Treating Keloid Scars with Steroids
Corticosteroid injections directly into the scar are often the first treatment used for keloids. Injections are used rather than topical forms of corticosteroids because the tissue cannot absorb the medication through the skin well enough to be effective in most situations. However, topical application to superficial wounds may be helpful.5,17
| STEROID INJECTION TREATMENT DETAILS | |
|---|---|
| What Happens During Treatment | The steroid is injected into the bulkiest part of the keloid at an angle. The needle will be inserted inside the scar tissue at tiny spaced intervals to spread the steroid throughout the scar.8 |
| Other Things to Expect Before and After Treatment | During treatment the scar tissue may temporarily look paler.8 |
| How Often | Repeated at intervals of 3-6 weeks for developing keloids (until it is stabilized) or monthly for 3-6 months on existing ones.5,17 |
| Usual Type | |
| Typical Dosage |
5-10 mg/mL for developing keloids and 10-40 mg/mL for a pre-existing, fully mature keloid.5,17 The larger doses are usually used on bulky, mature keloids.21 |
| Is it Painful? | Yes, especially at higher doses. Shots can be co-administered with a numbing agent (e.g., lidocaine) or after application of a topical anesthetic cream.8 |
| Side Effects |
Possible adverse side effects such as hypopigmentation, hyperpigmentation, dark red blotches, or tissue atrophy can occur. Tissue atrophy looks like indentations in the skin, and can occur with large amounts of steroids and/or injection in the surrounding normal tissue.2,8 Hypopigmentation may be reversible with time (up to a year), but fat atrophy can be permanent.8 Cushing’s syndrome can develop if too much steroid is used haphazardly.8 |
Steroid injections are often used in combination with other types of treatment, including surgery. The shots are given before or after the other treatment, depending on the type. With cryotherapy they are given first to soften the scar tissue and make it more receptive to the cryotherapy, while with surgery the shots are given afterwards. Some experts advise that steroid injections not be given until after sutures are removed to avoid risk of reopening the wound.5
How Do Steroid Injections Work?
Corticosteroids reduce the production of collagen and proteins that form fibrous scar tissue as well as inhibit inflammatory factors.3 This activity causes keloids to soften and become flatter.5,17
Evidence of Benefit
Although some medical experts assert that steroid injections cannot eliminate keloids,5 most others indicate that they do have some success and in some cases can completely resolve a keloid. Studies repeatedly show that using steroid injections in combination with other therapies significantly increases the overall effectiveness of treatment. Outcomes are also usually better the sooner treatment is administered after a wound.3,17,21
In addition to improved outcomes in terms of lower rates of recurrence and reduced keloid size, combining corticosteroid injections with other treatment modalities can have other benefits. In some combinations (e.g., 5-fluorouracil, cryotherapy) adverse side effects associated with both treatments (e.g., pain, pigmentation changes) also diminish. Additionally, combining therapies may also hasten response to the treatment.5,17
are not given until about 2 weeks following removal of stitches.