How painful is keloid scar treatment?

It must be frustrating to have a keloid in places that would make you unable to wear certain clothes.

Do let us know how long this keloid has been, as looking at it, it still looks fairly ‘active’, and I agree that you should consider steroid instillation at a regular basis to reduce the risk of worsening as well as to flatten the lesion.

There is minimal pain really, as I use numbing creams over the lesion before I even do the injection.

Consult your doctor early. This can be treated with intra-lesions steroids and other modalities which they can best advise you on.

Thanks for the question. I do agree with the answers posted by Dr Winston and Dr Ethan that intra-lesional steroid injections (injecting directly into the keloid) would be the most suitable treatment to reduce the size and thickness of the keloid. Several monthly injections will be needed. The initial injections may be a little more painful but the pain is usually better with subsequent injections.

There will be some pain with the injection but this is usually bearable. If you are really afraid of the pain, applying some numbing cream prior to the injection may help.

Other less painful options include applying silicone scar gels but these are far less effective that the intra-lesional injections. Excising the keloid also has a high risk of recurrence and is generally not recommended.

Keloids are unfortunately one of the trickiest conditions to treat successfully, as no treatment has been shown to be 100% effective at permanently getting rid of them. Even with optimal treatment, recurrence can occur, sometimes even years after treatment.

Serial steroid injections every few months are one of the most common and effective methods to treat steroids, but there isn’t a single “best” keloid treatment as any treatment should be personalised to the individual. This depends on factors like:

1. Location of keloid
2. Size of keloid
3. Propensity for recurrence

After evaluation of these factors, your doctor will then recommend you on the below treatments, which can be used singly or in combination:

1. Steriod injections
2. Lasers
3. Excisional surgery
4. Radiation
5. Silicone sheeting

Pain during steroid treatment is not typically a major complaint of patients – the needle is small, and the steroid itself isn’t painful.

But if your keloid is thick, dense and hard as it appears in the photo, the first few series of injections will likely be more painful then subsequent injections once it has softened up.

To minimise pain, your doctor can apply a topical numbing medication, as well as mix the steroid injections with lidocaine to decrease your overall discomfort.

Cheers