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IntroductionKeloid scars are defined as abnormal scar tissue that grows beyond the boundary of the original site of a skin injury.
The cause of keloids is not known, but many researchers believe they are caused due to the bodya€™s inability to shut off the process of healing needed to repair skin.
Another theory is that they are caused due to alterations in the signals cells give to control proliferation or growth connected to the method of keloid formation. While treating keloids, physicians rarely use surgery due to the area becoming even more inflamed as a response to the surgery. The risk of recurrence after surgery for certain keloids such as chest wall, shoulder keloids is near 100%.
It is well understood that keloid is a genetic and an inherited disorder of the wound healing mechanisms of the skin.
There are reports from Far East, of successful multi-modality treatments of earlobe keloids, using surgery, steroid injections, magnetic pressure earrings, etc.
Furthermore steroids injections can also cause worsening of keloids in some patients Keloids are often resistant to treatment and have high recurrence rates. Bleomycin has been used in other non cancer indications, such as keratoacanthoma, neurofibromas and certain warts. Cryotherapy, also known as Cryosurgery is the application of extreme cold to treat, or destroy keloids. Cryotherapy is used to treat a number of skin conditions like warts, moles, skin tags, etc. Application of liquid nitrogen to keloid tissue results in freeze destruction of keloid tissue. Upon application of Liquid Nitrogen to the skin, you may feel a slight burning sensation or pain. I advise patients to return to the office one week after Cryotherapy in order to assess the impact and efficacy of the treatment.
Once the scab falls off, the keloid is considerably smaller and is ready for the next treatment.
For more than 5000 years, Panax ginseng has been highly treasured in Chinese traditional medicine, with the belief that this mysterious plant with its man-shaped, bifurcated root promotes longevity, helps to maintain equilibrium in the human body and enhances our body’s ability to resist various illnesses. In laboratory experiments, Choi [3] reported on ginseng’s ability to promote and improve wound healing. Based on scientific laboratory evidence, and until we discover better topical treatments for scars and keloids, ScarFormula® is the most logical choice for treatment and prevention of scars. Panax Ginseng has been widely used in China, Japan and Korea to treat various conditions and to enhance resistance to many illnesses. Further Laboratory studies by Lee [6] have revealed that Panax Ginseng has a significant Radio-protective effect and reduces photo-aging. Based on our current understanding of wound healing, scars and keloid pathophysiology and laboratory research, topical usage and application of Panax Ginseng Cream, as an adjunct to standard treatments, is a logical choice for patinets with keloid and hyperthrophic scars. Radiation therapy remains a rather controversial issue in treatment of keloid with the most important concern being the development of cancer and other serious medical complications following this method of treatment. Using radiation therapy for treatment of benign skin conditions has long been abandoned due to excess rate of developing cancers in patients. Radiation therapy can cause cancer: Women will have a much higher risk of breast cancer if they receive radiation in their chest. The patient below had surgery followed by radiation therapy to the keloid in her neck area.
Patient depicted below also had surgery followed by radiation therapy to the keloid in his neck area.
If you have received radiation therapy to your keloid, I strongly urge you participate in Keloid Radiation Registry. CryoShape is an invasive method of freezing keloid tissue, using a long, thick needle, much like a metallic knitting needle. 1- Lack of Scientific Evidence : There is absolutely no evidence that freezing a keloid by CryoShape is any better than standard non-invasive Cryotherapy. 2- Highly Invasive Method: Puncturing keloids with a thick needle results in creating a deep injury, a longitudinal and wide tunnel, inside the keloid tissue with two open holes, the entry point and the exit site. 3- Risk of Infection : Cryotherapy obviously results in tissue damage, blister formation, oozing, leaking etc,. 4- Lack of Control over the Depth of the Freeze: With few exceptions, keloids and scars are never symmetrical. The operator has no control over the extent of freezing damage that he is causing to the normal ear tissue. 5- Injury from CryoShape needle can Trigger Keloid Formation: Keloid is a hereditary disorder.
6- Cost: Obviously, a plastic surgeon who spends an hour performing this procedure in an operating room setting will charge the patient accordingly. 7- Lack of Proper Research: CryoShape has never been studied properly to compare its efficacy to standard methods of Cryotherapy.
The company marketing the device, before advocating this method of treatment and this procedure, has the duty of conducting proper randomized clinical trials to compare the efficacy and safety of the CryoShape treatment to standard Cryotherapy.
There is almost no evidence to support the claims made on the CryoShape website and no reason to believe that simply inserting a needle inside a keloid and freezing it from inside will cure this condition. Images below depict the kind of precision that can be achieved with simple non-invasive standard cryotherapy. In an effort to shed more light on issues related to CryoShape, I encourage those of you have had CryoShape treatment for keloid to share your stories with us. I am a Medic, thus, I made extensive research for the best treatment for my facial keloids. It was a harrowing 5-hour procedure, the pain was unbelievable, and the post procedure bleeding was alarming. Keloids are raised scars that are pink in color and it varies in size ranging from small to extra large. Keloids develop on both men and women equally, but women are infected more for the reason that they do piercing a lot than men. Once a wound or injury has happened to the skin, both connective tissues as well as skin cells begin to multiply to repair any injury. Besides being potential cosmetic problems, these exuberant scars also tend to be tender, itchy or often painful to the touch.
But, they can develop almost anywhere, such as in scars that are surgically placed on the body as well as in the earlobes or other areas that have been pierced for any cosmetic purposes. Since physicians do not comprehend the specific reasons why certain individuals are more prone to the development of keloids, it is difficult to calculate if piercing will lead to any development of keloids. For individuals who are extremely susceptible to developing keloids the best treatment can be to just not treat the area at all. Keloid scarring managements are still being studied and there is no decisive cure currently available for those who are battling the scars. What is greatly needed is a methodology to make a risk determination as to which keloids will recur and which will not. Local injection of steroids after surgery reduces the risk of recurrence of certain keloids in the earlobe, not in other parts of the body. Although it can reduce the risk of recurrence to some extent, Radiation carries a major risk of causing cancers and should not be used to treat keloids in young and healthy individuals. Radiating neck will result in total loss of thyroid function, making the person hypothyroid, requiring lifelong thyroid supplement medications. These results are very encouraging, yet they need to be re-produced in individuals who are from African ancestry. Injecting steroids directly inside the keloid tissue, known as intralesional injection, is a commonly used method of treating small keloids. Sexton reported the efficacy of intradermal injection of this fluorinated prednisolone derivative in 1960 .
About one third of patients give up treatment because of pain and lack of immediate improvement.
This study shows that steroids work in about one third of pateints and for most part, their efficacy is temporary with about 16% chance of causeing worsening the keloids. Repeated corticosteroid injections can be very painful and may cause various complications such as loss of normal skin tissue, discoloration and Cushing’s syndrome, a condition that is due to excess systemic exposure to steroids.

Some anti-cancer drugs such as 5-FU and Bleomycin have been studied and shown to be effective in treatment of keloids.
It is primarily used intravenously for treatment of Hodgkin’s Disease and Testicular Cancer.
When used in very low doses and with tattooing procedure, Bleomycin seems to be well tolerated and free of systemic effects.
Cryotherapy is the most effective, safest, most economical, and easy-to-perform method of treating most keloid lesions as well as hypertrophic scars. Tirgan’s choice of treating most keloids in children, specially earlobe keloids in African American Children. Cryotherapy utilizes Liquid Nitrogen that is capable of producing extreme low temperatures.
Exposure to extremely cold temperatures for an extended period of time causes frostbites which can lead to loss of finger and toes in mountain climbers who are not well prepared. At this visit, if the keloid still appears alive, a second Cryotherapy is applied to the keloid. For these reasons, Panax ginseng has been one of the most sought after natural medicines in the world.
Kimura [1] reported on the efficacy of topical Panax ginseng in promoting wound healing in laboratory animals. In another study [4] Panax ginseng was shown to stimulate growth of skin cells during wound healing. ScarFormula® cream was carefully crafted for use in wound healing, scars and for keloid care. Ginseng contains many bioactive constituents, including various ginsenosides that are believed to have antioxidant, immune-stimulatory, and anti-aging properties [3].
Ginseng may also be useful in the prevention and treatment of skin photo-aging, wrinkles and as an anti-aging treatment.
ScarFormula® should be applied twice per day over all scars and keloids, and continued for at least eight weeks. Mechanism of angiogenic effects of saponin from Ginseng Radix rubra in human umbilical vein endothelial cells. Radiation therapy uses high-energy particles or waves, such as x-rays, gamma rays, electron beams, or protons, to destroy or damage cancer cells. Although effective, radiation therapy usage for treatment of facial acne and fungal infections of scalp was abandoned several decades ago, mostly due to excess number of cancers and leukemia seen in these patients.
Keep in mind that there is major opposition to performing routine mammograms in women, of the fear of mammogram causing breast cancer.
Several decades ago, radiation therapy at even lower doses was used for treatment of acne and fungal infections of the scalp. The treatment not only did not help him, but resulted in recurrence of a worse keloid that has now limited his ability to move his neck. The goals of this registry are to accurately determine the safety and efficacy of radiation therapy in treatment of keloids. This needle must be inserted into and pass through the keloid, or scar tissue, and pushed forward to exit from the opposite side of this tissue.
Additional punctures and injections are also required to numb the tissue to allow for insertion of the CryoShape needle.
The damage to the keloid and scar tissue from multiple puncture wounds required to insert the CryoShape needle puts the keloid at a greater risk for developing infection. The formation of keloid is triggered by injury to the skin and most patients are prone to forming keloids after even slightest injury to their skin, such a pierceing their earlobes. This cost, coupled with that of the needle itself, which is several hundred dollars, must be taken into consideration. Indeed, there is hardly any literature that discusses the effectiveness and safety of this extremely invasive method. Most patients require only a single procedure to significantly reduce the size and shape of keloid or hypertrophic scars. Though the website indicates that this is true in 97% of all cases, they have not substantiated their claims with hard facts.
I strongly believe that Cryotherapy is a very effective method of treating keloids and scars.
The medical and dermatology community has not endorsed this procedure either; hence after many years of marketing this procedure, hardly any physician in this country is using the device. I challenge anyone who performs Cryoshape procedure to achieve and disclose similar precision in freezing any keloid. Overall, it was expensive (thousands of dollars), invasive, and rather a traumatic experience.
Tirgan is a medical oncologist who specializes in the treatment and research of keloid disorder.
So, the treatment depends on the place at which it develops and how far it has intensified on the skin of the individual.
The dosage of injection has to be decided by your doctor and you have to take one shot for a month. The surgeon would inject steroids on the area and cut away the keloid totally bonding the area with pressure dressings. Some doctors would apply silicone sheets on the area and leave it aside for weeks and even months. Although anyone can form a keloid scar, some ethnic groups are at much more risk of developing these skin lesions. A scar is fabricated of gristle-like fibers, and connective tissues placed in the skin by the fibroblasts in order to clench the wound sealed. Even though there are many families that seem to be disposed to developing keloids, for the most part, it is difficult to tell who will develop them and who wona€™t.
Treatment for keloids using steroids needs the individual to visit the physician numerous times for these injections. But excisions are not every time effective, and there are cases where the keloid reform after the tissue has been removed and starts to heal again.
Keloids tending to resist handling as well as potential solutions need to be conversed between the individual and their physician. Dermatologist and plastic surgeons are still studying ways to both treat as well as prevent keloid scars.
Surgery only triggers the abnormal wound healing response, which is the core problem in keloid formation, and commonly results in development of a much more complex and bigger keloid. Applied intralesionally, triamcinolone acetonide is one of the most widely used treatments for keloids, whether alone or in combination with another type of treatment. 5-FU does have some efficacy and much like steroids, some keloids are sensitive to it, and some are resistant. Recurrence rate after successful removal of keloids with cryotherapy depends on a number of factor, including type, size and location of keloid lesions, as well as presence of keloids elsewhere and the family history of the disorder. We utilize the same principal in treating keloids, and induce very precise frostbite in the keloid tissue by direct application of liquid nitrogen to the keloid. Furthermore, everyone has a different pain tolerance is and each segment of skin has its own unique sensitivity to pain. Application of Liquid Nitrogen to the large keloids can be uncomfortable and require local anesthesia and pain medications. Using a Q-tip or cotton swabs, the edges of keloid, and where it comes in contact with normal skin should be cleaned. Morisaki [2] in 1995 showed that the local administration of ginseng extract markedly improved wound healing in diabetic and aging rats, proving the thousand year-old beliefs by modern scientific methodologies. Further studies by Pazyar [5] revealed that ginseng inhibits NF-kappa B, TGF-?, IL-6, ACE and MMP-2, factors that play a pivotal role in keloid and scar formation.
Image below depicts results that one of my patients has achieved using the cream twice per day for over two months.
Continue beyond eight weeks only if the product shows activity for your keloid and improves the appearance or reduces the symptoms that you have from your keloid, symtoms such as itching, burning, pain, etc. Same radiation is used for treatment of keloids often after the keloid is removed surgically. Although very effective, these practices were banned because of documented increased risk of cancer among the treated patients.

Radiation therapy also caused permanent damage to her thyroid gland and made her hypothyroid.
Radiation therapy also caused a permanent damage and fibrosis of his neck tissue and serious abscesses under the keloid tissue and cause constant infections and drain pus at all times. The needle is then connected to a source of liquid nitrogen, allowing free flow of liquid nitrogen through the needle.
That is nothing published in any medical literature that compares the two methods or proves that inserting a needle into a keloid would works better than the non-invasive cryotherapy method. With the CryoShape needle in place, especially for long and wide keloids, a round and symmetrical ice ball forms around the needle, over which the operator has absolutely no control.
The CryoShape needle is at least 20 times thicker than the needles used to puncture earlobes. The device has been in use for over a decade now, and there is hardly any peer reviewed medical literature about it.
This claim is only made on the website and not published or even referenced in any peer reviewed medical literature.
These claims, along with other data, should be supported by peer reviewed medical research, which to this date has never been performed. Effective cryotherapy can be safely applied to any keloid and any scar with using a cotton swab, without the need for injecting or injuring the keloid tissue by CryoShape procedure. Some believe that cellular signals and its changes have some relation with the development of keloids.
If it occurs on sensitive areas that are exposed then it has to be removed, failing which it would be embarrassing for the person. One individual might develop a keloid in one earlobe after being pierced and not in the other one. Even though steroids are successful in some cases, it needs to be remembered that individuals with skin that is darker may undergo tissue degeneration or hypopigmentation which is the loss of skin color.
One of the newest developments in keloid therapy is the use of lasers to lessen the size of the keloid and to progress the color of the scar. Every patient poses a unique challenge; therefore a careful cryotherapy plan has to be devised for each patient. Therefore, there cannot be one plan and one method of freezing that can be applied to all keloids and to all patients. Department of Toxicology, College of Pharmacy, Chungnam National University, Daejeon, Republic of Korea. There is no need for radically invasive methods such as this when keloids can be frozen with cotton swabs. They occur on the surface of the skin on your back, shoulders, ears and even on your chest. Therefore the keloids develop above the skin surface as well as form great mounds of scar tissue. It does make sense, however, for someone who has one keloid formed, to avoid any elective piercing or surgery since the body areas seem to be predisposed to scarring. Individuals who wish to treat scars with steroids are usually given shots of hydrocortisone every 2 to 3 weeks. Radiation is merely used in those cases where the keloid scar is mutilating and is very resistant to other management. As of December 15, 2012, 670 patients have responded to this survey among whom 193 had surgery for their keloids. Much more research is needed to figure out what drives this disorder and how best to treat it.
Tirgan has developed his own unique method of applying cryotherapy which allows for successful removal of many keloid lesions. Constellation of all these variables calls for design of an individualized cryotherapy plan, an art that can be mastered only by experience.
After completion of cryotherapy, there can be a short term surge in pain within the first hour. Each one of these tinny spots has the potential to increase in size and transform into a large keloid. This patient, at age of 23, is also at risk of other long term complications from the radiation.
This study reports an average of 51.4 percent of scar volume reduction was achieved after one session of intralesional cryosurgery treatment.
However, the most frustrating aspect is that the channels the cryprobe created through the keloids have become persistent foci of recurrent infections. Whenever there is any infection or lesions on the skin, it will leave behind a scar after healing. He used tattooing as his method of injecting very small amount of Bleomycin into the tissue.
Please keep in mind that cryotherapy is indicated for certain types of keloids and its efficacy varies from patient to patient and from keloid to keloid. Despite the knowledge about the carcinogenic risk of radiation, some radiation therapy centers still provide this treatment to young keloid patients. The best he can do is to insert the CryoShape Needle somehow through the central axis of the keloid. In my opinion, the cost, along with the tissue injury and risk of infection are not worth a 51.4 percent scar volume reduction. This type of scar is hypertrophic scar and it will be just the size of the wound and will never extend beyond it. The success of excisions is dependent on whether or not radiation therapy is needed to lessen the chances for the reoccurring of keloid. He reported complete flattening of keloids in six patients, and highly significant flattening in six other patients and significant flattening in one patient and disappearance of itching in all patients after only one treatment. This continues for 5-7 days before the keloid tissue dries out and forms a dark or black color scab and starts to shrink. We also know that exposure to radiation in Hiroshima and Chernobyl resulted in excess risk of various cancers and leukemia.
The procedure is continued until the operator can visually see superficial freezing begin to occur; however, he cannot see how much of the normal tissue located under or around the keloid will become damaged by his freezing. A more recent publication in 2008 that reported on 11 scars, concluding that there was a significant reduction in concern and deformity scores compared with those before the cryo treatment. From this point on, and over next few weeks, the keloid will become gradually drier, transform into a black color scab, and gradually shrink in size. The article is not at all clear about what a reduction in concern and deformity scores means and why did the investigator not use Reduction in Keloid Volume as an indicator of efficacy and instead they came up with a convoluted end point for their very small study. The report does not mention the response rate, or what percentage of patients had total disappearance of their scars. Infection at a wound site, repeated trauma to the same area, skin tension or a foreign body in a wound can also be important factors.There appears to be a genetic component to keloid scarring. Other theories for the causes of keloid scarring include a deficiency or an excess in melanocyte hormone (MSH), decreased percentages of mature collagen and increased soluble collagen, or that very small blood vessels get blocked and the resulting lack of oxygen contribute to keloid formation.Keloid scar prevention - the fact is that there may be very little a person can do if they are unfortunate enough to have the sort of skin that reacts by forming keloid scarring. They can assist the healing process by keeping any wounds clean to reduce the chances of infection. If a person knows they are susceptible because of previous experience or a family connection then they can avoid taking extra risks. The susceptible individuals should not have piercing or tattoos and make sure they tell their doctor if they are going to have surgery. Highly pigmented people should avoid tattoos, tattoo removal laser, skin lasers and body piercing.The best treatment is prevention in patients with a known predisposition. This includes preventing unnecessary trauma or surgery (including ear piercing, elective mole removal), whenever possible. Following injection treatments, Fraxel laser keloid scar removal can improve the keloid scar remnants in most patients. Scar removal surgery is not recommended because it may create similar or worse scars than the one being treated.

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