Leeds policy for management of Keloid and Hypertrophic scars



Leeds policy for management of Keloid and Hypertrophic scars

1. General principles

Keloid and hypertrophic scarring is usually harmless, and purely cosmetic. Treatment therefore should not routinely be offered.

In the first instance, referral should only be considered if there is diagnostic uncertainty sufficient to cause diagnostic concern (occasionally conditions can be confused with keloid scars e.g. a rare type of skin cancer called dermatofibroma sarcoma protuberans).

2. Management of symptomatic keloid/hypertrophic scars

Treatment should only be considered where the scar is symptomatic – i.e. those resulting in physical impairment due to contractures, tethering, severe pain/pruritus or recurrent breakdown.

When considering whether or not to proceed with treatment, patients should be informed that the effectiveness of intervention is generally poor and potentially associated with side-effects such as cutaneous atrophy and skin discolouration (hyper or hypopigmentation)

Patients should not be offered treatment for keloid and hypertrophic scarring on the face in primary care

3. Treatment options

Patients with symptomatic keloid or hypertrophic scars who opt to consider treatment may be offered the following treatments :-

• Super potent topical steroids may be applied directly to the scar on a daily basis. Care should be taken to avoid normal surrounding skin. Petroleum jelly or greasy emollients around the scar may help reduce the risk of side effects of steroid on normal skin. Scars should be treated for 8 weeks and response assessed. (Note – only a softening and reduction in scar bulk should be expected. Patients should be adequately counselled about the aims of any intervention)

• Steroid impregnated dressings (e.g Haelan tape) may be cut to the size/ shape of the scar and applied for up to 3 days at a time and replaced when needed/ after 3 days. Assess response after 8 weeks. (Note – only a softening and reduction in scar bulk should be expected. Patients should be adequately counselled about the aims of any intervention)

4. Referral into community dermatology providers

Patients should not be considered for referral to a community dermatology provider, unless the scar has not responded to the treatments outlined above. Before referral, patients must be forewarned about the risks of intra-lesional injection, including treatment failure, skin atrophy and hypopigmentation. Patient with facial hypertrophic or keloid scars should not be referred to community dermatology providers

Once referred to the community dermatology service provider, the patient will be assessed for suitability for treatment with intra-lesional injection. Up to three courses may be tried, (usually 4 weeks apart), after which the patient will be discharged back to their GP for ongoing management.

5. Referral to Secondary Care

No routine service is commissioned for keloid/hypertrophic scars.

Exceptional cases (i.e. facial keloid/hypertrophic scars or scars with severe symptoms or causing functional impairment unresponsive to standard treatment) can be considered for further possible treatments including surgery, laser therapy and/or radiotherapy under the Individual Funding Request (IFR) policy, (link below)



Such submissions will be considered by the Cosmetic Exclusions and Exceptions Panel

Submissions to this panel must include clinical photographs and a formal validated assessment as to the impact of the keloid(s) on the patient’s quality of life (e.g. Dermatology Life Quality Index).

June 2016

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