Keloid Removal in Miami, FL

Keloids affect many individuals and may be difficult to eliminate. In some cases they may become very conspicuous, and even cause discomfort. For residents of Miami, Ft. Lauderdale, and Kendall, FL, who want to explore keloid removal treatment, board-certified dermatologist Jill Waibel, MD, FACS, at Miami Dermatology and Laser Institute, provides a variety of treatments that may be effective in diminishing the size, thickness, and appearance of keloids. Unlike hypertrophic scars, keloids are raised or thickened scars that can form at any time after the skin has been injured or operated on. As such, they can appear after ear or body piercings, minor scratches, skin incisions, trauma wounds and vaccinations. They also can result from inflammation, such as that which occurs with acne, burns or insect bites. Some keloids even appear spontaneously with no apparent cause. New research suggests that keloids are a disease and six genes have been consistently identified in patients who tend to form keloids. The key characteristic is that keloids extend beyond the site of the original wound. They tend to be irregularly shaped and may become progressively enlarged. This tendency to continue to grow is the main difference between keloid and hypertrophic scars. Furthermore, unlike other forms of scarring, keloids do not resolve or soften over time. They’re also prone to recurring after surgical attempts to remove them. A combination treatment approach to improve keloids is needed including injections, laser, surgical procedure and compression. The causes of keloid scars can be varied. We do not fully understand why some people are more prone to developing keloids, or why a person may develop a keloid scar in one pierced earlobe and not the other.

What are the signs of a keloid scar?

Keloids are firm, raised scars that may appear shiny and dome-shaped, ranging in color from pink to red, purple or brown. They may also have surface ulceration and contain tiny visible blood vessels (known as telangiectasias). Some keloids become quite large and unsightly, causing severe disfigurement and social embarrassment. Keloids commonly feel painful, itchy, tender and/or tight. They appear most frequently at the shoulders, upper arms, back, sides of the chest and the earlobes. They are less common on the face, but can sometimes appear on the jawline.

Who is most susceptible to keloids?

Keloid scars are equally common in women and men, and less common in children and the elderly. These scars tend to occur most commonly in people during puberty and into their 20s and 30s, decreasing in size after menopause. Additionally, the tendency to form keloid scars often runs in families. Although people with darker skin types – predominantly African-Americans, Asians and Hispanics – are more likely to develop keloids, they can occur in all skin types.

Treatments for hypertrophic scars and keloids

Recommended treatments for both types of scars are highly similar, with minor differences noted below.

Over-the-counter treatments

Silicone gels and dressings: Silicone sheets, gels, patches and creams are commonly applied to scars with highly variable results. Although relatively inexpensive, widely available and safe, these products are best used in conjunction with other therapies. The board-certified dermatologists at Miami Dermatology and Laser Institute can recommend the best scar remedies to suit your individual concerns.

Prescription treatments

Corticosteroids: Injecting steroids directly into the scar can reduce itching and inflammation and sometimes flatten the scar. The most commonly used steroid for this purpose is triamcinolone. However, intralesional steroids may also make the flattened keloid redder by stimulating the formation of more superficial blood vessels. Additionally, overuse of steroid injections may also lead to skin atrophy (thinning) or depressions. 5-Fluorouracil (5-FU): Injections of this chemotherapy agent have been used, with and without steroid injections, to treat keloid scars. In fact, side effects (possible redness and increased pigmentation) occur less frequently when physicians combine 5-FU with corticosteroids and pulsed dye lasers (see below). Bleomycin: Studies suggest that injecting this antitumor agent improves the appearance of hypertrophic and keloid scars, perhaps by inhibiting collagen production. Potential side effects include skin atrophy and loss of pigmentation.

Surgical and other interventions

Surgery: Z plasty may be effective for hypertrophic scarring. However, performing surgery on a keloid may trigger the formation of a similar or even larger keloid. Applying pressure dressings to a wound site after excising the keloid can help prevent relapses in some cases, as can using postsurgical therapies such as radiation treatment or lasers. Pressure therapy: Physicians have long used special garments that apply pressure to the wound as a conservative means of preventing and managing hypertrophic scars. Though evidence behind these devices is mixed, they remain part of the standard of care.

Laser therapy

Pulsed dye lasers, operating at 585 to 595 nm, provide an effective option for primary keloids and early hypertrophic scars. Lasers, such as the fractional CO2 laser, fractional erbium (Er:YAG) laser, and often other lasers used in combination, provide an effective option when treating hypertrophic scars and keloids. Fractional lasers leave sections of healthy tissue between tiny zones of thermal injury to improve healing and aesthetic results. With many laser therapies, several treatment sessions may be needed. Avoid fully ablative laser therapies for scars due to a high risk of recurrence. Under the direction of Dr. Jill Waibel, the board-certified dermatologists at Miami Dermatology and Laser Institute can recommend the best laser therapy for treating your scars.

Radiation

Radiation therapy is usually reserved for hypertrophic and keloid scars that resist other treatments. However, there are risks such as an increase in skin cancer with radiation. Want to reduce the size and color of unsightly keloids in conspicuous locations on your body? At Miami Dermatology and Laser Institute, under the direction of board-certified dermatologist Dr. Jill Waibel, specialized treatments are used to help diminish the appearance of keloids for residents of Miami, Ft. Lauderdale, Kendall, and nearby communities in South Florida.