Successful treatment of human disease is reliant on a well thought through strategy; a treatment plan that takes into consideration many difference factors including:
Above and beyond these factors, a thorough understanding of the underlying disease process provides a road map for devising successful treatment strategies. Think about diabetes. The underlying issue is “lack of insulin”, which leads to a rise in blood sugar, which in turn can cause numerous problems. Treatment strategies focus on either boosting body’s ability to produce more insulin, or to provide insulin by way of injections.
As for Keloid Disorder, the matter is lot more complicated. Although there are many uncertainties about the disease process at the molecular level, there are several facts that we do know about this illness. These facts should be taken into account in treating each and every keloid patient.
The goal of treatment for keloid lesions, and ear keloids in particular, should not only be focused on simple removal of the keloid tissue but, most importantly, on two very important principles:
Performing surgery to remove keloids is inherently contrary to these principles. Surgery, by its nature induces a totally new injury to the skin which leads to triggering of the abnormal wound healing response and formation of a new, yet larger keloid. As for ear keloids, quite often, surgical removal of a keloid also results in the loss of surrounding normal ear tissue and unacceptable aesthetic outcome. .
So when we start on the path of treating keloid patients, we must respect all these very basic physiological principals. For over a century, dating back to 1905, surgeons noticed that treating keloid lesions is problematic, even when radiation therapy was used as an adjunct to surgery. Why? Simply because this approach does not respect the most basic principals that were mentioned above.
In addition to achieving results, one has to also be cognizant of risks associated with each treatment option. The diagrams below depict risks that are associated with each treatment path.
Unfortunately, many keloid patients are advised to have surgery for a small keloid. Once the keloid re-grows, they are offered more surgery. And once the keloids regrow bigger, they are offered more surgery and radiation. Although some patients do benefit from this treatment path, there are lots of risks associated with going down this path. The diagram below depicts this path:
In Dr. Tirgan’s opinion, a shift in the treatment approach to keloid disorder is needed. We need to distance ourselves from surgery and radiation, and focus on non-surgical treatments. Treatment approaches have to respect all above principals, and take into account the following: