Chinedu Akpa

KELOID SCAR MANAGEMENT BY CHINEDU AKPA Keloid scars are usually thick, elevated, with smooth or rough surfaces that form during the healing process of wounds. Although keloids are not cancerous and generally do not pose any significant health risks, they can cause discomfort especially when located near joints. In this review, we will briefly cover the basics of keloid scars and focus more intensely on their management. Keloid scar image UNDERSTANDING KELOID SCARS Keloid scars differ from other types of scars, such as hypertrophic scars. They are thick, raised, smooth or rough protrusions that develop beyond the area of injury on the skin. Unlike localized scars, keloids extend beyond the injured site due to the aggressive production of collagen during the healing process. These keloids can sometimes itch and cause discomfort, particularly when they occur around joints. KELOIDS AND COLLAGEN Collagen is a protein that acts as a glue to provide structure and support to various tissues in the body like bones, skin, tendons, and ligaments. When injured, depending on the degree of the injury collagen is usually produced as one of the components of a complex process needed by the body for healing. Keloids are usually produced when this collagen is aggressively produced in excess. REASONS FOR SEEKING KELOID TREATMENT keloids are non-cancerous, and their unsightly appearance can lead to emotional and psychological distress. The visible prominence of keloids may cause self-consciousness and anxiety, especially in a society that places great emphasis on physical appearance. Consequently, many individuals seek medical attention to address their keloid condition. TREATMENT OPTIONS Several treatment options are available for keloids, including corticosteroid creams and injections, silicone gel sheets, freezing, laser therapy, radiation, and surgical removal. This article primarily focuses on corticosteroids and silicone gel due to their accessibility and affordability, particularly in third-world countries. While treatment can lead to keloid flattening or surgical removal, it's important to note that keloids can sometimes reoccur and even grow larger. TRIAMCINOLONE TREATMENT Triamcinolone is a drug that falls under the category of drugs called a corticosteroid, others in this category are dexamethasone, betamethasone, prednisolone, etc. Triamcinolone, like other corticosteroids, has an anti-inflammatory property; the usefulness of this property will be revealed in its treatment of keloids. reducing inflammation: one of the ways the body deals with wounds is through inflammation by activating the immune system. Triamcinolone suppresses the immune system, limiting its ability to send proinflammatory responders thereby reducing the inflammation of keloid. Consequently, this process thereby reduces itching, redness, and some other discomfort caused by keloids. Inhibiting collagen production: triamcinolone can inhibit the production of collagen( this may explain its thinning effect on the skin) which is the main protein responsible for the excessive growth of the keloid. Preventing the production of collagen can lead to the flattening and further thinning of the scar. Modifying cellular activity: fibroblasts are cells responsible for the synthesis of collagen, by disrupting their activity, less amount of collagen is produced which in turn leads to a reduction in Keloid size and appearance. Promoting collagen breakdown: the existing keloid is broken down by the infiltration of this steroid into the collagen, breaking it down and stopping it from forming a scar. Triamcinolone comes in three forms; spray, cream, and injection but our focus would be on the latter two. The use of any of these options will be dependent on the nature of the keloid like the size and thickness. For a small-sized Keloid, using a cream might do while the bigger sizes might require injections. Since keloids tend to rebound, one can use the injection for bigger-sized scars and then maintain the treatment with cream. One-time triamcinolone injections can last for up to three weeks, this might be enough to take care of the keloid, for some others, they might require a repeat dose as people may respond differently to the medication. The use of any of the forms of triamcinolone would also be determined by its side effects and its tolerability in the body. Side effects of triamcinolone cream: ● Pigmentation changes ● Acneform lesions ● Skin atrophy ● Striae Side effects of triamcinolone injection: ● Cough; this occurs in about 2% of people ● Contusions; this occurs in about 2% of the population ● Sinusitis; this also occurs in about 2% of the population of people taking the medication ● Joint swelling; occurs in about 3% of the population The rest of the side effects do not have adequate data so their side effects on the body are frequently not defined, these side effects include: ● ● ● ● ● ● ● ● Thromboembolism Acne Stroke Fracture Osteoporosis Delayed wound healing Hirsutism Diabetes mellitus SILICONE GEL TREATMENT Silicone gel's hydrating and pressure-mounting effects make it effective for treating keloids. Applied to the keloid, the gel's pressure alters collagen production, therefore flattening and softening the raised scar. The hydrating effect of the gel creates a better appearance of the keloid scar. Some of the side effects of silicon gel include skin irritation and discomfort from constantly applying the gel. COMBINATION THERAPY Combination therapy(triple therapy) is the use of more than one drug to achieve therapy Why combination therapy Drugs usually work via different mechanisms of action to achieve therapy and when combined they tend to amplify each other's effect. Combination therapy also helps to combat resistance against medication and improve patient outcomes. They help to prevent disease rebound. Triple therapy involving corticosteroids, silicone gel, and surgery takes a particular order Corticosteroid injection: The order of things with the triple therapy begins with the injection of a corticosteroid into the keloid site by a healthcare professional. The steroid helps to suppress abnormal collagen production, reduce inflammation and flatten the size of the keloid. Multiple injections might be needed over some time. Surgery (if needed): An excision of the keloid is carried out after the injection especially if the keloid is large and causing functional impairment. It should be noted that the regrowth of keloid is possible after which is why the corticosteroid is injected before the exercise to minimize the risk of regrowth. Silicone gel: The silicone gel comes in last in the order of things because it is usually applied after the surgery and the site of surgery heals up. The silicone creates a protective barrier over the scar, helping to soften, flatten, and improve the texture of the keloid. The silicone gel sheet is worn for a recommended period until the desired result is achieved. It should be noted that there are different types of triple therapy combinations, the one covered here is based on the scope of this write-up. In conclusion, keloid scars are thick, raised skin protrusions that can occur during healing. While non-cancerous, they can cause discomfort and self-consciousness, leading people to seek treatment. Treatment options include corticosteroid injections like triamcinolone, which reduces inflammation, inhibits collagen production and modifies cellular activity. Another treatment is silicone gel, which hydrates and pressure-mounts keloid scars. Combination therapy, involving corticosteroids, silicone gel, and surgery in a specific order, can yield better results by suppressing collagen production, reducing inflammation, and improving scar texture.