Hypertrophic Scarring and Keloids Treatment
People with a history of hypertrophic or keloid scars should be discouraged from having cosmetic procedures and piercing. This is best explained as unpredictable scarring. Patients who require surgical procedures in areas at increased risk of abnormal scarring should be advised of this possibility in advance and should be reminded at the time of suture removal. Despite meticulous surgical and post-surgical care, keloid and hypertrophic scars do occur. This process is determined genetically. The parents of a child who has had a procedure that resulted in a keloid or hypertrophic scarring need reassurance and a management plan.
Early abnormal scarring typically responds better than older, less active scars. Early intervention is advised in these cases. Intralesional corticosteroid injection is probably the treatment of choice, initially, for most patients. Radiation therapy and more recently pulse-dye laser therapy have been used for hypertrophic scars and keloids. Compression therapy and silastic sheeting are helpful but inconvenient. Newer topical silicon-containing gels have been marketed for the treatment of hypertrophic scars, although efficacy in all patients is questionable.
Surgical removal or correction of hypertrophic scars and keloids requires experience and careful monitoring. Keloid scars tend to recur often, sometimes larger, after surgical removal. Combination therapy with intralesional steroids and surgical excision are sometimes required. A referral to a dermatologist or plastic surgeon with an interest in scar removal should be considered. Hypertrophic scars and keloids are difficult to eradicate no matter what procedure is used.
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