Why Corticosteroid Therapy?

Corticosteroid therapy has been commonly used for years to treat hypertrophic and keloid scars. Corticosteroids suppress inflammation, reduce collagen synthesis and inhibit cell proliferation; itch and thickness of scars is reduced. Corticosteroids can be given through injection, steroid tape or topically (by cream). Intralesional injections (injections into the scar) are common treatments for linear scars, hypertrophic scars and small keloids. Other treatments alongside corticosteroid therapy are often required for large keloids and thick hypertrophic scars.

Intralesional Corticosteroid Injections

An intralesional steroid injection (ISI) involves the injection of a corticosteroid such as triamcinolone acetonide directly into the scar or immediately below the skin. Intralesional steroid injections can be given on their own or in combination with 5-Fuorouracil (5-FU) or Botulinum Toxin Type A. A recent systematic review suggests that the best results are seen when corticosteroid and Botulinum Toxin Type A are given together, followed by 5-FU. When ISI is given weekly after surgical excision (removal) of a keloid scar, reoccurrence rates (the chance of the keloid returning) is reduced. Recent studies show that the delivery of ISI with CO2 Fractional Laser treatments have promising results.

The recommended treatment interval for ISI varies from 2 to 5 weeks and until the scar is flattened. The most frequently reported side effects are skin atrophy, hypopigmentation (loss of colour) and telangiectasia (appearance of small blood vessels).

Steroid Tape

Steroid tape is tape containing fludroxycortide (medium-strength) or deprodone proprionate (high-strength). It is used as first line treatment for small keloids and hypertrophic scars, especially with children and the elderly. It can also be used post-radiation or post-excision (removal) of keloid scars. The steroid tape is applied by cutting the adhesive material to the size and shape of the scar, with minimal overlap onto the surrounding skin. You can shower as normal with the tape on, the tape is changed every 24–48 hours. Side effects are more likely with the higher concentrations of steroid tape. Reported side effects are: burning/stinging sensation, contact dermatitis (skin inflammation), skin irritation and folliculitis (inflammation of the hair follicles).

Steroid Cream

Topical application of corticosteroids is not common. Two studies reported good results with the use of a methyl prednosone cream on post-caesarian and pubic incision scars. Two other studies reported moderate to good results with laser assisted drug delivery of betamethasone and desoxymethasone ointments. However, the evidence for this type of corticosteroid application is low.

Photo of the injection of corticosteroids into a scar (istockcopyrighted)
Photo of a hand holding a little tube with steroid cream in it

Used for

Atrophic scar | Burn scar | Horizontal keloid | Hypertrophic scar | Itch | Linear scar | Pliability | Redness | Small keloid | Thickness | Vertical keloid

F.A.Q.

How long does it take to see results when using cortisone therapy for scars?

The timeframe for seeing results with cortisone therapy for scars can vary depending on several factors, including the severity of the scar, the chosen treatment method, and individual differences in healing response. Generally, improvements in the itchiness, thickness, and appearance of scars can be noticed after a few weeks to months of regular treatment. Some patients may experience faster results, while others may need more time before seeing noticeable improvements.

Are there any side effects or risks associated with cortisone therapy for scars?

While cortisone therapy can be effective in reducing scar tissue, there are also side effects and risks associated with this treatment. Side effects may include skin atrophy (thinning of the skin), hypopigmentation (lightening of the skin), and telangiectasia (appearance of small blood vessels). Additionally, some patients may experience a burning or tingling sensation when using steroid tape. It is important to discuss these potential side effects with a healthcare provider before starting the treatment.

How is cortisone therapy applied to scars and how often should I undergo the treatment?

Cortisone therapy can be applied to scars in various ways, including intralesional steroid injections, steroid tape, or creams. The specific method and frequency of treatment can vary depending on factors such as the size and location of the scar, the severity of the scar tissue, and the response to the treatment. Generally, intralesional steroid injections may be given every few weeks until the scar becomes flatter, while steroid tape can be replaced every 24-48 hours. It is important to follow your healthcare provider's recommendations regarding the appropriate application and frequency of cortisone therapy for your specific situation.