Noninvasive Management of a Keloid Scar

A keloid scar is like a weed in a garden, disorganized and growing out of control. There are ways to prevent the weed from spreading without digging up the roots. For a keloid scar, there are ways to slow down growth without having another surgery.

What is a keloid scar? 

A keloid scar is a surgical scar that grows thick and firm. It grows outside the original scar border. Keloid scars may continue growing for months or years after the surgery. Many options are available to slow the growth of keloid scars. 

Symptoms 

Symptoms are different for each person. Some people have a lot of symptoms. Other people just have a couple symptoms.

The symptoms of a keloid scar are:

• Itching

• Pain 

• Stiffness

• Raised or bumpy 

• Continues growing for months or years (Kim, 2021). 

• Scar that is bigger than 0.5cm wide (Tomaszewski, 2022). 

Symptoms of a keloid scar develop after your scar is fully closed. Symptoms may continue to get worse for months or years without treatment. 

Causes

Excessive scar growth causes keloid scarring. The cells that connect tissues are overactive, which leads to extra tissue in the scar. Since the scar has extra tissue, it is raised and larger than a normal scar.

Treatments 

Keloid scars have two treatment options: surgery or noninvasive treatments. If a keloid scar is surgically removed, additional noninvasive treatments are needed to prevent the keloid from growing again.

Noninvasive, or nonsurgical, treatments means that the scar is not reopened. Noninvasive interventions can be successful at slowing the growth of keloid scars. Noninvasive treatments can also prevent the need for surgery. 

Nonsurgical treatment options include: 

• Silicone dressings

• Manual scar therapy

• Physical therapy 

• Topical Imiquimod 

• Topical Mitomycin C

It is best to use a combination of treatments to prevent or slow the growth of the keloid scar. 

When to start scar treatment after surgery

 

Prevention starts right after surgery while your scar is healing. Treatment begins after your scar is fully healed.

To prevent a keloid scar, follow all directions from your doctor after surgery. You may have tape covering your scar after surgery. Leave on any scar covering as long as the doctor recommends. After your scar is open to air, avoid sun exposure to minimize scar growth during healing (Kim, 2021). A keloid scar may develop even if you follow all directions from your doctor. 

Begin keloid scar treatment after your scar is closed and healed. The scar needs to be closed to prevent infection. Use multiple types of treatments for your keloid scar as soon as possible.

Silicone dressings

Silicone materials are the gold standard for treating keloid scars (Kim, 2021). Silicone dressings reduce keloid growth by hydrating and covering the scar (Kim 2021). Silicone gel sheets can be sticky like tape or need securement to keep it in place over the scar. 

Silicone dressings prevent keloid scar growth by trapping moisture. Your skin naturally produces moisture from the inside out. This moisture is evaporated off

your skin. Silicone dressings prevent evaporation, so your natural moisture stays within the scar tissue.

Use silicone dressings at least twelve hours per day. Some studies recommend twenty-four hours of use (Kim, 2021). This is a long-term treatment and must be used for at least 3-6 months. Some people benefit from twelve months of treatment (Betarbet, 2020). 

Other hydrating options 

An important part of treating keloid scars is moisture. You can apply lotions or creams to keep your scar hydrated.

Vitamin E is an important ingredient to look for in a lotion or cream for your scar. Vitamin E is also known as tocopheryl acetate. Look for either name in the ingredients list. It can hydrate deeper layers of the skin and can reduce darkening of your scar (Bagheri, 2023).

Aloe vera is another helpful ingredient in moisturizers. Aloe vera is widely used in natural medicine. Scientific studies have also shown it can improve healing (Bagheri, 2023). Aloe vera provides hydration. When combined with other fatty ingredients, it provides a barrier to keep the scar hydrated, like silicone dressings (Bagheri, 2023).

Manual scar therapy 

Manual scar therapy is scar massage. Massaging the keloid may reduce scar thickness (Tomaszewski, 2022).  A bonus benefit of scar massage is that it helps regain mobility and strength in the scar and area around the scar (Lubczyńska, 2023).

Physical therapy

A physical therapist can help support your keloid scar treatment plan. They can recommend specific massage techniques for your scar. At the end of your appointment, they can apply kinesio tape. The kinesio tape provides tension, which helps prevent the tissue overgrowth that occurs with keloid scars (Lubczyńska, 2023). The kinesio tape can help a scar for multiple days following the appointment. 

Physical therapists offer other keloid scar treatment options, too. They can perform laser therapy, shockwave therapy, and needle therapy (Tomaszewski, 2022). 

Ask your doctor about

There are prescription ointments available to supplement keloid scar treatment. Ask your doctor if they are a good option for you. Topical Imiquimod and topical Mitomycin C are two prescription options. Both are creams that go on top of your scar. 

Topical Imiquimod 

Imiquimod 5% is a cream applied directly to your keloid scar. This cream limits the production of collagen, the tissue that forms a scar (Betarbet, 2020). The cream success rate varies based on where the scar location is on your body. 

Topical Mitomycin C 

Mitomycin C is soaked into a gauze or other material. Then, it is placed over the scar for 3 weeks (Betarbet, 2020). Mitomycin C works by preventing the scar cells from quickly replicating. 

Summary 

A keloid scar is an overgrown scar. There are many treatment and prevention options for keloid scars. Moisture and movement are essential. Silicone dressings keep moisture in the scar. Lotions with Vitamin E or aloe vera provide hydration on top of the scar. Scar massage and physical therapy will also help your scar heal normally.You can ask your doctor if topical imiquimod or topical mitomycin C are a good option for your scar. Using more than one of these treatments will be most effective.

References 

Bagheri, M., Werres, M., Fuchs, P. C., Seyhan, H., Lefering, R., Grieb, G., & Schiefer, J. L. (2023). Which moisturizer to use in scar therapy after burn injuries? A subjective and objective skin and scar evaluation after topical treatment with dexpanthenol, aloe vera, and Plant Oil. Medicina, 59(10), 1874. https://doi.org/10.3390/medicina59101874

Betarbet, U., & Blalock, T. W. (2020). Keloids: A review of etiology, prevention, and treatment. Journal of Clinical and Aesthetic Dermatology, 13(2), 33–43.

Kim, S. W. (2021). Management of keloid scars: noninvasive and invasive treatments. Archives of Plastic Surgery, 48(02), 149–157. https://doi.org/10.5999/aps.2020.01914

Lubczyńska, A., Garncarczyk, A., & Wcisło‐Dziadecka, D. (2023). Effectiveness of various methods of manual scar therapy. Skin Research and Technology, 29(3). https://doi.org/10.1111/srt.13272

Tomaszewski, W., Cabak, A., & Siwek, J. (2022). The use of physiotherapy in the treatment of scars – a review of the literature. Polish Journal of Sports Medicine, 38(4), 191–201. https://doi.org/10.5604/01.3001.0016.1258