From the Research
The recommended duration for using topical steroids on keloids is typically 2-4 weeks for high-potency steroids and up to 3 months for medium-potency steroids, after which skin thinning becomes a significant concern. For intralesional steroid injections, treatments are usually given at 4-6 week intervals for up to 6 months 1. Signs of skin thinning include increased transparency, visible blood vessels, and a tissue-paper appearance of the skin. To minimize these risks, use the lowest effective potency, apply only to the keloid (not surrounding skin), follow a tapering schedule, and consider combination therapy with other treatments like silicone sheets or pressure therapy 2, 3. Regular monitoring by a dermatologist is essential, as individual responses vary based on skin type, keloid location, and genetic factors. If signs of atrophy appear, steroid treatment should be discontinued immediately and alternative treatments considered.
Some key points to consider when using steroids for keloids include:
- Using the lowest effective potency to minimize skin thinning risks
- Applying steroids only to the keloid, avoiding surrounding skin
- Following a tapering schedule to reduce the risk of skin atrophy
- Considering combination therapy with other treatments, such as silicone sheets or pressure therapy
- Regular monitoring by a dermatologist to adjust treatment as needed
It's also important to note that the evidence for steroid treatment of keloids is largely based on clinical experience and expert opinion, with limited high-quality studies available 4, 5. However, current literature supports the use of silicone gel or sheeting with corticosteroid injections as first-line therapy for keloids 1.