Indications for intralesional corticosteroid therapy are acute and chronic inflammatory processes [ 4 ], hyperplastic and hypertrophic skin disorders, and conditions that typically have a favorable response to systemic and topical corticosteroids. In addition to anti-inflammatory properties, the atrophogenic side effect of corticosteroids also can be used advantageously when treating hypertrophic types of lesions, including hypertrophic scars and keloids, lichen simplex chronicus, hypertrophic discoid lupus erythematosus, psoriasis, and cutaneous sarcoidosis (ie, lupus pernio).
For severe cases, the keloid can surgically excised and given x-ray treatments to the site immediately afterwards, usually the on the same day. This works in about 85% of the most severe cases. Electron beam radiation can be used, which will not go deep enough to affect internal organs. Orthovoltage radiation is more penetrating and slightly more effective. There have not been any reports of this causing any form of cancer in many years of use, but it is very expensive. Silicone pads and creams are sold over the counter for use on keloids. These do benefit hypertrophic scars but will not cure a true keloid. However, they can reduce pain, swelling and itching from a keloid. They usually take 3 months or more to work.
Cortisone injection, in my practice, is used for hypertrophic or keloid scarring and reduction in inflammation. These type of scars are indicative of over-stimulation of collagen. Cortisone is injected to slow collenogenesis and decrease inflammation. A decline in reddness is also noted if discoloraton has occurred. The area injected may be swollen for a few minutes. Following the initial edema and absorption of the fluid, the tissue should not be more swollen than pre-injection. After a few days, the inflammation for which one is treating, should begin to diminish. Results are exptected to last weeks, or hopefully forever.