Prevention

Prevention is undoubtedly vital for keloid scars because of the difficulty with treating established lesions.

Basic surgical precepts include:

• avoiding all but essential surgery in individuals with a strong personal or family history of keloid scarring
• incise along relaxed skin tension lines and close wounds under no tension
• reduce the risk of infection with thorough debridement and elimination of 'dead space'
• perfect apposition of skin edges with gentle eversion
• avoidance of placing scars in areas of the body that are more prone to keloid scarring including the pre-sternal area, deltoid area of the shoulder and on the earlobes

When a keloid is established, a number of techniques have been used to prevent recurrence after further surgery is undertaken on the site. These include:

• steroid injection into the surrounding skin at the time of keloid excision
• compression to the site of excision eg the ear lobule with dedicated compression earrings
• radiotherapy to the site

None of these techniques are completely effective. They are considered in the section on 'treatment'.