LAM FACIAL PLASTICS

Just wanted to get your view Dr Lam on the use of Cortisone for the treatment of keloids. Also l have claims being made of the use of kelo cote for the 'treatment' of old scars, is this useful at all in this regard?

cortisone works for keloids. unfortunately, i gave up using them in isolation. they tend to lead to ongoing recurrence of the keloid, i.e., failure. the only thing that i have seen that definitively works on keloids is surgical excision with timed radiation starting within 24 hours after removal. in most cases you do not even need steroid if you do that.

as far as kelo-cote, yes i recommend anything silicone gel based for the skin surface to help with collagen alignment for keloids and hydration for hypertrophic scars. in other words silicone works for both types of scars. i used to think it only worked for keloids but new evidence suggests that it can work on both.

i just got back from boston for a hair transplant meeting and one of the most fascinating things i learned was using ACE inhibitors (a blood pressure medication) to treat keloids and other scars. i now use 5% captopril cream on the scar and have not prescribed the oral pill because i am worried about blood pressure drop but have advised my patients to get a prescription from their family doctor if it is ok for enalopril 10 mg once a day for 6 months which has through case studies been thought to be effective.

Dr Lam,

Thanks for your response. You mention what definitely works for keloids is surgical excision along with timed radiation, would this procedure be open to a child of 5 years old with keloid on her ear lobe?

I note with fascination what you say about captopril and enalapril, especially considering they are normally used for treatment such as hypertension, how do they work for keloids?

hmmm, the 5 year old age is perhaps a problem. i don't have an easy answer for a 5 year old. maybe pressure clips? that is a hard one. i really have no idea how ACE inhibitors work but i have started to put everyone on them in whom i think would benefit.

So at what age, Dr Lam, would you, in your case, be prepared to carry out the procedure you describe as best for getting rid of keloid? I am just concerned that as my child gets older so would the keloid grow bigger.

With pressure clips can these be used on raised keloids on the earlobe or are they best used immediately after excision?

many thanks.

that is a great question. i typically only deal with adults for this so i don't have a clear answer. i would have you check with a radiation specialist to understand the risks in a young child because that is my limiting factor not the surgery. once radiation is done, typically you don't need the pressure clips. i rarely use them since i typically do a combination of surgery and radiation for keloids to get the highest chance of success.
best,
sml