Keloid Injections

A keloid is a scar that keeps growing beyond the boundary of the original injury, producing a raised, firm, often itchy or painful lump. Keloids are most common on the earlobes, chest, shoulders, upper back and jawline, and they are far more common in patients of African, Asian and Hispanic descent. They do not go away on their own, and cutting them out without additional treatment usually brings them back larger. Injections are the first-line treatment, and Dr. Darvish has treated keloids in Los Angeles since 2005.

How keloid injections work

The primary medication is a corticosteroid, triamcinolone (Kenalog), injected directly into the keloid. It reduces inflammation, suppresses the overactive collagen production that drives the keloid, and breaks down existing collagen bundles so the scar softens and flattens. For stubborn or very firm keloids, Dr. Darvish combines or alternates the steroid with 5-fluorouracil (5-FU), a medication that slows the fibroblasts that build scar tissue; the combination is more effective than steroid alone and reduces the risk of steroid side effects. Injections are repeated every four to six weeks until the keloid is flat and symptoms have resolved.

What to expect

Before. An examination to confirm the lesion is a keloid rather than a hypertrophic scar, cyst or other growth, and a plan for the number of sessions.

During. The keloid may be numbed with a topical or a small amount of local anesthetic. Firm keloids require pressure to inject, which can be uncomfortable for a few seconds. Most sessions take five to fifteen minutes.

After. No downtime. The area may be sore for a day or two. Softening is usually noticeable within two to four weeks and the keloid flattens progressively with each session.

Combination treatment

• Cryotherapy. Freezing the keloid immediately before injection softens it so the medication distributes more evenly. Used with care on darker skin to avoid pigment loss.
• Laser. Vascular laser reduces redness and itch; radiofrequency microneedling or fractional laser improves texture once the keloid is flat.
• Surgical excision plus injection. For large earlobe keloids, Dr. Darvish removes the keloid and begins injections immediately, which greatly reduces recurrence compared with surgery alone. See earlobe repair.
• Silicone and pressure. Silicone sheets or gel and pressure earrings between visits support the result.

Results and recurrence

Most keloids flatten substantially and stop itching with a series of three to six injections. Some soften but remain slightly raised, and a minority recur months or years later and need a maintenance injection. Dr. Darvish will give you a realistic expectation at your visit. Early treatment of a new keloid is always easier than treating one that has grown for years, so do not wait.

Hypertrophic scars and acne keloids

The same injections are used for thick hypertrophic scars from surgery or injury and for the keloidal bumps that acne leaves on the jawline, chest and back. See scar removal and acne cyst injections.