What is Radiation Therapy in the Treatment of Keloids?
Keloids are harmless raised scars that develop due to an overgrowth of tissue and excess skin protein known as collagen during the skin healing process. Even though they are non-cancerous, keloids can sometimes negatively affect one’s self-esteem and quality of life. Normally, when the skin is injured, the wound closes and leads to a flat scar. But, if something goes wrong during the wound healing process, it can result in the continuous growth of a keloid scar, which can be painful and itchy.
The keloid can show up a few months to even a few years after the original skin injury and can continue to grow non-stop with no signs of shrinking.
What Causes Radiation Therapy in the Treatment of Keloids?
The exact reasons why keloid scars form aren’t fully known. While some keloids can appear on their own, most of them usually develop due to abnormal healing after an injury or surgery. Sometimes, they can even form years after the initial skin damage. These scars can be triggered by a variety of events including acne, body piercings, tattoos, insect bites, vaccinations, surgery, or accidents.
They’re more likely to appear in areas of the body where the skin is naturally tight, like the chest or earlobes.
Risk Factors and Frequency for Radiation Therapy in the Treatment of Keloids
Keloids, which are a type of skin bump, can occur in between 30% to 90% of people. These tend to be more common in people with dark skin, such as those of African-American, Hispanic or Asian descent, as well as people who have family members with keloids. They mostly affect those between the ages of 10 and 30, especially during times of hormonal changes like puberty and pregnancy. Other factors that can increase the risk of developing keloids are having blood type A or a condition known as hyper-IgE syndrome.
- Keloids are skin bumps that can affect 30% to 90% of individuals.
- They are more likely to occur in people with darker skin, including African-Americans, Hispanics, and Asians.
- Having a family history of keloids can increase the risk of developing them.
- People between the ages of 10 and 30 are at higher risk of developing keloids.
- Hormonal changes during puberty and pregnancy can further increase this risk.
- Having blood type A or the condition called hyper-IgE syndrome also increases the risk.
Signs and Symptoms of Radiation Therapy in the Treatment of Keloids
Keloids are thick, raised scars that can form on the skin, often after an injury or surgery. They can sometimes appear on their own, but most people with keloids have had some sort of skin damage or operation. Ideally, a well-healed scar would be flat and light in color, but sometimes a scar can become a hypertrophic scar or a keloid. Hypertrophic scars are raised, red, and can be itchy, but they stay within the boundary of the original injury. Keloids, are also raised, red, and sometimes itchy but they spread beyond the original injury site, affecting nearby skin. They can cause visible changes, make it difficult to move, affect a person’s appearance, and can be distressing.
Keloids are divided into two categories. Minor keloids are small, focused scars that are less than 0.5 cm high, while major keloids are bigger and can be taller than 0.5 cm. Regardless of their size, keloids can affect nearby skin and can continue to grow for years after the injury that caused them. They usually won’t go away by themselves and can come back after being surgically removed. Keloids can form anywhere on the body but are most common on the neck, earlobes, chest, shoulder, upper back, sternum, knees, and ankles.
Testing for Radiation Therapy in the Treatment of Keloids
When doctors want to assess the severity or extent of keloid scars, they use a variety of methods. The most common methods include using a type of rating system like the Vancouver Scar scale and taking 2-dimensional photographs. The Vancouver Scar scale lets doctors easily rank the scar’s characteristics, and the photographs give a more concrete, unbiased view of the scar. Other methods used less frequently include studying the scar’s biochemical properties, using ultrasound or laser-based techniques, or even taking a small sample of the scar tissue (biopsy) for further examination.
Treatment Options for Radiation Therapy in the Treatment of Keloids
No specific medicine is universally effective for treating keloids, which are raised scars. Keloids often grow much larger than the wound that caused the scar and can be itchy or painful. First-line treatments usually involve injecting steroids directly into the scar to reduce its size and relieve symptoms. For these treatments to work better, other therapies are often combined since steroid treatment can sometimes have side effects like lightening of the skin, thinning of the skin, appearance of small blood vessels on the skin’s surface, and pain at the injection site.
While it is common to use steroid injections for treating keloids, other treatments may also be employed even though their effectiveness can vary and there may not be strong proof about their benefits. These treatments include massage therapy, dressing with pressure garments, using adhesive tape or silicone sheets to provide support, cryotherapy (which uses extreme cold to kill cells) and laser or light therapy.
Surgical removal is commonly used for treating mature keloids. However, as a standalone treatment, surgery cannot eliminate the risk of the keloids coming back. The recurrence rate after surgery can range from 45% to 100%. To reduce this risk, it is advisable to combine surgery with other treatments like radiotherapy (use of high-energy rays to kill cells), cryotherapy, or steroid treatment.
The preferred surgical approach for removing keloids typically involves excising (cutting out) the keloid with a safety margin. After the keloid is cut out, the wound is closed using sutures (stitches) and minimal tension to prevent the keloid from recurring. Additional techniques, including the use of special sutures and surgical methods to reduce the tension on the healing tissue and redirect the orientation of the wound, may also be used to prevent the keloid from coming back.
What else can Radiation Therapy in the Treatment of Keloids be?
Keloids may look like hypertrophic scars to the naked eye, but when examined under a microscope, they show different characteristics.
What to expect with Radiation Therapy in the Treatment of Keloids
Multiple studies have proven that the most effective treatment for keloids is having surgery and then undergoing radiation therapy. A review of over 70 studies showed that there was a significantly lower chance of keloids coming back (22% +/- 4%) after using this combination compared to only using radiation treatment (37% +/- 12%). This large review further revealed that the use of a specific type of radiation therapy, called post-excisional brachytherapy, resulted in the lowest chance of keloids returning at only 15%, compared to 23% for other types of radiation therapy.
Other than the type of treatment, the chances of keloids recurring can also vary depending on where they are on the body. Out of all the locations, keloids on the chest and truck have the highest chance of coming back at 34%. The lowest chance of recurrence, at 12%, was seen with keloids on the ear. This varying rate of recurrence depending on body part might be because the tension in the skin differ for each body part.
Possible Complications When Diagnosed with Radiation Therapy in the Treatment of Keloids
Radiation treatment for keloids, an abnormal scar growth, can result in multiple side effects, with the most frequent complications being skin redness (erythema) and changes in skin color (hypopigmentation or hyperpigmentation), which occurs around 30% of the time. Short-term side effects can emerge during radiation or about one to two weeks following treatment. They usually relate to the total amount of radiation given and can take the form of skin redness, swelling, peeling, sores, or tissue death.
Late complications may happen weeks to months after treatment and correspond with the dose of radiation given per session. These may involve changes in skin color, hair loss, skin thinning, and the enlargement of small blood vessels beneath the skin’s surface. Even though it’s quite rare (less than 1% of cases), keloid treatment can result in infection and the opening of the wound. To reduce the risk of these side effects, using moisturizing and steroid cream after radiation treatment can be beneficial.
Common Side Effects:
- Skin redness (Erythema)
- Changes in skin color (Hypopigmentation or Hyperpigmentation)
- Swelling (Edema)
- Skin Peeling (Desquamation)
- Skin Sores (Ulceration)
- Tissue Death (Necrosis)
- Hair Loss (Alopecia)
- Skin Thinning (Atrophy)
- Enlarged small blood vessels (Telangiectasis)
- Potential Infection
- Reopening of Wound (Wound Dehiscence)
