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Correction of keloid scars

 
, medical expert
Last reviewed: 04.07.2025
 
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Conservative treatment. Throughout the history of treatment of keloid and hypertrophic scars, a large number of methods have been proposed that have had a certain effect, but have not led to a reliable solution to the problem. Currently, the most common types of treatment for hypertrophic and keloid scars are as follows.

X-ray therapy. The radiation dose depends on the size of the scar. B.Cosman et al. suggest the most effective average dose of 800 R 4 times for 4-8 weeks. E.K.Vasilieva, L.I.Krikun and V.F.Bolshakov used an average radiation dose of 1000 R once a month, a course of treatment of 10 sessions. The treatment is successful in 80% of cases.

Despite the impressive results, this type of treatment should be used with great caution, as complications are often observed - tissue atrophy, hyperpigmentation, formation of telangiectasias and even ulcers.

Cryotherapy with liquid nitrogen. The scar surface is treated with liquid nitrogen, which results in necrosis of the protruding part of the scar tissue. The surface is treated until a blister appears, which indicates a sufficiently deep impact. After epithelialization of the resulting wound, the procedure is repeated.

This method gives good results for young keloid and hypertrophic scars, but it is less effective for old scars.

Laser therapy. The main advantage of the CO2 laser is minimal trauma to surrounding tissues. When using a laser, a minimal amount of necrotic tissue is formed, resulting in a smaller scar.

Steroid injections. The most widely used drugs in recent times are triamcinolone (Kenalog-40) and hydrocortisone acetate suspensions.

Injections are administered in courses of 3-5 sessions, with a break of 7-10 days between them.

Before the steroid is administered, the soft tissues surrounding the scar are infiltrated with a 0.5% lidocaine solution. Under the influence of hormone therapy, the scar becomes soft and its volume is significantly reduced. However, in some cases, several months after the completion of the treatment, the growth of the keloid scar resumes.

Application of silicone sheets. The first publications on silicone-gel sheets appeared in the early 80s. These works showed that the silicone coating itself (without pressure bandages) reduces the processes of excessive scar formation.

Silicone gel coating ("Epiderm") is a soft, sticky fabric coating made of reinforced gel. It is completely non-toxic and does not irritate tissues.

The main requirement for the use of the plates is to maintain the cleanliness of the plate surface and the area of skin to which it is applied. The optimal period of action of the plate is 24 hours a day, the minimum period of application is 12 hours a day.

The plate is applied to the skin surface, previously washed with soap, so that it protrudes beyond the edges of the scar by 0.5 cm. Every 12 hours, the plate is removed, washed with soap solution (as well as the scar area) and put back in place. After 10-14 days, the adhesive properties of the gel surface are lost. In this case, the plate must be replaced with a new one. The duration of the course of treatment is 2-3 months.

According to published data, relapses with this type of treatment were observed in 20-46% of cases.

In the Center of Plastic and Reconstructive Surgery, silicone plates "Epiderm" were used in the treatment of 30 patients with keloid scars. The application time of the plates was 1.5-2 months. The accumulated experience allows us to make the following statements:

  • isolated use of Epiderm silicone sheets for 1.5-2 months leads to a significant reduction in the volume of keloid and hypertrophic scars, however, this effect is not stable, and the volume of the scar may increase again;
  • Silicone sheets have a beneficial effect even on scars that are many years old, but their therapeutic effect is more pronounced when the course of treatment is carried out in the period from 1 month and later from the day of surgery (during the period of final reconstruction of the scar);
  • The use of silicone plates is possible only in cases where the scar is located in an anatomical area that has a flat, non-curved surface that is not subject to deformation during movement.

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