Keloid Steroid Injection Singapore —
Placed In The Scar, Reviewed Each Visit

A keloid is a repair that never switched off. Fibroblasts in the deep dermis keep making type I and type III collagen, and a low level of inflammation keeps them going. The broader reasons keloids recur, and why cutting one out alone backfires, are covered on keloid treatment; this page is about the injection.

A corticosteroid interrupts that loop at several points at once. It reduces the inflammation, slows the fibroblasts' collagen production, increases the breakdown of collagen already laid down, and narrows the small vessels feeding the scar. Given as a suspension, it stays largely where it is placed instead of travelling round the body.

Placement is the whole technique. The medicine goes into the dense body of the keloid, not into the normal skin around or beneath it, because steroid in normal skin thins it. Over a course, most keloids become softer, flatter and less itchy, and the itch often eases before any change in height shows. How far it flattens depends on the keloid's size, age and site, and on you.

Injection is offered for a keloid that has been confirmed on examination and is raised, itchy, tender or still growing, whether on the earlobe, the chest or shoulder, or the jawline. It is also used for a hypertrophic scar that has not flattened with silicone and pressure, usually at a lower strength and over a shorter course, once the scar type is clear; the difference is set out on keloids and hypertrophic scars.

The tendency to form keloids is largely inherited, and keloids form far more often in Chinese, Malay, Indian and African skin. Triggers include piercings, acne, surgical wounds, burns, BCG vaccination and sometimes a minor scratch, and high-tension sites such as the chest, shoulders, jawline and earlobes are most affected.

Wait, or talk it through first

• Deferred when the skin over the scar is broken or infected.
• Reviewed carefully in pregnancy and breastfeeding, when treatment is often put off unless symptoms are severe.
• Discussed before starting if you have diabetes, glaucoma or another condition a corticosteroid can affect.
• Examined first, and possibly biopsied, if a lump appeared without any injury, grows quickly, bleeds or ulcerates.

Steroid injection is for raised scars only. Sunken acne scars are the opposite problem and are treated by scar reconstruction.

1. At the first visit, Dr SY confirms the scar is a keloid and records its size, firmness and symptoms, your family history and any earlier treatment. Photographs are taken with your consent for your medical record only.
2. You receive a written plan with the staging, and what will sit alongside the injections between visits.
3. On the day, the skin is cleaned and numbing cream or cold is used if agreed.
4. Small amounts go into several spots within the keloid, until the scar turns faintly pale. Because the tissue is dense, expect pressure and a sting.
5. Silicone or pressure resumes as advised.
6. At each later visit, flattening, softness, itch, tenderness and the surrounding skin are checked, and the strength, amount and timing of the next injection are adjusted. Softening usually comes before flattening.

Tenderness and slight swelling settle over a few days. Silicone is worn daily to help hold the flattening, and an earlobe keloid usually goes back under a clip earring for steady pressure.

Leave the area alone: no squeezing or picking, no tying off with thread, and no acids, vinegar or unregulated bleaching creams. Put off new piercings and tattoos on keloid-prone skin during treatment.

A flattened keloid is controlled, not gone for good. The tendency remains, regrowth is more likely at high-tension sites, and keeping up silicone or pressure, with early treatment of any thickening, is part of the plan.

Expected: pain during the injection, tenderness afterwards, a little swelling and small bruises.

If steroid reaches the skin around the keloid: thinning of that skin, a dent where fat beneath has shrunk, lighter patches that show more in darker skin, and fine visible vessels. These are limited by placing the medicine within the keloid, keeping the dose to what the scar needs, and checking the surrounding skin at every visit.

With large or repeated doses, some medicine can be absorbed into the body. Before a course starts, possible effects such as period changes, acne and higher blood sugar in people with diabetes are discussed.

Contact the clinic if pain increases, redness spreads, pus or fever appears, the scar opens, the lesion grows quickly, or the nearby skin thins or changes colour markedly. More on complication care.