Injections of steroid are commonly used to treat heavy scars called keloidsor hypertrophic scar. A commonly used steroid is triamcinolone injected directly into the scar.This works by increasing the activity of an enzyme called collagenase. This enzyme breaks down collagen so that scars become less thick and red.
The steroid does not change the amount of collagen made by the cells nor does it decrease the number of cells making collagen. Its action is primarily to remove some of the excess collagen from the wound.
Steroids are not usually used immediately after surgery because they decrease inflammation and weaken the wound. In severe scars the benefits of injecting the steroid immediately may outweigh the risk of weakening the scar.
Many doctors do not recommend pressuretherapy at the same time as steroid injections.
For a true keloid former there is no good treatment and steroid will probably not make a large difference. Hypertrophic scars which appear very similar can often be improved by steroids or scar revision. It is fair to think of scar revision using the 99 rule; you have 90% chance of improvement 9% chance the scar will be about the same and a 1% chance the scar will be worse.
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