Not to do list: when suffering with keloids

Whether keloid should be operated or not is an area of great controversy. Keloids not only re-occur after surgery, but often are often bigger in size and much harder to treat. In first place The onset of a keloid is triggered by wounding of the skin. In surgical keloid removal, a much bigger injury is induced by the surgeon. This new and larger injury will obviously result into formation a much larger keloid. The risk of recurrence after surgery for certain keloids such as chest wall, shoulder keloids is near 100%. Local injection of steroids or chemotherapy or radiation after surgery may reduce the risk of recurrence of certain keloids. These interventions have their own limitations and side effects. Flat, small and minor keloids should never be treated with surgery. It commonly observed that a surgeon has removed a small keloid from the skin, and the result has been worse than the original keloid. If keloid is a genetic and an inherited disorder of wound-healing, how Surgery canchange the outcome? Surgery only triggers the abnormal wound healing response, which is the core problem in keloid formation

Surgery does more harm than good to keloid patients so it is better to be avoided. In spite of so many treatments available outcome in individual patient is highly unpredictable. Steroid creams and injections usually trigger acneform rash or folliculitis leading to fresh keloid formation while surgery give recurrence of more aggressive keloid. “Giving patients false hopes is another major problem when it comes to keloid treatment. Many of the treatments can in fact make the keloid scar look worse. If one has no idea what to do, the best advice is to leave the keloid alone!” These are comments by scientific author Sarah McGinty; Waqas J. Siddiqui. While writing on keloid in a medical journal.

Historically most common treatment used in past for keloids is steroids only. It can produce excellent results in short period but does not affect keloid progression. In fact most of the keloids which are slowly progressing become more aggressive after injection therapy. Steroid creams if used in wrong potency will cause either skin atrophy in surrounding skin. It induced acne and folliculitis in and around keloid. These follicular inflammation and infections act as trigger for growth of same keloid and occurrence of new keloids at periphery. Steroid injections given into bulk of keloid usually give impressive thinning of keloid. Steroids comes in variety of potency and strengths. Triamcinolone is commonly used steroid available in 10 to 40mg/ml strength. Dilution, depth of injection, quantity, interval between injection all matter in final outcome. Most doctors lack the skill and experience of using steroids in correct protocol and dosage. Common practice of injecting steroid into keloids have more harm than good. Dr Dhepe warns doctors and patients to refrain from inadvertent use of steroid of in keloids.