How much do you know about keloid scar treatment? Principles of management to reduce recurrence

The goal of keloid scar treatment is not to 'completely eliminate' them, but to reduce their size, soothe symptoms like itching and pain, prevent recurrence, and improve their appearance. Since keloids are abnormal scars that grow beyond the boundaries of the original wound into normal skin, it is rare for a single treatment to clean them up perfectly. Therefore, in most cases, a 'combination therapy' approach is used, combining methods such as intralesional steroid injections, silicone, compression, and lasers to suit the condition.

Particularly, it is important to note that keloids do not disappear on their own over time. If left untreated, they may actually grow larger or spread. Therefore, accurately diagnosing the scar's 'activity' and establishing a treatment plan tailored to that state is the first step. Gangnam Onlif Clinic views keloids from this perspective—directing treatment to manage tissue activity through non-surgical procedures from a dermatological standpoint.

🔍 What exactly is a keloid?

A keloid is a raised scar that occurs when excess collagen is produced during the wound healing process. The key causal cells are **fibroblasts (Fibroblast)**, which are abnormally active and continuously build up collagen.

The biggest risk factor is a **genetic predisposition, the so-called 'keloid constitution'**. About 1 to 2% of the total population has this constitution, and it occurs with high frequency in individuals of African, Asian, and Hispanic descent. The most common age of onset is between 10 and 30 years. They tend to occur in areas of high skin tension, such as the anterior sternum, earlobes, shoulders, upper arms, and jawline.

One reassuring point: Keloids are benign lesions, they are not contagious, and they do not turn into cancer. However, if they suddenly grow larger or are accompanied by ulceration or bleeding, they require differentiation from other diseases, so it is recommended to seek medical attention.

📌 Key Summary: Keloids are caused by the overproduction of collagen by fibroblasts, have a strong constitutional factor, and are benign scars that do not disappear on their own.

⚖️ How do keloids and hypertrophic scars differ?

These two types of scars are often confused, but their management directions are different. The most definitive point of differentiation is **'whether they cross the wound boundary' and 'whether they improve naturally'**.

While time can be the cure for hypertrophic scars, it is not the case for keloids. If a scar grows beyond the boundary and does not shrink on its own, there is a high probability that it is a keloid, and it is approached as an object of active management.

📌 Key Summary: If it grows beyond the wound boundary and shows no natural improvement, it is a keloid; if it stays within the boundary and has the potential to improve, it is a hypertrophic scar.

💉 What keloid treatments are available?

For keloids, combination therapy is better than a single treatment for both suppressing recurrence and improving symptoms. Here is a summary of the representative methods.

Intralesional Steroid Injection (First-line Treatment)

The most common first-line treatment is drug intralesional injection. It is used to suppress the activity of over-proliferated tissue and reduce its size. It is usually repeated at intervals of 3 to 6 weeks, with a reported response rate of about 50 to 100% and a recurrence rate of about 9 to 50% in literature.

If the response is insufficient, it is used in combination with steroids. If there is still no response to anticancer-type drugs that suppress fibroblast proliferation, other drugs are sequentially reviewed and the response is monitored.

Silicone Gel/Sheet (Prevention/Auxiliary)

Silicone gels and sheets are the primary non-invasive options for scar prevention and early management. They must be used consistently for at least 12 hours a day for at least 2 to 3 months to be meaningful. However, it is difficult to eliminate already matured keloids with this alone.

Compression Therapy

This applies continuous pressure to the tissue to suppress overgrowth. It is recommended to maintain a pressure of about 20 to 30 mmHg for several months to over a year. For earlobe keloids, **pressure earrings** are sometimes used, and studies have shown that when compression is combined, the recurrence rate drops to about 5%.

Laser Treatment

**Laser treatment is utilized to improve vascular symptoms such as redness and itching, improve surface texture, or assist in drug delivery. Eliminating keloids completely with laser alone is not realistic; synergy is achieved when used alongside injections and compression.

📌 Key Summary: Steroid injections are first-line, and combination therapy, which mixes silicone, compression, and lasers according to the condition, is the standard.

⚠️ Doesn't surgical excision lead to recurrence?

This is an area where many people misunderstand. When surgical excision is performed alone, the recurrence rate is reported to be 45 to 100%, meaning that recurrence must be expected in virtually almost all cases. This is because keloids have a vicious cycle where a new wound forms at the excision site, and that wound turns into a keloid again.

Therefore, even if surgery is unavoidable, adjuvant therapy must be combined. For example, if radiation therapy is started within 24 to 48 hours after surgery, the recurrence rate can be lowered to below 10%, and some studies report a recurrence suppression effect of over 90%. A total dose of about 12 to 20 Gy in fractionated therapy is used. However, radiation therapy must be approached with extreme caution in children, adolescents, and areas adjacent to the thyroid, breast, or gonads.

The direction in which Onlif Clinic views keloids is slightly different. Instead of surgical excision, we prioritize non-surgical management that diagnoses the scar's activity and combines intralesional drug injections, lasers, and compression therapy. This approach places weight on suppressing and stabilizing overactive tissue activity rather than stimulating tissue to create new wounds.

📌 Key Summary: Surgery alone has a very high recurrence rate and absolutely requires adjuvant therapy; Onlif prioritizes non-surgical lesion management.

📈 How is treatment progress monitored?

Keloid treatment is not a procedure that ends in one session; it must be viewed as a long-term maintenance concept. Depending on activity, treatment is often continued multiple times at intervals of 3 to 4 weeks in the early stages.

For determining progress, standardized scar assessment scales such as the Vancouver Scar Scale (VSS) or POSAS are used. These are tools that score color, thickness, flexibility, and subjective symptoms to objectively monitor trends of change. After treatment, regular observation for usually 1 to 2 years is required to check for recurrence.

For reference, evidence that topical agents like onion extract gel alone significantly reduce keloids is limited. Although there are auxiliary topical agents under study, such as imiquimod, aimed at suppression through immune regulation, it is accurate to understand them strictly in an auxiliary role.

📌 Key Summary: Keloids require long-term management, and it is recommended to evaluate progress with VSS and POSAS, and carry out regular observation for 1 to 2 years.

🛡️ How do you prevent keloids?

If you have a keloid constitution, prevention is the most reliable strategy. The key is to avoid creating new wounds.

• Carefully decide on unnecessary piercings, tattoos, or cosmetic procedures.

• If a wound occurs, manage it with silicone gel or sheets from an early stage.

• Avoid irritation to high-risk recurrence areas such as the ears, chest (sternum), shoulders, upper back, and jawline.

• If there is a family history, consult beforehand to check the risk.

While dealing with skin concerns, points of intersection with other axes like texture, elasticity, and volume also arise. The fact that Onlif deals with skin texture and elasticity through non-surgical procedures like ultrasound HIFU, radiofrequency RF, and skin boosters stems from the same philosophy—removing the concerns that were masking it, without harming the skin's inherent state.

📌 Key Summary: For a keloid constitution, avoiding unnecessary wounds and managing wounds with silicone from an early stage is the best prevention.

❓ Frequently Asked Questions (FAQ)

Do keloids go away on their own?

No. Unlike hypertrophic scars, keloids rarely regress naturally and tend to maintain their size or even grow larger over time. Instead of waiting for them to improve on their own, it is better to have their activity diagnosed and managed.

What is the most effective keloid treatment?

Combination therapy is more effective than a single treatment. The best results for suppressing recurrence and improving symptoms are achieved when combining silicone, compression, laser, and 5-FU based on the condition, with intralesional steroid injections as the foundation.

How often should steroid injections be administered?

They are usually performed repeatedly at intervals of 3 to 6 weeks at a concentration of 10 to 40 mg/mL. Depending on the activity and response level of the keloid, it is often continued 3 to 6 times or more in the early stages, and the exact number of times is determined after diagnosis.

Can lasers completely remove keloids?

It is difficult to completely eliminate them with laser alone. PDL plays an auxiliary role in improving redness and itching, and fractional CO₂ helps with surface texture improvement and drug delivery; they show synergy when combined with injection and compression therapies.

Is keloid treatment covered by health insurance?

If accompanied by functional symptoms such as pain, itching, or contracture, partial coverage may apply. However, since it varies depending on the scar condition and the purpose of treatment, it is accurate to check individually during medical consultation.

How is a keloid that forms after ear piercing treated?

In many cases, intralesional drug injections are combined with compression therapy, such as pressure earrings. Studies show that when magnetic compression is combined after excision, the recurrence rate drops to about 5%, making recurrence prevention management particularly important.

Can keloids turn into cancer?

No. Keloids are benign lesions that are not contagious and do not turn into cancer. However, if they grow rapidly or exhibit ulceration or bleeding, they require differentiation from other conditions, so please seek medical attention.

Can I receive keloid treatment during pregnancy?

During pregnancy, certain drug injections or radiation therapy may be restricted. Since non-invasive management like silicone and compression is often prioritized, you must inform your doctor of your pregnancy and decide on a safe method through consultation.

Keloids are scars whose course varies greatly depending on individual constitution and condition. Therefore, rather than a standardized answer, accurately diagnosing the activity and type of your scar before choosing a direction is more important than anything. We recommend checking for an accurate diagnosis and a management plan tailored to you through consultation. Gangnam Onlif Clinic aims for a direction that helps stabilization without excessive irritation, using personalized designs tailored to the scar type and tissue condition.

Keloid Scar Treatment, Things to Check Before Choosing a Clinic

Even for the same procedure, the results and recovery process vary depending on where, by whom, and how it is performed.

Asking these questions directly during consultation will help you make a decision.

• Is it a clinic that performs the procedure frequently? — Each clinic has different procedures they focus on. Check if it is a place that regularly performs keloid scar treatments.

• Can I verify the products and equipment used? — Ask if you can verify the product name and authenticity (whether it is an officially imported product and if there is an unboxing verification process) during the consultation.

• Is the cost breakdown explained? — Rather than just hearing the total amount, you need to hear an explanation of what product is used, how much, and on what area to make an informed judgment.

• Is the treatment designed with the whole face in mind? — Even for the same procedure, the injection location and amount vary depending on face shape, skin condition, and left-right asymmetry.

• Are adverse reactions and the recovery process explained first? — It is better to choose a place that informs you of possible adverse reactions and coping methods, rather than a consultation that only talks about expected positive changes.

• Is there a follow-up pathway after the procedure? — Check if the timing for progress checks, how to contact if there is an issue, and criteria for re-visiting are established.

This is how Onlif Clinic treats keloid scars

• We divide responsibilities — With the belief that a single doctor cannot cover every single procedure, Onlif divides medical treatments among doctors responsible for each specific field.

• We verify products and equipment together during consultation — We guide you through the products used and the unboxing verification process during the consultation.

• Costs are guided along with the breakdown after diagnosis — Since the area, dosage, and scope differ for each person, we explain what costs how much together.

• We design by looking at the balance of the whole face — Looking at the face through three axes—texture, balance, and signals of youth—we plan to tidy up parts that mask your inherent impression rather than changing your features.

• We tell you about adverse reactions and the recovery process first — Along with the expected changes, we guide you through individual differences, potential adverse reactions, and coping methods before the procedure.

• We monitor progress together after the procedure — If verification is needed during the recovery period, we provide guidance on re-visits and contact channels.

If you are considering keloid scar treatment, it is best to first check what is possible and what is difficult in your current state.

Accurate diagnosis and treatment planning can only be determined through an in-person consultation. Please check through a consultation at Gangnam Onlif Clinic.