What are keloid and hypertrophic scars?

Keloid scars are the result of an imbalance in the production of collagen (a protein found in the human body which holds the body together) when wounds are healing. They can grow beyond the boundary of the original wound and may be painful and cause itching. The appearance of keloid scars may not improve over time.

Keloid scars can result from any type of injury to the skin, including:

  • Acne.
  • Vaccination sites.
  • Piercing.
  • Surgical incision.

Anybody can get a keloid scar, although young people and those with dark skin are more prone to developing this type of scarring, particularly on the ears, chest, shoulders and back.

Hypertrophic scars are red and raised. They may be painful or cause itching. They do not extend beyond the boundary of the original wound but may continue to thicken for up to six months.

Hypertrophic scars usually improve within 12-24 months but may cause distress, because of their appearance, intense itching or restricted movement if located over a joint.

What treatment is recommended?

The treatment for keloid and hypertrophic scars involves a course of steroid injections to help soften and flatten as well as relieve the symptoms of pain or itching. The application of silicone in sheet or gel form may also be advised, to help reduce the size or restrict the growth of the keloid or hypertrophic scar.

Triamcinolone acetonide

Triamcinolone acetonide is a corticosteroid. Corticosteroids, often referred to as steroids, are an anti-inflammatory medicine. They are man-made versions of hormones which are produced naturally by our body’s adrenal glands (two small glands that sit on top of the kidneys).

Triamcinolone acetonide is used to treat keloid or hypertrophic scars. Its effects may last several weeks or even months.

Recommended dose

You receive triamcinolone acetonide in concentrations of 10-30 mg/ml.

How the steroid is injected

The steroid is injected through a very fine syringe directly into the scar and very little is absorbed into the blood stream. The steroid injection can be painful. Discomfort may be reduced by the application of an ice pack for 10 minutes.

Treatment schedule

Injections are repeated at four to six weekly intervals up to three to four months. You will be given a blue ‘steroid card’ if you are given this medicine for more than three weeks. Always keep the blue ‘steroid card’ with you and show it to the practitioner treating you.

You will be able to continue to apply silicone gel or silicone sheets, usually from two or three days after the steroid injection. The plastic surgery team will assess your scar during your treatment with follow-up appointments.

Risks and side-effects

Side effects are minimal although complications occur to one in five cases at or around the site of the injection. These include skin atrophy (decrease in size/wasting), hypopigmentation (lightening of the skin), hyperpigmentation (darkening of the skin) and telangiectasia (small, dilated blood vessels within the skin). If you experience any of these symptoms, contact your GP and the plastic surgery team on the contact number below.

Alternative treatments

 The alternatives may include non-invasive methods such as psychological counselling, cosmetic skin camouflage and pressure garments, or invasive methods such as surgical excision, radiotherapy, laser therapy or cryotherapy. If your scar does not respond to the recommended treatment an appointment will be made for you to see your consultant plastic surgeon to discuss alternative treatment options.

Consent

Before carrying out any procedure or treatment, we will seek your consent. Staff will explain the procedure or treatment to you, along with the associated risks, benefits, and alternatives before they ask you for your consent. If you have any questions about your care, or any concerns, please do not hesitate to ask for more information.