Alternative therapies for keloid and hypertrophic scars have had variable success and are typically used in specialist centres under the supervision of dermatologists or plastic and reconstructive surgeons.
Interferon is thought to reduce keloid production of collagen I, III and VI. It has been administered as an intralesional injection, either to the lesion itself or to the surrounding skin after excision. Studies have shown an improvement in erythema and texture.
5-fluorouracil is an antimetabolite. It is thought to reduce fibroblast proliferation. It has been injected intralesionally into active keloids and has produced flattening. It has been found to be effective in combination with other modalities like immunomodulators and laser irradiation. Bleomycin, another chemotherapeutic agent, has been used in a similar manner.
Verapamil is a calcium channel blocker that inhibits the deposition of extracellular matrix molecules. Intralesional injection has produced an improvement in texture, vascularity and size of keloids.
Imiquimod is an immunomodulator molecule that is applied as a 5% cream. Early results indicate that it may be effective for both hypertrophic and keloid scars.
Radiation is a longstanding treatment for keloids showing relentless progression. 12 Grays is thought to be the minimum superficial dose to be efficacious. However, outcome studies are conflicting with a high rate of recurrence in some reports. Also, there is the theoretical risk of neoplastic change.
Excision of keloids in isolation is associated with an unacceptably high recurrence rate. In combination with adjunctive modalities like pressure garments, recurrence can be reduced to less than 50%.
The pulsed-dye laser has found great utility in the treatment of erythematous scars. Its mechanism is thought to be that of microvascular thrombosis. After treatment, scars demonstate less redness and increased pliability. Its main use is in hypertrophic scarring. However, a great commitment is required by the patient as often, multiple treatments are required in an outpatient setting.
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