Keloid scar refers to the overgrowth and modification of an area of connective tissue that replaces the site of damage to the skin or muscles. This occurs as a result of the healing of cut, stabbed or chopped wounds, and also often accompanies the rehabilitation period after surgery. In the course of operations, regardless of the qualifications of the surgeon, a keloid may develop, which indicates a failure of the healing process.
The very mechanism of the appearance of keloids is associated with an excessively strong formation of connective tissue at the site of damage and its transformation into hyaline. And if a skin defect affected the dermis, then the risk of developing a keloid increases. Ways to prevent its formation have not yet been developed. Because of this, plastic surgeons and beauticians must treat them after they appear.
Arguments for the need for treatment
In cosmetology and medical practice, the treatment of a keloid scar is considered a priority. The reason for this is a cosmetic defect and the risk of developing tumors. In the healing site, inflammation is maintained, which leads to the proliferation of connective tissue. The sluggish course of the inflammatory process and the further uncontrolled growth of the keloid creates the prerequisites for the formation of dermal benign and malignant tumors.
For lesions such as keloid scars, treatment is a relative necessity. This concerns scars located on open areas of the body. Keloids without progressive expansion or contraction of the skin above the surface can be left alone: their growth has either completely stopped or have little activity. For this reason, the main substrate for treatment is keloid scars on the face, legs, arms, neck, breast, pubic and perineal regions.
Methods for treating keloid scars
In cosmetology and medicine, keloid scars are treated in a variety of ways with varying effectiveness. Cosmetology sets the goal of improving the body, and within the framework of medicine, plastic surgery, physiotherapy, pharmacological local and systemic therapy are used. The main goal of treatment is either complete removal of the scar or its smoothing.
Medical methods include plastic surgery treatment. To do this, you need to specially go to the regional or metropolitan hospital, where the direction of plastic surgery is practiced. In the regions, such operations cannot be performed, since there is no special instrumentation and suture material. Also, the treatment can consist in the transplantation of a skin area, which takes a long time.
The second way is pharmacological treatment. It comes down to the local administration of glucocorticoids (diprospan) in the form of injections. With such a pathology as keloid scars, treatment with diprospan is the easiest way. The third technique is local physiotherapy. As a result, enzyme preparations of proteases are used that can destroy part of the keloid tissue.
The basis of cosmetic methods is laser and cryogen treatment. Drug injections and manipulations similar to surgical procedures are not used. Priority in cosmetology is doubtfully given to local treatment: the application (application) of substances that have a cosmetic effect on healthy skin. But their effect on keloids has not yet been proven, although such therapy allows you to mask the defect.
Treatment of keloid scars by a plastic surgeon
Surgical methods carry a certain risk, which is associated with the growth of new keloids after healing. The operation itself is performed with the aim of removing scar tissue and re-flattening the edges of the wound. On a wide area of the scar, for example, after a burn, a delayed skin graft will be performed.Further, the edges of the operating wound are brought together and connected by an intradermal cosmetic suture.
The advantage of plastic surgery is high efficiency. For a specialist, there is almost no difficulty in doing it. But this can be done at the level of a private plastic clinic or in regional and federal scientific and practical centers. For this reason, the patient needs to seek a referral for a consultation with a plastic surgeon. The second way to undergo surgery is to go directly to a private plastic clinic.
Diprospan treatment of keloid scars
With such an intradermal formation as keloid scars, treatment with diprospan is very effective. The drug is a glucocorticoid, a steroid hormone that acts locally. It is used as an injection into the central scar tissue. There are a huge number of treatment methods with different periods. The specific scheme is required to be clarified with your doctor, dermatologist, plastic surgeon or cosmetologist. Only these specialists have the right and sufficient qualifications for treatment with Diprospan.
Diprospan, as a local steroid, suppresses sluggish inflammation in the thickness of the keloid scar. This reduces the risk of its growth, although it does not completely exclude it. Also, the drug reduces the ability of connective tissue cells to synthesize new collagen molecules. At the initial stage, the future keloid scar consists of them. These are structural proteins that provide strength to the skin and other tissues.
By reducing collagen synthesis, the rate of its transformation into hyaline (a strong protein that makes up the bulk of a solid "ripe" keloid) also decreases. Because of the protein, it practically does not lend itself to the pharmacological and local application method of treatment with cosmetics, because none of the drugs can get inside the scar.
Diprospan treatment is carried out according to the course method. Initially, 1 or two injections are performed (depending on the size of the scar and is determined by the doctor), after which the patient is sent home. After the period indicated by the doctor, a second injection of the hormone will be performed. The time is set after the choice of the initial base dose, since there are really many methods of treatment with diprospan. And for a successful treatment result, you just need to competently follow the doctor's recommendations, because it is impossible to inject diprospan on your own.
Laser cosmetology treatment of keloid scars
With such intradermal formation as keloid scars, laser treatment can reduce the appearance of the defect. With the help of a laser correction device, the top layer of the scar is burned out, which protrudes above the skin surface. As in the case of diprospan, the treatment is completely dictated by the specialist, because his schedules and the sequence of therapy sessions are individual for each patient.
Laser treatments can also be performed in a cosmetic clinic, although most of these procedures are performed by a dermatologist. Laser treatment involves several sessions, during which the top layer of the scar is partially removed. The dermatologist, cosmetologist or surgeon himself prescribes a schedule of procedures. As a rule, 1 session is carried out per week. Treatment may take 8 to 15 sessions.
The effectiveness of this technique is low, because only the upper part of the scar can be removed with a laser. The keloid scars themselves are located intradermally, and therefore, without surgical intervention, their complete removal is impossible. For this reason, the main task of the cosmetologist is to reduce the cutaneous defect. The laser can successfully mask a scar, which will be almost invisible.
Cryogen treatment of keloid scars
Cryogen is another topical treatment. It is a cold agent that kills the skin at the site of application.The procedure is very painful, which distinguishes it from the practically safe laser technique. However, much fewer sessions are required to mask the defect. Cryogen treatment is much cheaper, although there is always a risk of new scarring due to severe traumatic effects.
Treatment by application methods of keloid scars
The most useless method in the treatment of keloid-type scars is the application of cosmetics. None of the known caring, rejuvenating or regenerating compounds can penetrate through the thickness of the connective tissue, and even more so through the hyaline of the keloid scar. Therefore, they are useless, and the purpose of their appointment looks vague.
They are used to accelerate skin regeneration. But at the level of its internal structure, it has long been restored. These funds should not be prescribed even if the skin itself is damaged. In any of the books on practical dermatology, it is stipulated that caring and cosmetic formulations can only be used on intact skin. Therefore, they cannot be applied after laser treatment or cryotherapy. The main task of the patient, who is trying to reduce the visibility of the scar, is not to interfere with the doctor's work.
However, from the application methods, there is one effective technique. The essence of the treatment is the application of proteolytic enzyme dosage forms to the scar area. Substances that can break down protein molecules of the rumen are applied topically in this case. They are not yet used in the form of injections, because they are difficult to dose for each individual patient.
The procedure for treatment with enzyme preparations is lengthy, but more gentle than cryotherapy or surgery. It lasts from 2 months to a year. Moreover, sometimes physiotherapeutic techniques are used to accelerate the passage of enzymes into the thickness of the scar tissue. The most commonly used are electrophoresis and ultrasonic cavitation.
Treatment with leeches and analysis of its effectiveness
With such an overgrowth of connective tissue as keloid scars, leech treatment looks absurd. The reason for this is the absence of substances that can affect the structure of the scar in the secretion of the salivary glands of leeches. They are able to give a person only one useful substance, which has nothing to do with cosmetology. This is hirudin, which reduces the blood's ability to clot (indirect anticoagulant). There are no other beneficial effects from using leeches.
Risks in treating keloid scars
As with any exposure, treating keloid scars has its own risks. Most of them are due to surgical operations. The complexity of their implementation is not high, but it is not always possible to isolate a section of the scar, remove it, and then close the defect of the body with your own skin. Sometimes this requires skin grafts from adjacent areas of the body. The risk of surgical techniques is also associated with infectious complications. They, despite antibacterial agents, aseptic, antiseptic and disinfection measures, can manifest themselves, increasing the risk of developing a hypertrophic scar, and only later a keloid one.
Also, the risks are associated with laser therapy. This effect does not exclude that the rate of scar regeneration will be higher than the frequency of radiation sessions. As a result, the scar can heal before a new treatment session. For this reason, especially in the case of post-burn keloid scars, it makes sense to carry out several sessions of cryotherapy, and then continue the laser treatment.
The most justified methods are still the following: laser therapy and treatment with diprospan. Surgical treatment can be carried out only with wide and deep, or post-burn scars. At the same time, the incidence of tumors from the connective tissue is about 0.1 percent, which does not indicate an urgent need to get rid of all keloids on the body.Therefore, it is required to remove or mask only those scars that are located on the neck, face, in the pubic or perineal region, on the open areas of the arms or legs.