfacing, dermabrasion, punch excisions, and the use of soft tissue biological and alloplastic biological fillers. Some of those can be done by non-medical specialists, and we will talk about them further below.
It is important to distinguish between hypertrophic and keloid scars as inappropriate management can lead to reappearance and worst scars. Simple surgical excision of keloids has a 50% - 80% risk of recurrence. The combinated use of surgery with either intralesional corticosteroid injection or radiotherapy has been the mainstay of treatment. For scar contractures, surgical release with splinting, acrylic casting, and compression therapy may be required. Full thickness and split or partial thickness skin grafts and, perhaps more effectively, local and free flaps are used for reconstruction of difficult and extensive scars and contractures.

Only an expert's opinion can assure an adequate Scar Treatment for each scars case.

Recent Research about Scar Management

Keloid and scars management

Slemp AE, Kirschner RE.
Division of Plastic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA.

PURPOSE OF REVIEW: The precise mechanisms of normal and abnormal scar formation are unknown. Only recently have researchers begun to delineate the complex biochemical signaling pathways that regulate these processes. This article reviews basic wound healing, while focusing on medicine's latest understanding of the development and treatment of keloids and hypertrophic scars.

RECENT FINDINGS: The importance of the transforming growth factor-beta signaling pathways and the related downstream effector molecules has proven to offer a new detailed view of scar biology. Regulation of scar metabolism with regards to collagen and wound matrix degradation is likewise showing promise in generating alternate therapies to treat abnormal scars.

SUMMARY: Understanding the exact process of normal and abnormal scar formation will help define better ways to successfully manage and potentially prevent abnormal healing like hypertrophic scars and keloids.