Best treatment options to remove keloids are actually a judicious combination various treatments tailormade for each patient
Keloid is non-cancerous growth of collagen. Fibroblasts deposit collagen but forget where to stop. This uncontrolled growth is controlled by many chemotherapy drugs similar to cancer chemotherapy. Steroids, methotrexate, mitomycin C, 5 fluorouracil, bleomycin are common agents used. They are either used alone or in combination. Usually one chemotherapy agent with steroid in different dilutions are tried by different doctors with different success rates. SkinCity has experience and expertise of using most of them and has unique expertise to use proper combination that gives best result and nil or minimum side effects.
Pressure is one of oldest way of preventing hypertrophy in wound healing. It reduces blood circulation in the scar and stops collagen deposition. It also stimulates break down of old collagen. Not all parts of body are convenient for pressure therapy. Whenever and wherever possible one should add this to treatment combination. Ideal pressure garment should be customized as per size of that body part aiming a pressure of 20-30 mm of Hg. This pressure garment has to be worn at least 22 hours in a day and for minimum 6 to 12 months.
Many creams claim to reduce scars. They contain various ingredients. We classify these creams as good scars creams and bad scar creams. Bad creams contain steroids that may cause side effects like atrophy, depigmentation and telangiectasia (red visible capillaries) and acne (pimples) or folliculitis (hair Infection). These steroid induced pimples or infection may trigger new keloid formation. Good scar creams usually contain silicon. This reduces collagen production without side effects and are very safe. Silicone may be used as cream or sheet and can be combines with pressure tharapy.
Fractional CO2 lasers commonly used in scar treatments. It melts down the bad collagen and helps deposition of good collagen. But this needs very discrete and deep vertical columns of ablation. This is achieved ONLY by Ultrapulse CO2 lasers. To simplify lasers are safe if its energy is fired in very short time. Weak CO2 lasers deliver energy in milliseconds while Ultrapulse does this in microseconds. One of the best and patented device for collagen remodellingis Ultrapulse SCAAR FX. SkinCity is the first dermatology set up to launch this technology in India for scar treatment.
Injection of steroids and keloid chemotherapy agents into keloids through needles and syringes lead to uneven distribution and uneven thinning of keloid. Instead application of these active ingredients immediately after SCAAR FX fractional Ultrapulse CO2 laser will help uniform and full thickness penetration. Hypertrophic burn scars (burn keloids) totally flattened fractional drug delivery.
As mentioned earlier, needle injections will lead uneven penetration of active ingredient into keloid. Another revolutionary approach for uniform penetration is a needle less injector called Enerjet. This works on principle of JVR jet volumetric remodeling of collagen. This is very unique approach to improve ratio bad collagen to good collagen. (ratio of type 1 vs type 3 collagen).
Cryotherapy is one of the effective modality for keloid therapy. It is application of liquid nitrogen to keloid tissue. It freezes the tissue to -1960C. This destroys bad collagen and helps controlled deposition of good collagen. Though it is effective it is extremely painful and only 2 out of ten patients could tolerate this. It leaves a raw wound behind that takes several weeks to heal. It invariably leaves white depigmented scar behind as it destroys melanocytes irreversibly. In Indian scenario, white depigmentation as never wecome by patients. So cryotherapy is NOT a treatment of choice in Indian skin.
Removing the bulk of keloid with surgery and applying radiation on the raw area is another effective modality. This has shown result in massive keloids in dark skin. Radiation approved by American FDA for keloid is SRT 100 device. Though it is proven effective in keloids its safety in long run is yet to be established. Most serious side effect of radiotherapy is induction of cancer.