Information about cause, treatment, and prevention

Is Compression Therapy Effective on Keloid Scars?

Compression garments may help reduce keloid scar size and also prevent keloid scars after surgery.

Pressure therapy involves the use of pressure-gradient garments or other mechanisms to constrict the wound region. Compression therapy became popular after doctors noticed that patients with burns on their legs healed faster and better with pressure stockings. It is often used as a first-line therapy to improve scarring outcomes in burn victims, and to treat keloids and hypertrophic scars in general.5

How Does Compression Therapy Work?

According to research, compression may work by decreasing oxygen and blood flow to the wound, creating conditions that help get rid of the cells that produce collagen and also shrink keloid scar tissue. Examination of pressure-treated keloids by an electron microscope confirmed that there was less cohesiveness between collagen fibers, indicating the breakdown of collagen nodules in keloid tissue.3,8

It appears that pressure increases the enzyme activity that breaks down collagen, as well as lowers the number of certain proteins and large carbohydrate molecules that block this breakdown. As it breaks down these knots of collagen, the fibers become more like normal bundles. Pressure also increases the rate of apoptosis, helping to get rid of the excess collagen in keloid tissue.5,8

Is Compression Therapy Effective on Keloids?

Despite decades of acceptance by modern medical practices, evidence supporting its effectiveness when used by itself is primarily anecdotal or from retrospective review studies. However, there are a number of clinical studies that demonstrate its effectiveness in treating and preventing reoccurrence of keloids on the ear.5,20 Using compression therapy along with steroid injections appears to work better than either alone, especially when combined with surgery.8

Pressure therapy reportedly is more effective on scars less than 12 months old, and is recommended to prevent keloids from developing altogether in wounds that typically take 2-3 weeks to heal.8 It is usually done daily for at least 6-12 months at 8-24 hour intervals for maximum effectiveness.5

Patient compliance with applying the pressure mechanism and keeping it on for the required time and frequency can directly affect the outcome.21 Other concerns about compression therapy include discomfort (especially in humid weather or climates), swelling, rashes, and additional skin injury (e.g., sores).20

Devices for Ear Keloids

Zimmer splints can be used as a pressure treatment for ear keloids following steroid injection.7 Compression therapy of this type has been shown in a small clinical study to reduce ear keloid size by at least 50%.22 An added benefit is that the flexible aluminum splints can be decorated to look like jewelry.22

Another stent-type of pressure device custom-molded from methyl methacrylate demonstrated an 83% success rate in a small study involving 23 patients who used them following surgical removal of the ear keloids.23 Custom-made silicon molds can be used as a more effective compression therapy option for ear keloids that extend beyond the ear lobe.24

Pressure earrings are also used following surgical removal of the keloid. However, to avoid chances of the wound reopening, they should not be put on until two weeks or more after stitches are removed.8

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Customized stockings or sleeves that are made to apply
varying pressures to an area.
Chondroitin 4-sulfate.
Regulated cell death, a normal part of a functioning cell cycle.