Frequently Asked Questions About Keloid Scars

There are two crucial parts to making steroid injections successful: concentration and consistency. First, the concentration of Kenalog (triamcinolone). For my keloids, 40 mg/mL made the biggest difference in flattening the scars. A patient can return for injections month after month, year after year and if the concentration is too weak, the scars won’t flatten. If your injections aren’t working, ask your dermatologist what concentration they’re using and if it’s not 40 mg per mL, you’re not getting the full strength of the steroid.

The second component is consistency. Patients will get steroid injections once or twice and expect their keloid to flatten completely and never return. That’s not how keloids work. For thicker keloids, it may take six to twelve injections, or more, to flatten the scar. Even then, you may still need an occasional injection to keep it flat. For example, after I initially flattened my chest keloids with the right concentration and consistent treatment, they would still start to regrow every so often. I’d have to return for another injection, but much less frequently. Only years later did they finally stay dormant permanently.

The corticosteroid injected into keloid scars is triamcinolone acetonide. In the United States, a common brand is Kenalog; in other countries, Kenacort is frequently used. These are simply different brand names for the same active medication. Any reputable brand will do.

The steroid is injected directly into the keloid using a very fine needle. When I received treatment, my dermatologist used a 30-gauge, half-inch needle.

Yes. Dermatologists commonly use triamcinolone acetonide in concentrations such as 10 mg/mL and 40 mg/mL, or somewhere in between. Kenalog-10 contains 10 milligrams of the medication per milliliter, while Kenalog-40 contains 40 milligrams per milliliter.

A higher number means the solution is more concentrated. Depending on the keloid’s size the dermatologist may use the medication at full concentration or dilute it with saline or a local anesthetic such as lidocaine.

In my experience, 10 mg/mL injections did not flatten my keloid scars, though they helped some with the itching. A dermatologist may choose this concentration for a very small or thin scar, particularly in a sensitive area such as the face.

Keloids that are located on the chest, shoulder or back should be treated with 40 mg/mL injections, in my opinion.

Kenalog-40 contains four times as much triamcinolone per milliliter as Kenalog-10. In my experience, 40 mg/mL injections produced noticeable flattening and softening of keloid scars over a period of time and multiple injections.

Diluting the steroid allows the dermatologist to adjust its concentration. Lidocaine may also help reduce discomfort during treatment. In my experience, undiluted triamcinolone provided a stronger treatment for keloids so I did not get any saline or lidocaine mixed with the triamcinolone (Kenalog).

The number of injections depends on the keloid’s size. Injections should be scheduled every 4 to 5 weeks apart. Some people may flatten their keloids in less than 6 visits or 6 months. Larger or thicker keloids may require a longer course of treatment, potentially lasting a year or up to 12 visits.

Atrophy, or thinning of the skin, is a possible side effect, especially if the scar is injected after it is already flat or close to being flat. In my opinion, dermatologists overstate the risk of atrophy, which can appear as a small indentation in the skin.

Put it this way: If you asked 100 patients with painful, lumpy keloid scars whether they would prefer a minor indentation in the skin or to keep the keloid scar, I believe 100 out of 100 would choose the minor indentation.

If a dermatologist tells you they prefer to use 10 mg/mL or 20 mg/mL instead of the full 40 mg/mL I would thank them for their caution and politely insist on the undiluted Kenalog-40. The one exception would be if a patient had a tiny and very thin keloid scar on their face. Thicker keloid scars on the jawline or face should receive 40 mg/mL injections in my opinion.

These injections can be expensive and painful. Using a lower concentration wastes time and money and delays progress by not using the most potent concentration, the one that produces the greatest flattening.

Yes, they can be painful. The injection often causes a sharp pinching or stinging sensation. In my experience, softer and more pliable keloids were easier and less painful to inject than very firm scars. To help soften your keloid scars moisturize them daily and wear silicone sheets secured with Hypafix tape.

Not necessarily. Keloid scars are stubborn and can become raised again after successful treatment. Reaching a point where the scar is flat does not guarantee that it will remain flat permanently.

If the scar becomes irritated or starts growing again, go in for a steroid injection. For some people, keloids require monitoring and ongoing management. Even today, long after my keloids were successfully treated by most standards, I still go in for an occasional 40 mg/mL injection.

A silicone sheet is a soft and flexible patch made from medical-grade silicone. It is placed over a keloid scar to create a protective barrier that keeps the scar tissue hydrated and soft. Wearing a silicone sheet won’t flatten a scar on its own, but it can be more effective if combined with other treatments.

Check out my article on how I treated chest and shoulder keloid scars:

Chest Keloid Treatment: What Actually Worked

Most silicone sheets have a self-adhesive side that sticks directly to the skin. The strength of the adhesive varies by brand and weakens as the sheet becomes older. In my experience, I can use a piece for 2 to 4 weeks before needing to start a new patch.

I recommend using Hypafix tape to hold the silicone sheet in place. It is flexible and light and works particularly well on curved or moving areas of the body. I’ve used this tape on my jawline, chest, and shoulders.

Here is a link to Amazon that sells the Hypafix tape:

Amazon Hypafix Tape

A silicone sheet may help soften and modestly flatten some keloid scars, but it should not be expected to completely flatten your keloid. It’s important that you include other treatments in combination with wearing silicone sheets.

I would try to wear the silicone sheet for 20 to 24 hours a day. For example, with a chest or shoulder keloid, I would apply the sheet after my shower each night, secure it with Hypafix tape, and then remove it before the next evening, right before I took a shower. Was I perfect? No. Would I take days off? Yes. Just try to wear it as often as you can.

There is no easy answer to this, as it depends on the size of the keloid scar and where it’s located. I wore my silicone sheets off and on over a two-year period, but keep in mind that I had multiple keloids that were thick and melded together. I was also moisturizing daily and getting Kenalog steroid injections. If you wear silicone sheets without doing anything else to treat your keloids, you may only see small improvements. The most improvement comes from combining all 3 treatments.

If for example you have one small chest keloid that is less than 1 year old you may only need to get a few steroid shots and wear the silicone sheet for 3 months. The treatment length is dependent on the person and their unique circumstances.

In my opinion, the thin silicone tape you can buy at drugstores or online is not effective. It may be fine for blemishes but not for tough keloid scars. A silicone sheet that is 1 mm to 1.5 mm in thickness is heavier, applies more pressure, and stays flush against the scar, making it more effective.

Silicone sheets are generally well tolerated, with very few people reporting side effects. If you get a rash or irritation, then stop wearing it.

Yes.

Yes. Run it under water to clean it of debris or oils. Do not clean it daily, though, or you’ll degrade the adhesiveness. Make sure the silicone sheet is dry before applying it to your keloid scar.

Yes. I personally have been applying thick moisturizer to my keloid scars every day for many years. Every day after my shower, I apply the lotion and let it absorb. When I was wearing silicone sheets, I’d let the lotion absorb, apply the silicone sheet, and then secure it with Hypafix tape. I personally have found Lubriderm Advanced Therapy to be the best lotion for my keloid scars, as it’s incredibly thick and long-lasting, but use whatever lotion you’re comfortable with.

Reader question: A reader sent me an email asking if it was preferable to wear silicone sheets without lotion, and this was my response:

You can certainly use the silicone sheets without lotion. I personally let the lotion absorb for about 5 minutes before putting on the silicone sheets and securing them with tape.

Silicone sheets do not release a steroid into the skin. They work by trapping moisture and creating an occlusive environment that helps maintain hydration of the scar. So, moisturizing before applying a silicone sheet does not prevent a medical application from working on the keloid scar.

I recommend Hypafix tape over the silicone sheets to make sure they stay on. Silicone sheets would always fall off for me without tape, regardless of whether I applied lotion first.

Keep in mind that steroid shots were an important part of what worked for me. Silicone sheets, with or without lotion, will not flatten keloids on their own.