Medical Treatment for Scars & Keloids

Dermatologists at NYU Langone understand that noticeable, poorly healed scars can affect how you feel about your appearance, especially if they are located in a highly visible place such as your face or hand. Our doctors offer noninvasive techniques to minimize the appearance of all types of scars and, in some instances, prevent a surgical wound from becoming a hypertrophic scar or keloid.

 

Over-the-Counter Topical Treatments

A variety of topical silicone products, which are available without a prescription, may reduce the size and color of scars. When applied to the scar, silicone attaches to the tissue at the molecular level. It is thought that by creating tension on the surface of the skin, silicone can prompt the body to shrink excess collagen and repair broken blood vessels, which cause scars to look red and swollen. 

Topical silicone products are available as gels, as well as adhesive sheets that have a layer of silicone gel on one side and fabric backing on the other. Topical silicone products can be applied to scars that are still pink and healing, as well as older scars, including small hypertrophic scars and small keloids. These products are safe for people of any age and skin tone. 

When a silicone-based product is applied and left on the skin for 12 hours or more per day, many people see results within two to four months, although the time frame varies from person to person. Our dermatologists determine how often you should apply the topical silicone and how long to continue treatment based on the size and location of the scar, the cause of the skin wound, and the type of scar. 

Additionally, there is a new silicone surgical dressing that is designed to take tension off the wound itself and may minimize postsurgical scarring.

Steroid Injections

Dermatologists may inject a corticosteroid solution directly into a hypertrophic scar or keloid, which may help reduce its size. Steroids break the bonds between collagen fibers, which reduces the amount of scar tissue beneath the skin. Steroids also have powerful anti-inflammatory properties, which can help reduce swelling, redness, itching, or tenderness.

Steroid injections are usually administered in a dermatologist’s office after a scar has healed. If you have a history of hypertrophic scars or keloids and require surgery, a doctor may inject steroids into the area before surgery begins. Presurgical steroid injections may prevent a hypertrophic scar or keloid from forming—or they may reduce the scar’s size. Surgeons may administer an additional steroid injection during surgery as well. 

If a hypertrophic scar or keloid develops after surgery, dermatologists recommend getting steroid injections every four to six weeks, limiting the total number of injections to five. The procedure takes about 15 minutes, and often no anesthesia is required. 

In the hours after an injection, you can break up scar tissue yourself and improve the effectiveness of the injections by gently massaging the scar. Side effects may include thinning or sunken skin at the site of injection.

Superficial External Beam Radiotherapy

Superficial external beam radiotherapy is a low-dose radiation treatment that uses highly focused beams of light called superficial X-rays to destroy collagen-producing cells and limit the growth of new ones. These specialized X-rays do not penetrate deep layers of skin, so they don’t affect healthy tissue. Dermatologists may recommend radiotherapy if a keloid does not respond to steroid injections and topical silicone treatment, or if the keloid is particularly large. 

Radiotherapy is a painless process. Depending on the location of the keloid, you sit or lie down on an exam table. A radiation therapist covers the surrounding skin with a lead apron to protect it from radiation, then positions the radiotherapy machine so that it rests directly on the keloid. Treatment takes less than 10 minutes. Afterward, a doctor may place a bandage over the keloid to prevent infection and protect it from sun exposure. 

Often, superficial external beam radiotherapy is used to prevent a keloid from growing back after it has been surgically removed. Radiotherapy is typically recommended within 24 to 48 hours of surgery for the best results. 

Doctors determine whether more than one radiotherapy session is necessary based on the size of the keloid, whether you had the keloid surgically removed prior to radiotherapy, and the results of the first radiotherapy session. Your dermatologist evaluates the success of radiotherapy in a follow-up appointment about a month after the first session. Side effects include redness and tenderness at the site of therapy. 

Laser Treatment

Dermatologists may recommend laser treatment to reduce redness or discoloration in older scars. Laser therapy is also used to correct uneven skin tone affected by acne scarring and to minimize the appearance of stretch marks. 

Pulsed Dye Laser Therapy

Pulsed dye laser therapy is an effective treatment for reducing redness and discoloration in scars, even if a scar healed a long time ago. The pulsed dye laser is a highly focused beam of light that dermatologists focus on scarred skin using a handheld device. The energy from the laser causes the blood vessels in scar tissue to shrink and eventually dissolve. 

It also causes a scar to lighten because the blood vessels are what cause redness and discoloration in a scar. Over several sessions, pulsed dye laser therapy can more closely match the color of a scar to the surrounding skin. 

Pulsed dye laser therapy is administered in a dermatologist’s office and causes few side effects. There may be slight bruising around the area of the scar; this fades in one or two days. 

Fractional Carbon Dioxide Laser Therapy

Fractional carbon dioxide (C02) laser therapy uses a high-energy beam of light to speed up the skin’s exfoliation and repair processes, and to remove scarred or discolored outer layers of skin. The term “fractional laser” means the beam hits only a fraction of the surface at a time. 

Rather than completely resurfacing the area being treated, the laser touches tiny areas of skin with microscopic beams of light, leaving the skin surrounding a scar untouched. Because large areas of the skin are left untreated, the healing time is faster. 

A dermatologist performs fractional C02 laser therapy in his or her office using a small handheld device. After a local anesthetic is applied to the areas being treated, the device is passed over the skin. Depending on the size and texture of the scar, multiple sessions may be needed. Dermatologists typically recommend scheduling sessions every six to eight weeks. 

After each treatment, the dermatologist places a bandage over the areas that were treated. Swelling, redness, and itching are normal and typically diminish in five to seven days, when the top layer of skin begins to peel. A dermatologist recommends keeping your skin moisturized and clean during the healing process to prevent infection. Wearing a broad-spectrum sunscreen with an SPF of 30 or above is also recommended when you are exposed to the sun. 

Possible side effects include permanent light or dark spots and burns.

Dermabrasion

Another method used to remove scars is dermabrasion, which is a technique similar to sanding or scraping. Doctors may recommend dermabrasion if you have burn or acne scars or hypertrophic scars that span large areas of skin. Dermabrasion is not recommended for the removal of keloids.

To perform the procedure, a dermatologist first injects a local anesthetic into the areas of skin being treated. He or she then uses a small tool that has a rough, rapidly spinning surface to remove scar tissue. This technique does not completely eliminate a scar, but it softens the skin and helps the color and texture of the scar blend in with the surrounding skin. 

After dermabrasion, the skin may bleed. This is normal, and doctors apply antiseptic bandages to prevent infection while the skin heals. It may take 10 to 14 days for the skin to completely heal. During this time, doctors recommend using a broad-spectrum sunscreen with an SPF of 30 or above every time you are in the sun. Your skin may have a pink appearance for several weeks while new skin cells replace the layers that were removed. Most people see smoother skin after two months. 

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