Keloid Treatment Strategy:
Successful treatment of a disease is dependent on a well thought through strategy and a treatment plan that takes into consideration many different factors including:
- Available treatment choices and expected best outcomes,
- Risks associated with each treatment,
- Benefits expected from each treatment,
- Past treatment results, both benefits and side effects,
- Patient's expectations,
- Patient's age,
- Distance from the treatment center
There are many other additional factors that come up in meeting with the patient such as important life events, travel plans, exam schedules, etc. Above and beyond these factors, a thorough understanding of the underlying disease process provides a roadmap for devising successful treatment strategies. Think about diabetes whereby the underlying problem is lack of insulin which leads to a rise in blood sugar. This in turn can cause numerous problems. Treatment strategies for diabetes, therefore, 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 condition, and therefore, these known facts about keloid disorder should be considered in treating each and every keloid patient.
- Keloid disorder is a genetic condition, as such the underlying problem does not go away and will remain with the patient.
- It is a chronic condition, and all patients require ongoing care.
- It is a wound-healing problem, whereby the abnormal healing process, once it is triggered, it usually does not stop.
- The intensity of the underlying genetics is very variable. There are patients who have a mild form of the illness and develop one or few keloids, and some who have a very severe form of the disease and over time develop numerous large keloids.
- The disease process involves different parts of the skin and is not limited to the site of the first keloid.
- Besides genetics, there must be an injury to the skin, that would trigger the abnormal wound healing response that leads to the formation a keloid lesion. Treatment approaches should not cause a new injury to the skin. In case of surgery as a method of treating keloids, the treatment path starts with inflicting a totally new injury to the skin by the surgeon’s scalpel.
As part of the treatment plan, we also need to set certain goals before starting the treatment. These goals include:
- Successful and complete removal of the keloid lesion
- Prevention of loss of normal tissue. This is most important when we deal with ear keloids. Minimizing the risk of recurrence
- Detection and treatment of recurrence at the earliest stage
Performing surgery to remove keloids is inherently contrary to many of these principles. Surgery, by its nature, induces a totally new injury to the skin and often leads to triggering of the abnormal wound healing response and formation of a new keloid that often grows to become larger than the original keloid. As for ear keloids, quite often, surgical removal of a keloid also results in the loss of normal ear tissue and deformity of the ear.
So, when we start on the path of treating keloid patients, we must respect all these basic principles. 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 principles.
Risks of Treatment
In addition to achieving results, one must also be cognizant of risks associated with each treatment option. The diagrams below depict the risks that are associated with each treatment path.
Risk Assessment in Treatment of Keloid Patients
Risk Assessment in Treatment of Keloid Patients
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:
Keloid Successful Treatment
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:
- Cryotherapy is an effective method to reduce the mass of bulky keloids,
- Cryotherapy does not trigger keloidal wound healing response,
- Cryotherapy, when applied properly, is the best method for the treatment for almost all ear keloids,
- Cryotherapy should be delivered properly and repeated as many times as required.
- Flat keloids are best treated with injection of steroids or chemotherapy drugs.
- Laser treatments and most topical products are minimally effective,
- Radiation therapy carries a risk that is unwarranted,
- Treating keloid patients is much like treating hypertension and diabetes. Patients need to be followed for a very long period of time.
- We desperately need systemic treatments for patients with diffuse and extensive keloids.
KRF - Treatment Guidelines - Keloid Treatment Strategy
To learn more about Keloid Treatment Risks and Treatment Strategy, you can read Keloid Treatment Strategy that was authored by Dr. Tirgan.