From the Guidelines
To prevent keloids, it is crucial to avoid unnecessary skin trauma, especially in high-risk areas, and consider preventive measures such as pressure therapy, corticosteroid injections, and careful wound closure techniques for individuals with a history or genetic predisposition to keloids. Preventing keloids involves several strategies that can be implemented before and after skin injuries. If you're prone to keloids, avoid unnecessary skin trauma such as elective surgeries, tattoos, piercings, and cosmetic procedures in high-risk areas like the chest, shoulders, and earlobes, as advised by pediatricians for adolescents with a history of keloid formation 1. For unavoidable injuries or surgeries, some potential preventive measures include:
- Pressure therapy using silicone gel sheets or compression garments for 12-24 hours daily for at least 2-3 months
- Corticosteroid injections administered immediately after surgery and repeated every 2-4 weeks to inhibit excessive collagen production
- Cryotherapy applied to healing wounds to reduce keloid risk
- Techniques like minimal tension closure, careful wound edge alignment, and placing incisions along skin tension lines for surgical wounds to minimize keloid formation. These preventive measures work by controlling the inflammatory response and regulating collagen production during wound healing, which is particularly important for individuals with a genetic predisposition or history of keloids, as keloid formation is a possible complication of skin trauma 1.
From the FDA Drug Label
When the strength and dosage form of the drug lend the preparation to the treatment of the condition, those products labeled for intralesional administration are indicated for: Keloids The answer to preventing keloids is intralesional steroid administration.
- Intralesional administration of steroid is indicated for keloids. 2
From the Research
Prevention of Keloids
- There are several treatment modalities that can be used to prevent keloids, including silicone gel sheets, compression, and steroid-impregnated tape 3.
- Silicone gel sheets have been shown to be effective in treating keloid scars and preventing their recurrence 4, 5, 6.
- Early recognition of keloid formation is integral in treatment and prevention of recurrence 7.
Treatment Options
- Current literature supports silicone gel or sheeting with corticosteroid injections as first-line therapy for keloids 6.
- Adjuvant intralesional 5-fluorouracil (5-FU), bleomycin, or verapamil can be considered, although mixed results have been reported with each 6.
- Laser therapy can be used in combination with intralesional corticosteroids or topical steroids with occlusion to improve drug penetration 6.
- Excision of keloids with immediate post-excision radiation therapy is an effective option for recalcitrant lesions 6.