Preventing Keloids

Q:  Since our daughter gets keloids, we were wondering if you had any inside unpublished information about whether anything (diet, medicine, treatment) can stop the over production of collagen and prevent keloids from forming.

She has lived with it for fifteen years and already has a mass of keloids on her chest. Since a new one has developed from a scratch on her wrist, she is devastated.

Her former dermatologist moved to Indiana. She lived in Europe for three years and Hong Kong the last two. Currently she is here on vacation from her teaching assignment in Hong Kong and I am hoping you could give her a doctor or facility that she could contact for possible treatment in Hong Kong. The short vacation time she is in the States is not long enough to be seen as a “new” patient.

A:  The formation of keloids is not very well understood today—by doctors and patients alike, and I don't know of any special diet or medication for preventing them. When the body is injured anywhere —the skin, the liver, or the heart—it responds by forming scar tissue. In most cases the scar tissue heals in a very predictable fashion and the injured area continues to function quite satisfactorily. On rare occasions the formation of the scar is not controlled very well by the body and too much scar is formed. In some cases the scar just seems to “pile up” within the area of injury, and this is called a “hypertrophic scar.” But in other situations the scar tissue continues to grow and extends beyond the margin of the original scar, forming a “keloid.”

David Larson, MD, Interim Chair of Plastic Surgery at the Medical College of Wisconsin, was kind enough to take time from his busy schedule to explain what is known and describe the latest treatments. He says that keloids are a much more difficult problem than hypertrophic scars, and there are still things we don’t have explanations for. Although the two scars are different in appearance and prognosis, they look the same under the microscope! Just because someone has a keloid scar in one area of the body does not mean they will develop another one elsewhere. Certain areas of the body are predisposed to these scars—the earlobes, chest and shoulders for instance. They are most commonly seen in young, black people and red heads, but can also occur in elderly Caucasians.

The most effective treatment is early diagnosis and injection with a steroid solution. This will frequently slow down the scar production, but not always. Another early treatment is the application of silicone gel sheeting for at least 12 hours a day for a minimum of three months. We don’t know why this works, but it is effective in about 1/3 of patients. Sometimes the sheeting is not practical to use, depending upon the location of the scar. Pressure garments, or pressure earrings for keloids of the earlobes, work well as an early treatment, but their use must be continued for 8-12 months for full effect.

Sometimes the only treatment is to re-excise the scars, starting the healing process all over again, and then institute some of the above treatments earlier than could be done initially. On rare occasions a short course of radiation therapy will control the scar formation, but this treatment is reserved for particularly difficult cases and carries some risk of its own!

Your daughter who has many keloids should see a plastic surgeon or a dermatologist, and she should have no trouble finding one since Hong Kong has excellent medical care. There is a fine medical school in Hong Kong and many of the hospitals have physicians who are British-trained. I spent a few months at the Hong Kong Adventist Hospital at 40 Stubbs Road which is a state-of-the-art facility.

"Dear Doctor" is a compilation of patient questions answered by doctors from the Medical College of Wisconsin.