Steroid Injections

Non-Surgical

Corticosteroids reduce the production of collagen and proteins that form fibrous scar tissue as well as inhibit inflammatory factors. This activity causes keloid scars to soften and become flatter.

A keloid scar is a thick raised scar. It can occur wherever you have a skin injury, but usually forms on earlobes, shoulders, cheeks or the chest. If you are prone to developing keloid scars, you may develop them in multiple areas. A keloid scar is different from that of a hypertrophic one.

A hypertrophic scar stays within the bounds of the original wound and can fade over time without treatment.

What does the procedure involve?

Steroids are often used as a treatment for smaller scars. However, in larger scars (or if injections are not effective), then a combination of surgical excision and steroid injections may be required.

The steroid is injected into the bulkiest part of the keloid scar at an angle. The needle will be inserted inside the scar tissue at tiny, spaced intervals to spread the steroid throughout the scar.

During treatment the scar tissue may temporarily look paler. It will sting and feel tense for a few seconds.

The injection needs to be repeated at intervals of 3 to 6 weeks for developing keloid scars (until it is stabilized), or monthly for 3 to 6 months on existing ones.

What are the risks and side effects?

Complications are infrequent and usually minor. However, no treatment is without risk, and it is important that you are aware of the possible complications. All the risks will be discussed in detail with you at your consultation.

Hypopigmentation / Hyperpigmentation

It is possible that the scar may become lighter or darker than the surrounding tissue. Hypopigmentation may be reversible with time (up to one year), but it could be permanent.

Skin/Fat atrophy

This occurs when scars become very thin and looks like a depression in the skin. This can occur following large amounts of steroids and/or injection in the surrounding normal tissue, which is likely to be permanent.

Cushing’s syndrome

This unlikely syndrome can develop if too much steroid is used but is very rare, given the small dose that is usually injected.

Pain on injection

Injections normally sting but can be improved with local anaesthetic or topical numbing creams. As the keloid scars soften, treatment becomes easier and less tender.

Recurrence

Steroid injections need to be repeated if there is any sign of recurrence.

What happens after the procedure?

A plaster is applied if there is a small amount of bleeding. This can be removed the same day, and you can resume normal activities.

Before you leave the clinic, you will be given a follow up appointment for 3 weeks’ time, when we can perform further injections as required.

I recommend that you massage the incisions, using small circular motions at least twice a day for 5 minutes. You can use any moisturising cream of your choice and apply firm pressure until it blanches.

The scars will also benefit from silicone scar gel (ScarAway® or Kelo-Cote®) twice a day, which will soften and fade them, as well as applying sunblock for 12 months to provide sun protection. The ScarAway® can be purchased from Healthcare Pharmacy at Governors Square in Grand Cayman.

What is the estimated time for recovery, absence from work and return to usual activities?

This is a minimally invasive procedure, and you can return to work and full activities on the same day.