Hi! I’m Dr Loo Keng Shien.

Here's Episode 20 of the Patient Mailbox series, where we collect handpicked questions submitted by patients suffering from various skin diseases and condition, and personally answer them with our best efforts. I hope to help any one of you who face challenges from similar situations.

Editor’s Note: Dr Loo Keng Shien is a Consultant Aesthetic Physician with a special interest in Dermatology and Aesthetic Medicine. She has highly certified qualifications from the American Academy of Aesthetic Medicine, American Academy of Anti-aging Medicine, and in Practical Dermatology from Cardiff University. She currently practices at Peter Ch'ng Clinic Skin & Laser Specialist in Desa Park City.

Question:

Hi Dr Loo,

I’m Emily, and I’d like to ask about getting rid of a keloid scar on my arm.

I have had this scar since my BCG vaccination in primary school. Since then, the scar has developed into a keloid as big as my thumb, and in a dark colour, too.

It’s been so long that I’ve avoided wearing sleeveless shirts because I just hate how my arm looks like with this scar. Why do I have a keloid but my other friends who took the same injection don't?

I’ve heard of some people talking about removing it casually at home with some methods, but I worry about the pain and any side effects - I don’t want any more scars to worsen the situation!

What would you recommend as the most effective way? Can it be simply removed with a laser treatment? Is it safe?

Answer:

Scars and keloids are caused by an overgrowth of tissues that usually develops during our skin healing process. They are usually red or purple in colour and have the appearance of a raised scar.

Causes of keloids

"Why do I have a keloid but my other friends who took the same injection don't?"

Keloids are actually caused naturally by your skin.

After the recovery of a wound on our skin, some of us get a normal scar, some of us get a hypertrophic scar (a raised scar), while some of us get keloid scars.

And if your skin has the ability to form keloids, any scars that you have can potentially turn into a keloid scar.

Keloid can appear at any part of our skin, but especially at skin areas where there's tension and movement. Some of these areas are the skin over the joints where there is constant movement, and our chest wall that constantly moves as we breathe.

Removing keloids on your own

"I’ve heard of some people talking about removing it casually at home with some methods"

I'd strongly advise not to remove keloids scars at home.

Moreover, even for us aesthetic physicians and dermatologists, we don't do any keloid removal by excision (cutting off the scar), unless it is really, really necessary. Because any cutting would form a wound, and that wound can potentially form an even bigger keloid!

Any cuts or burns (fire or acid, both common home treatment methods) on your skin can potentially lead to keloid scar formation.

Treatments for keloid scar removal

"What would you recommend as the most effective way? Can it be simply removed with a laser treatment?"

I would recommend to start a keloid scar removal treatment with injections.

There are a few medications administered by a verified dermatologist or aesthetic physician that can be injected into the scar to reduce the scar.

Then, we can move on to laser treatments to reduce the size of the blood vessels causing the swelling and dark, blood coloured vascularity of the scars. 

Some of the lasers that can be used are copper bromide laser and fractional co2 laser. In some cases, it may also be necessary to infuse steroids to control the swelling of the scar.

*Editor's note: Even though laser treatments may sound simple, laser treatments provided by beauty centres or unverified non-medical sources may not provide the best option for safety and effectiveness. The handling of the laser machine, the adjustment of the laser intensity, and the diagnosis of treatments all come from the knowledge and experience of a certified dermatologist or aesthetic physician. If you want to get your skin condition checked by Dr Loo, you can always call us at +6011-22882299, WhatsApp us here, or book an appointment with Dr Loo here!

During the treatment, you may feel a certain degree of pain. But we usually inject local anaesthesia around the scar before injecting medication into the scars so that the pain is reduced during the treatment process.

After the injection, you may experience blisters, darkening of the skin around the treatment area, or peeling of the skin. But these are all temporary symptoms, part of the recovery process to remove the keloid scar.

Always talk to your dermatologist or aesthetic physician in detail regarding the treatment expectations before undergoing any treatments!

"Will my keloid appear again?"

To be honest, there is indeed a chance of recurrence or reappearance of the scars on your skin. And if it does happen, there are always other medications that can be injected to prevent a reappearance of the scars.

I always tell patients of keloid scars - always be careful not to cause any further injury to the site of the scar to prevent any reformation of the keloid.

And if you have acne problems, do make sure you control your acne very well, because acne can cause keloid scars, too.

*Editor's note: To know more about how to take care of your acne problems, do take a look at the advice from our dermatologist, Dr Peter Ch'ng, here: Patient Mailbox: Acne Affects My Job

And before going under any surgery, remind your surgeon that you have the tendency to form keloid scars, so that your surgeon can reduce the chances of keloid formation by injecting the medication immediately after the surgery.

Like any skin growth, a scar that is protruding can be removed by cutting, pulling, or burning it with any acidic substances. However, this can either cause an ever worse scarring or burns to our skin.

To avoid any complications, it is important to always opt for a safe and effective treatment rather than a cheap but risky method.

Safety first!

Stay tuned next week as we take a look at some simple steps to prevent a keloid scar formation, see ya!

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If you’d like to ask more about your skin condition or have a discussion with Dr Loo, call us at +6011-22882299, Whatsapp us, or book an appointment with Dr Loo here!