A keloid scar is a hypertrophic scar, that is, it is larger than it has to be. It happens if there is any trauma or injury, when the repair of that wound occurs it does it in an excessive way. Instead of being a normal scar, where a scab forms first and then it falls and continues to form. As normal tissue regenerates, it does so in a much more important way than it should be, thus leaving an irregular scar, generally enlarged, on the raised skin. This type of scar, which continues to evolve slowly, can produce symptoms: itching, pain and when they are located in visible places, it brings a cosmetic issue. That is, it is not pleasant because sometimes they acquire a different coloration to the skin, and it motivates the concern of what to do with that scar.
How is a keloid scar treated?
How to treat a keloid scar has long been a troublesome topic. Generally, the results are never entirely satisfactory on the scar. It must be removed with surgical treatment, because basically, the formation of a keloid scar is related to the generation of cells, increased in their development, which are fibroblasts. When trauma occurs and there is injury and blood Fibroblasts are in charge of repairing that injury. In the case of people who do keloid scarring, the amount of Fibroblasts is increased. It is not well known what the cause is, there is some immune factor, predisposing in that person. There are people who tend to make keloids in all scars, in some it is less and in others they do not.
What does the procedure consist of?
The therapeutic behavior consists of removing the scar and adding immediate Radio Therapy to try to inhibit the formation of Fibroblasts. Thus, these cells will have a normal formation and they would not have to generate that hypertrophic scar. The scar in that case will have a normal characteristic.
When is it recommended to do it?
Once the scar has been removed, Radio Therapy has to be immediate. Within 24 hours of surgery. In other words, Radio Therapy must be applied because what it is going to do is that this rapid formation of Fibroblasts is neutralized.
What differences are there between the different treatments?
Generally, what we apply with Radio Therapy are different alternatives, and we adapt them to the type of scar.
When the scars are small, we may use beta therapy . It is an applicator, which has Strontium, this has the advantage that it is a very superficial irradiation, which does not penetrate more than is necessary to treat the skin surface. This method is used for a scar that is two centimeters long, since the applicator has that size.
When we have to treat longer scars, in those cases we use other methods. Electrons, that is, linear accelerators, can be used. They have X-rays that are protons, which they treat in depth. Also, they have a scale of radiation energy that is the electrons. These are readable to identify how deep I want the irradiation to go. From these differences, we choose which is the best for treatment.
In cases where we need the dose to be very superficial, we use Bolus to resemble the skin.
Is there any surgery that can produce a keloid scar?
In general, the generation of a keloid is not going to be strictly related to the scar. Keloids are generated through a stimulus, that stimulus can be produced by trauma or surgery. So, it generates that the Fibroblasts are excessive, they are much more concentrated than normal.
There has been an advance in recent times related to piercing, to the placement of rings. Those keloids are very common, they occur in young people who have not had experience in surgery or trauma. Also, they can be produced with the application of a vaccine.