Keloid Treatment Strategy
Keloid Successful Treatment
Successful treatment of human disease is reliant on a well thought through strategy; a treatment plan that takes into consideration many different factors including:
- Available treatment choices and expected best outcome,
- Risks associated with each treatment,
- Benefits expected from each treatment,
- Past treatment results, both benefits and side effects,
- Patient's expectations,
- Patient's age,
- And many other factors that come up in meeting with a patient,
Above and beyond these factors, a thorough understanding of the underlying disease process provides a roadmap 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.
- Keloid disorder is a genetic skin condition, as such the underlying problem does not go away,
- It is a chronic condition and all patients require ongoing management,
- It is a wound-healing problem, whereby the abnormal healing process, once it is triggered, it does not stop,
- The intensity of the underlying genetics is variable among different patients. Some patients have a mild form of the illness, and some have a very severe form,
- 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 a new injury from the scalpel.
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:
- Prevention of damage to normal tissue. This is most important when we deal with ear keloids.
- Prevention of the recurrence of keloid
- Detection and treatment of recurrence at the earliest stage
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.
Risks of Treatment
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:
- 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.