Keloids Treatment

Keloid disease does not yet have a cure and the phrase ‘permanent removal’ is therefore unfitting. In any area where a keloid had once been, a new keloid could form with significant trauma at any time.
Surgical removal of keloid results in recurrence about 85% of the time and sightly less if immediately followed by 4 days of radiation or weekly steroid injections x 4. Only keloids on the ear have a lesser recurrence rate because there is no movement beneath the healing skin in the post operative period of 3 months. Of the recurrent keloids, 14% will be bigger than the previous one.
Your next best step might be Cryoshape or external cryotherapy. Cryoshape works best for keloids that are about the size of a Lima bean. This technique that shrinks about 80% of the keloid from within after one treatment. We have not seen worsening keloids after Cryoshape and they have not been reported. There is a 5% chance that the keloid does not respond to treatment. Keloids that a larger than a Lima bean may require several treatments 4 months apart.
External cryotherapy can shrink keloids that are smaller than a Lima bean. When combined with injections, the results after 4-6 monthly treatments are equal to Cryoshape. It can fail to shrink the keloid about 10% of the time. It is not associated with worsening keloids.
The residual scar after Cryoshape or external cryotherapy is not as smooth as an ideal surgical wound.

We do not participate with Aetna Better Health but you have the option to pay out of pocket.

Pulsed dye laser treatment is used to treat keloids up to one inch in diameter. It is often used in conjunction with other treatments. This treatment is recognized by insurance and submitted per insurance guidelines.

Cryoshape is freezing a keloid from within whereas cryotherapy refers to freezing from outside. It takes many monthly treatments to flatten a keloid with cryotherapy and pigment overlying the keloid will be lost after the procedure. Cryoshape flattens a keloid usually in one treatment and pigment on the surface often recurs within a year. The recurrence rate behind the ear is low with either method. Both are safe and the infection rate is low. Cryoshape is FDA approved but is not accepted by insurance. It is more expensive than cryotherapy per treatment due to the consumable cost of the Cryoshape probe. Cryotherapy is FDA approved and accepted by most insurances.

Painful keloids respond favorably to steroid or fluorouracil injections, pulsed dye laser treatment, internal or external cold (Cryoshape/cryosurgery). We do not perform excisions on the chest because the chance for the keloid to grow bigger than before is greater than 95%. Web-shaped keloids that cross the midline of the chest, can be revised with Z-plasty and CO2 laser when they are no longer painful.

Indeed, pulsed dye laser and injections with triamcinolone or combintaion of traimcinolone and fluorouracil (5FU) are a great solution for keloids along the jawline. Fractionated lasers, whether ablative or non-ablative, do not seem to be very helpful for keloids and on occasion they can even trigger a keloid to fare up again.

The CO2 procedure is similar to cutting with a knife, Instead of a knife, the CO2 laser energy is used to cut out the keloidal tissue. The wound can than either be closed with stitches, or, if small enough, left open for healing with a scar. It is not yet possible to use hair transplantation to cover a scarred area, because the scar does not provide the environment for hair follicles to survive. The risk for another keloid to form is slightly less than with a traditional scalpel but still exists. A proper evaluation is needed to assess your options for keloid treatment/removal and proper price quote. And, yes, we treat many people with acne keloidalis nuchae.

I wish there was a great treatment for acne keloidalis nuchae.
It can be prevented to some extent when hair is not clipped too short. When the condition has occurred, treatment of the keloiding area is the only know approach.
If the keloids are green pea sized, injection of steroid pr steroid/fluorouracil into each one of them is reasonable. If they are up to 1.5 inches long and at least a quarter inch wide, Cryoshape is an option. Larger keloids are sometimes excised by CO2 laser locally or as an entire section across the lower scalp and then the skin pulled together if possible.The biggest worry with excision is the possible recurrence of keloids.
Oral anti-inflammatory antibiotics (doxycycline or combination of clindamycin and rifampin), topical steroids and topical retinoids are used to minimize the inflammation when it has already occurred, hence reducing the chance that new keloids form.

Cryoshape will work as long as the keloid is raised at least 0.4 cm above the surface of your skin. The thinner the keloid, the greater the chance to loose pigment in the treated area. Most of the time, pigment returns after 6-24 months, and matched cover up (Dermablend or Covermark) can be used during that time if desired. Please make an appointment for consultation with any of our dermatologists or use online consultation https://www.ringpfeildermatology.com/tools/onlinederm.php. The Cryoshape procedure is performed by me and can be scheduled after consultation.

Keloids on the earlobes are not as difficult to treat as elsewhere on the body. Depending on the size and position, they can be treated by injection, internal or external cryosurgery, or excised and injected afterwards to avoid recurrence. The initial consultation as well as treatments apart from internal cryosurgery (Cryoshape) can be submitted to insurance unless the diagnosis keloid is excluded from your benefit. If the keloid is very small, cost for treatment ranges in the hundreds without insurance coverage. If Cryoshape is desired, cost of treatment is $1000.