Keloid treatment for all skin types

Treatment for patients with skin of colour may result in hyperpigmentation, according to Dr. Beach, and the condition could get worse before it gets better (700 words, 4 minutes)

Hyperpigmentation may be a common result of the treatment of keloids for patients with brown, olive or black skin, according to Dr. Renée A. Beach. The best treatment for keloids is to try to avoid them altogether, said Dr. Beach, who presented on scarring at Skin Spectrum Summit in Montreal in 2019. 

“The problem with keloids is that we do not have great treatments,” Dr. Beach explained. “We have treatments that help and treatments that work for a subacute period, whether that is three to six months, but I always tell people to prevent it so that we do not have to have this conversation.” 

“If you know it is in your family or you know you have a tendency, try to prevent it or avoid practices that are going to help form keloids.” 

On top of there being no permanent removal of the scar, it is also difficult to find surgeons who will excise keloids because they can recur in some capacity. 

“This is an instance where you want to use your side-effects as your therapeutic effect,” Dr. Beach said. 

Often times you will hear a patient say, ‘Oh, I don’t want to use a steroid because it is going to thin my skin.’ This is the time we say, ‘Exactly; this is what we are hoping for.’”

Patients using this regimen for three to five months will not improve the colour of the scar. A Caucasian patient will end up with a flat, red scar but will not have a keloid anymore, while a patient with brown, olive or black skin can experience hypopigmentation, Dr. Beach said.

“Clobetasol treatment is certainly OK, as long as your patient understands you are not doing anything to improve the colour of the keloid, and that is across skin colours,” she said. 

For a patient with an unlimited budget, Dr. Beach suggests consulting a plastic surgeon to see if the keloid can be removed cosmetically. Therapy with pulsed dye laser can be used to mitigate some of the redness. CO2 ablation is also an option. Additionally, for a patient not concerned with costs, Dr. Beach recommends a three- to six-month course of imiquimod. 

“I usually ask them to use it about four to five days a week and see them back in about four to six weeks,” she said.

The takeaway: Dr. Beach said the patient needs to understand that their condition is highly likely to look worse before it starts to look better. Their prescription will need a couple of refills, so patients should plan for that expense and check their formulary coverage or drug plan.

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FROM THE LITERATURE ON KELOIDS

Keloids: A review of etiology, prevention, and treatment

  • In a review of preventative measures and treatment options for patients with keloids, researchers noted that for patients with darker skin tones, side effects from pulsed-dye laser therapy are common. Side effects include temporary purpura, blistering, crusting, and postinflammatory pigmentary changes.

From "J Clin Aesthet Dermatol"

Keloids: Current and emerging therapies

  • In a study on emerging therapies for keloids, researchers explained that intralesional cryotherapy has been developed in order to avoid hypopigmentation in darker-skinned individuals who underwent external cryotherapy. Investigators said that the intralesional cryotherapy works by destroying the internal structure of the keloid.

From “Scars, Burns & Healing”

Intralesional cryotherapy – A pilot study of African treated for keloids plastic surgery

  • In a pilot study of 11 African patients with keloid lesions, researchers found that intralesional cryotherapy resulted in the total resolution of keloid symptoms in 10 patients. Researchers said that intralesional cryotherapy shows promise in people of African descent, though larger studies are needed to fully investigate the benefits of the therapy.

From "Ann Med Res Pract"

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Dr. Andrew F. Alexis of New York City explains how to diagnose psoriasis in Fitzpatrick skin types V and VI. Subscribe to Skin Spectrum Weekly and have each issue sent directly to your phone or inbox.

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