Keloid Treatment Using Botulinum Toxin

The human body has an amazing ability to repair and heal itself when your skin is damaged, all thanks to the presence of stem cells in the skin which produce fibroblasts, increasing the production of collagen for wound repair.

Why do keloids form?

As a natural response to protect our body, collagen production occurs to form a fibrous scar tissue over the wound to protect and repair the skin. However, when an overzealous response occurs, hypertrophic scars or keloids will form. This is caused by excessive amounts of collagen deposited at the site of the wound.

Patients often seek treatments for keloids not only for aesthetic, but medical reasons. The keloids can be uncomfortable because they rub against our clothes. They can also restrict range of motion, itch, and bleed. 

Keloids grow bigger than the margins of the original scar, making them unsightly. They are usually found on the chest, ears, shoulders, cheeks, arms, and knees. 

Identifying first signs of keloids

Close up of a Keloid Scar

Look out for the following signs and symptoms which may mean that keloids may be forming:

  • RAISED PINK, RED OR PURPLE SCAR If the scar appears to be slightly raised that is either red, pink or purple, you need to monitor the change of its size and appearance over the next few weeks. Keloids tend to be round or oval if it is behind the earlobes and it tends to have a wide, flat surface if it’s on the chest, legs or arms.
  • SLOW GROWTH Keloids tend to grow slowly. Some can grow in size and continue to spread for weeks or months. In rare cases, keloids may even continue to grow for years.
  • FEELS RUBBERY AND SOFT When you touch the scar, it feels soft but firm to the touch.
  • MAY FEEL PAIN OR ITCHY Keloids may sometimes feel itchy or painful to the touch when they are growing.
  • TURNS DARK Once keloids stop growing, it will turn darker than the surrounding skin. 

First line of treatment for keloids

Keloids are very challenging to treat because they tend to recur. In some cases, incomplete management of keloids can lead to worsening and growing of the scar tissue.

Some common treatment modalities for treating keloids are:

  • CORTICOSTEROIDS Intralesional steroids are usually the first line of treatment for keloid scars. Several rounds of injections at intervals of 4 to 6 weeks are required. 
  • TOPICAL CREAMS Topical ointments and steroids may be given to reduce the redness and itch which one may experience.
  • LASER TREATMENTS Vascular lasers such as the Dual Yellow Laser have been shown to improve the appearance of keloids by flattening the scar tissue.
  • 5-FLUOROUCIL A well-known chemotherapeutic drug, 5-fluroucil can be administered intralesionally for the treatment of recalcitrant keloids.

Keloid treatment using Botox

Botulinum Toxin or Botox

Treating keloids using botox is a relatively new modality to accelerate scar healing as well as to prevent the worsening of keloids.

The use of corticosteroid injection is often the only treatment modality, but they usually appear again in 3 to 4 weeks. Despite using other modalities such as 5-fluorouracil, silicone gel, lasers and IPL, results are still poor.

At Radium, we use a 3-step approach to treating newly formed keloids is as follows:

  • Corticosteroid is then injected into the scar to flatten the keloid. 
  • Laser treatment is first given to reduce any redness and inflammation of the skin. The treatment also reduces blood flow to the keloid.
  • Botox Micro-injections are administered all around and into the keloid to decrease muscular tensile force of the scar on the surrounding skin. It also inhibits the growth of the keloid by modulation collagen deposition and inflammatory cytokines. 

This therapy is done every 4 weeks until the size of the keloid has significantly reduced. This usually takes about 6 to 8 treatments on average. Your doctor may need to perform all 3 steps, or just 2 out of 3 of the steps, depending on your condition. 

The treatment can also be preventative. If you are prone to getting keloids and suffer a fresh wound, only botox treatment is required to prevent the formation of keloids.  The first treatment can be done 6 to 7 days after sustaining the injury. 

Although the mechanism of action of Botulinum toxin on keloids remain somewhat unclear, there has been no significant adverse side effect attributed to its treatment.

Certainly, more in-depth studies need to be carried out to understand the effects of botulinum toxin on keloids are needed before we can claim its long-term benefits on recalcitrant keloid scars.

Radium Medical Aesthetics now offers this 3-step approach to treating keloids. Make an appointment with us to get rid of stubborn keloid today.

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