Intralesional interferon alfa-2b has been shown to reduce keloid scars to a greater extent than steroids and may be particularly useful in cases which are resistant to intralesional steroids.A combination of intralesional steroids and intense pulsed light has been found to produce clinical improvement in the size of the scar.Laser treatment may reduce the redness of keloids without shrinking them.Combination treatment of CO 2 fractional laser, pulsed dye laser and triamcinolone acetonide injection has been successfully used for refractory keloid scars on the upper back. However, pulsed dye lasers are less effective on dark skin. Pulsed dye lasers and Nd:YAG lasers are reported to give encouraging results, with few adverse effects.One study reported the successful use of carbon dioxide laser ablation followed by intralesional steroids.Further research is required to determine the mechanism of action for different laser systems and to examine such outcomes as scar erythema, scar texture, degrees of symptom relief, recurrence rates and adverse effects. The evidence base supporting the use of lasers in keloid scars is not as large as that supporting their use in hypertrophic scars.Steroid-impregnated tape applied for 12 hours/day may flatten keloids. Side-effects: pigment changes, telangiectasias and subcutaneous atrophy (which may resolve).Injections are given every 2-6 weeks until improvement. ![]() Intralesional steroid injections, with triamcinolone, are a mainstay of treatment and prevention - reviews suggest that it improves the majority of scars. Reviews suggest that combinations of treatments are probably the most effective. Hypertrophic scars usually appear within a month of the injury, grow for several months and then regress, whereas keloid scars may appear later and continue growing for longer. Hypertrophic scars are also red and prominent but do not extend beyond the wound border. Check if the scar reduces mobility - eg, near a joint.Assess the patient's concerns and the impact of the scar(s) on their life.The diagnosis is made clinically in most cases.If there is significant diagnostic uncertainty and alternative diagnoses are suspected, a skin biopsy may be helpful. ![]()
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