Keloid Treatment

A keloid extends beyond the boundary of the original wound into surrounding normal skin. A hypertrophic scar is raised but stays within the original wound margins. Hypertrophic scars often flatten over months to a couple of years; keloids characteristically do not regress on their own. The distinction is made on examination and it decides the approach, because the two behave differently.

A keloid represents an abnormal, prolonged wound-healing response with excess deposition of type I and type III collagen. Rather than the normal remodelling phase bringing the scar back toward the skin surface, collagen production continues and the lesion expands. Genetic susceptibility is a major factor, which is why keloids often run in families.

Yes. Keloids are substantially more common in individuals of Chinese, Malay, Indian and African descent than in those with white European skin. In Singapore's population this is a common presentation, and it is one reason keloid history is asked about before any procedure that breaks the skin.

Earlobes after piercing, the upper chest, the shoulders, the upper back and along the jawline. These are sites of relatively high skin tension. Keloids also form on surgical scars, burns, acne lesions and sometimes at vaccination sites.

Excision alone has a high recurrence rate, and a recurrent keloid is frequently larger than the original. Surgery, where it is appropriate at all, is combined with adjuvant treatment rather than performed on its own. This is one of the more important things to understand before agreeing to removal.

Intralesional medical therapy is first-line, sometimes in combination. These require assessment and monitoring. Pressure therapy, silicone, cryotherapy and laser are used as adjuncts depending on the site, the age of the lesion and how it has responded previously. Plans are usually combined rather than single-modality.

Keloids have a genuine tendency to recur, and any honest discussion includes that. Treatment aims at flattening, softening and symptom control rather than a promise that the keloid will not return. Ongoing review is often part of the plan, and that is discussed openly at consultation rather than after.

Frequently. Itch, tenderness, a burning or stinging sensation, and restriction of movement where a keloid crosses a joint or the neck. For many patients the symptoms rather than the appearance are the reason they seek assessment.

A personal or family history of keloid formation is relevant to any procedure that breaks the skin, and it is asked about before treatment here. It does not rule everything out, but it changes what is advisable and how a procedure is planned.

Cost depends on the size and number of lesions, the site, which modalities the assessment indicates, and how the plan is staged over time. Because keloids vary so widely between patients, a figure quoted before assessment would not be meaningful. Cost is set out clearly at consultation.

Not on its own. Laser is used as an adjunct: it can reduce the redness of an active keloid and improve surface texture, but it does not flatten a bulky lesion by itself. It is usually combined with intralesional medical therapy and other measures chosen for the site and the age of the keloid.

A keloid usually follows an injury, piercing, acne spot or surgery and spreads beyond the edge of that wound. A lump that appeared without any injury, grows quickly, bleeds, ulcerates or looks different from your other scars should be examined before it is treated as a keloid, because other skin growths can look similar. A biopsy is occasionally needed to confirm the diagnosis.

Injections into a keloid are uncomfortable because the scar tissue is dense, and cryotherapy stings while the area is frozen. Discomfort varies with the site and the size of the lesion, and comfort measures are discussed before treatment. Silicone and pressure therapy involve no procedure.

The cost of keloid treatment in Singapore depends on the size and number of lesions, the site, the modalities the assessment indicates, the medicines and consumables involved, and how the plan is staged with review. A written quote is given at consultation, after Dr Sin Yong has examined the scar. The consultation also decides whether treatment is advised, so no figure is given in advance.

It can be worthwhile for people whose keloid itches, aches, feels tight or affects daily life, and who accept that the aim is flattening, softening and controlling symptoms, with a real tendency to recur. It is less suitable for anyone expecting a keloid to be cut out and gone, or unable to attend ongoing review.

How long the effect of keloid treatment lasts depends on the size, site and age of the lesion, skin type, genetic factors and earlier treatment, and keloids have a genuine tendency to recur. No duration is promised. Ongoing review is often part of the plan, and its timing is set at consultation after the scar has been examined.

Disadvantages include a tendency for keloids to return, a plan that is staged and reviewed over time instead of finished in one visit, and local tenderness, swelling or bruising. Thinning or lightening of nearby skin can occur, more noticeably in darker skin. Not every approach suits every keloid, and excision alone is avoided because it often recurs larger.