Keloids - Patients ask, Dr. Ringpfeil answers
Please feel free to use the blog below to share information about Keloids or to ask Dr. Franziska Ringpfeil a question that might be of interest to others.
Philadelphia and Mainline Center of Dermatology and Cosmetic Surgery
Keloids Treatment
A keloid is a type of scar that occurs spontaneously. Keloids may be hereditary and are commonly formed on areas such as the frontal midline of the body. People of Mediterranean or African descent are at higher risk of developing keloids. In our office, the treatment options for active keloids include intralesional Kenalog, intralesional Kenalog combined with 5-fluorouracil, pulsed dye laser (PDL) treatments, and CryoShape™.
Keloids may become itchy and tender, with the degree of pain varying from person to person. Intralesional steroid injections are recommended into firm keloids to treat symptoms and to reduce these keloids. Pulsed dye laser treatments help reduce acute inflammation and further soften the keloid. The CryoShape™ procedure utilizes a probe to freeze and destroy the scar tissue on the inside of a keloid with minimal discomfort and no pigment changes to the surrounding skin. This treatment is most appropriate for larger keloids that have been unresponsive to steroid injections.
Dr. Ringpfeil:
"Keloid disease does not yet have a cure and the phrase ‘permanent removal’ is therefore unfitting. In any area where a keloid had once been, a new keloid could form with significant trauma at any time.
Surgical removal of keloid results in recurrence about 85% of the time and sightly less if immediately followed by 4 days of radiation or weekly steroid injections x 4. Only keloids on the ear have a lesser recurrence rate because there is no movement beneath the healing skin in the post operative period of 3 months. Of the recurrent keloids, 14% will be bigger than the previous one.
Your next best step might be Cryoshape or external cryotherapy. Cryoshape works best for keloids that are about the size of a Lima bean. This technique that shrinks about 80% of the keloid from within after one treatment. We have not seen worsening keloids after Cryoshape and they have not been reported. There is a 5% chance that the keloid does not respond to treatment. Keloids that a larger than a Lima bean may require several treatments 4 months apart.
External cryotherapy can shrink keloids that are smaller than a Lima bean. When combined with injections, the results after 4-6 monthly treatments are equal to Cryoshape. It can fail to shrink the keloid about 10% of the time. It is not associated with worsening keloids.
The residual scar after Cryoshape or external cryotherapy is not as smooth as an ideal surgical wound."
Treating Keloids with Cryoshape
Many physicians have performed surgical removal of keloids over the years; however, the likelihood for keloids to recur in surgically treated areas is extremely high and it is expected that any new keloid that forms is much bigger than the original one. If a keloid responds very well to corticosteroids but does not entirely flatten, surgery may be attempted if desired by the patient. Steroid injections must be performed at the time of surgery and every 2 weeks thereafter to prevent keloid formation at the site of surgical trauma. Usually, 3 injections after surgery are required to minimize the risk of keloid formation.
Keloids that do not respond to corticosteroids or are too big for meaningful injection may benefit from excision with subsequent radiation. If this is the case, we will refer you to a specialist that offers both treatments.
I have a keloid on the back of my neck slight above the hair line. I ahve had it removed surgically but it always comes back. The steroid injections do not seem to be helping. What do you think the next step would be to have it removed permanetly
Keloid disease does not yet have a cure and the phrase ‘permanent removal’ is therefore unfitting. In any area where a keloid had once been, a new keloid could form with significant trauma at any time.
Surgical removal of keloid results in recurrence about 85% of the time and sightly less if immediately followed by 4 days of radiation or weekly steroid injections x 4. Only keloids on the ear have a lesser recurrence rate because there is no movement beneath the healing skin in the post operative period of 3 months. Of the recurrent keloids, 14% will be bigger than the previous one.
Your next best step might be Cryoshape or external cryotherapy. Cryoshape works best for keloids that are about the size of a Lima bean. This technique that shrinks about 80% of the keloid from within after one treatment. We have not seen worsening keloids after Cryoshape and they have not been reported. There is a 5% chance that the keloid does not respond to treatment. Keloids that a larger than a Lima bean may require several treatments 4 months apart.
External cryotherapy can shrink keloids that are smaller than a Lima bean. When combined with injections, the results after 4-6 monthly treatments are equal to Cryoshape. It can fail to shrink the keloid about 10% of the time. It is not associated with worsening keloids.
The residual scar after Cryoshape or external cryotherapy is not as smooth as an ideal surgical wound.
I have three keloids on the back of my neck the size of a nickel I have state insurance Aetna better health wondering if you take it
We do not participate with Aetna Better Health but you have the option to pay out of pocket.
Hi, what is pulsed dye laser treatment? Is it effective for larger keloids on the body? And is it covered by insurance? Thanks
Pulsed dye laser treatment is used to treat keloids up to one inch in diameter. It is often used in conjunction with other treatments. This treatment is recognized by insurance and submitted per insurance guidelines.
Whats the difference between cryoshape and cryotherapy?
why is one better than the other?
Is it safer? Is it more effective? Does it cost less? Is one more dangerous than the other?
what is the recurrence for the behind the ear keloid in both options
Thank you in advance for your reply and time
Cryoshape is freezing a keloid from within whereas cryotherapy refers to freezing from outside. It takes many monthly treatments to flatten a keloid with cryotherapy and pigment overlying the keloid will be lost after the procedure. Cryoshape flattens a keloid usually in one treatment and pigment on the surface often recurs within a year. The recurrence rate behind the ear is low with either method. Both are safe and the infection rate is low. Cryoshape is FDA approved but is not accepted by insurance. It is more expensive than cryotherapy per treatment due to the consumable cost of the Cryoshape probe. Cryotherapy is FDA approved and accepted by most insurances.
I have a keloid on my chest I’ve had it for abput 8 years now it’s gettinh bigger amd bigger it really hurts and from time to time it bleeds i need it removed hpw much would it cost
Painful keloids respond favorably to steroid or fluorouracil injections, pulsed dye laser treatment, internal or external cold (Cryoshape/cryosurgery). We do not perform excisions on the chest because the chance for the keloid to grow bigger than before is greater than 95%. Web-shaped keloids that cross the midline of the chest, can be revised with Z-plasty and CO2 laser when they are no longer painful.
Hello Dr. Ringpfeil. I hypertrophic/keloid scars on my jawline from cystic acne. They have flattened out a lot but I have about 6 small raised bumps on both sides of my face that are still red in color. I have tried kenalog injections up to 40mg in the past with good results, but after I stop getting them they become raised again. I have tried 1540 fractional laser with little or no improvement. I saw that your office provides 5-fu and intralesional injections combined with pulsed dye laser. This sounds promising and I would like to try this method. Please give me feedback Dr. I was thinking of making a consultation very soon.
Indeed, pulsed dye laser and injections with triamcinolone or combintaion of traimcinolone and fluorouracil (5FU) are a great solution for keloids along the jawline. Fractionated lasers, whether ablative or non-ablative, do not seem to be very helpful for keloids and on occasion they can even trigger a keloid to fare up again.
Thank you Doctor Ringpfeil for the feedback from my previous question in regards to Acne keloidalis nuchae. I just have a couple more questions in regards to Acne keloidalis nuchae.
How much would the CO2 laser procedure cost? After the CO2 laser procedure, would I need to get a hair transplant? And do you often encounter this condition with your patients?
Thank you again Ringpfeil for shedding some light on my condition.
The CO2 procedure is similar to cutting with a knife, Instead of a knife, the CO2 laser energy is used to cut out the keloidal tissue. The wound can than either be closed with stitches, or, if small enough, left open for healing with a scar. It is not yet possible to use hair transplantation to cover a scarred area, because the scar does not provide the environment for hair follicles to survive. The risk for another keloid to form is slightly less than with a traditional scalpel but still exists. A proper evaluation is needed to assess your options for keloid treatment/removal and proper price quote. And, yes, we treat many people with acne keloidalis nuchae.
Hi Doctor Ringpfeil,
I have been having acne keloidalis nuchae (AKN) for about five years. My head is always itching, bleeding, and it hurts when I sleep. I have been on several pill, creams, kenalog shots, and ointments. But nothing has work and I have been really frustrated living with this condition on my head. Doctor, have you done any type of procedures with acne keloidalis nuchae, if so what are the measures that you take?
I wish there was a great treatment for acne keloidalis nuchae.
It can be prevented to some extent when hair is not clipped too short. When the condition has occurred, treatment of the keloiding area is the only know approach.
If the keloids are green pea sized, injection of steroid pr steroid/fluorouracil into each one of them is reasonable. If they are up to 1.5 inches long and at least a quarter inch wide, Cryoshape is an option. Larger keloids are sometimes excised by CO2 laser locally or as an entire section across the lower scalp and then the skin pulled together if possible.The biggest worry with excision is the possible recurrence of keloids.
Oral anti-inflammatory antibiotics (doxycycline or combination of clindamycin and rifampin), topical steroids and topical retinoids are used to minimize the inflammation when it has already occurred, hence reducing the chance that new keloids form.
hi
i have done topical cryo rx to my ear, cheek and chest. i had moderate improvement to my ear but little to no response to the other areas. i have also tried steroids and chemo. the most troubling site is on my cheek. it is slighlty raised and tentacle like. would you recommend intralesional cryo given topical seemed not to work
Cryoshape will work as long as the keloid is raised at least 0.4 cm above the surface of your skin. The thinner the keloid, the greater the chance to loose pigment in the treated area. Most of the time, pigment returns after 6-24 months, and matched cover up (Dermablend or Covermark) can be used during that time if desired. Please make an appointment for consultation with any of our dermatologists or use online consultation https://www.ringpfeildermatology.com/tools/onlinederm.php. The Cryoshape procedure is performed by me and can be scheduled after consultation.
Hi,
I have a keloid on the back of my earlobe from an infected piercing from years ago. It is fairly small bur I do not think my insurance would cover any treatment and have not had any prior treatment for the keloid. Which procedure do you think would be recommended for this kind of keloid and about how much would that be? Just curious before I take the step of getting a consultation.
Thank you.
Keloids on the earlobes are not as difficult to treat as elsewhere on the body. Depending on the size and position, they can be treated by injection, internal or external cryosurgery, or excised and injected afterwards to avoid recurrence. The initial consultation as well as treatments apart from internal cryosurgery (Cryoshape) can be submitted to insurance unless the diagnosis keloid is excluded from your benefit. If the keloid is very small, cost for treatment ranges in the hundreds without insurance coverage. If Cryoshape is desired, cost of treatment is $1000.