Keloid scars usually hard to treat

Q. My 14-year-old son recently had a keloid scar removed from the crease of his neck for the third time and had it radiated for the second time. Should I have consulted with more than one radiologist? Is there more than one way to radiate a keloid scar? Are there any other postoperative treatments to prevent the body from producing collagen?

A. Keloids are overgrown scars that are raised and typically reddish in color. They result from various skin injuries, which may include burns, cuts, surgical incisions, minor bumps or scrapes, or even rubbing from certain articles of clothing or jewelry.

Normal scars are formed when skin cells and connective tissue cells known as fibroblasts multiply to repair an injury. The fibroblasts deposit gristle-like fibers that hold the wound closed. If the fibroblasts continue to multiply after the wound is repaired, an overabundance of scar tissue forms, resulting in a keloid.

These lesions are benign tumors and never become malignant. They are primarily a cosmetic annoyance but may become large, itchy or even painful. Keloids are notoriously hard to treat, and recurrence is common. It is also fairly common for new ones to form, because they are the result of a known or unknown injury in susceptible people (such as those with a family history, personal history or darker skin pigmentation often seen in African-Americans or Asians).

There is no treatment that will completely rid the patient of the keloid, but there are several methods that may change the appearance or reduce the discomfort after one has formed. These include steroid injections, radiation or laser therapy, surgical removal (which itself may cause new keloids to form) and cryosurgery (freezing).

Initial treatment often begins with long-acting steroid injections directly into the lesion once a month. This typically causes it to become less noticeable and flatter in appearance; however, it may take up to six months before results are seen.

Laser treatments are usually favorable for improving skin color and texture but may not flatten the scar. Cryosurgery is an excellent option for those with small keloids and lightly pigmented skin. Steroid injections are often used following removal.

Severe cases may be treated by surgically removing the keloid, immediately followed by radiation therapy. About 85 percent of those patients with severe lesions, treated in this manner, experience success. This is likely what your son underwent, but, unfortunately, he seems to have fallen into the 15 percent for whom it does not help.

I suggest your son get a second opinion from a dermatologist familiar with keloid scars. He or she should be able to provide more information regarding other treatment options available and which is most likely to help your son.

In the meantime, he should be careful to avoid injuries to his skin. Should he become injured, you may wish to try to prevent a keloid from developing by immediately applying a pressure dressing or silicone gel pad to the area for 23 hours a day. It should then be removed for one hour, the area cleaned and then a new dressing applied. The process may want to be repeated daily for up to a month, but if it prevents a keloid from developing, both you and your son will likely find the minor inconvenience worth it.

© 2010, United Feature Syndicate