Treatments
Treatments for keloids and hypertrophic scars
No single treatment suits everyone. This page sets them out side by side so you can see what each one is good at — and what it is not.
Which treatment is likely to suit your scar?
Four questions, based on the guidance in Dr Buckley’s own patient information. Nothing you enter is stored or sent anywhere.
Roughly how big is the scar?
Measure the longest edge. An estimate is fine.
Available at the clinic
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Intralesional cryosurgery
Freezing the scar from the inside out with a probe placed into the scar tissue. Dr Buckley was the first doctor in Ireland to offer it for keloids.
Best for: Medium and large keloids, 1–3cm
More details →
Steroid injections
The usual first-line treatment for small, recent keloids and hypertrophic scars. Quick, non-surgical, no downtime.
Best for: Small scars under 1cm, less than 2 years old
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Silicone sheets
Non-invasive, available over the counter, and most useful early — while a scar is still forming.
Best for: Preventing a scar progressing; small scars under 2 years old
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Cryosurgery
Freezing scar tissue with liquid nitrogen at −196°C. Dr Buckley is internationally recognised for his work in cryosurgery.
Best for: Small to medium scars, up to 2cm
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Radiosurgical excision
Removing scar tissue with ultra-high frequency radio waves under local anaesthetic. Always followed by another treatment to prevent recurrence.
Best for: Keloids with a narrow base
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Combination treatments
Most good results come from combining treatments rather than relying on any single one. Here is how they are paired, and why.
Best for: Most scars, particularly larger or recurring ones
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Laser
Reduces the redness, pain and itch in a scar. It does not usually make the scar smaller, so it is rarely used on its own.
Best for: Red, itchy scars on lighter skin
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Imiquimod cream
An immune response cream used after a keloid has been removed, to reduce the chance of it growing back.
Best for: After surgical removal of a keloid
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Cosmetic camouflage
Medical-grade makeup that conceals a scar. It does not treat the scar, but it works immediately and it is free through the Irish Red Cross.
Best for: Small flat scars, and residual marks after treatment
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Available by referral
These are not provided at the Kerry Skin Clinic. If Dr Buckley considers one of them right for your scar, he can refer you on.
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Superficial X-ray therapy
Low-dose radiation to stop a keloid regrowing after removal. Rarely needed now, and provided by referral rather than at this clinic.
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Bleomycin and 5-FU
Chemotherapy agents injected into the scar. Reserved for scars that have not responded to anything else, and provided by referral.
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How they compare
Efficacy and recurrence as set out in Dr Buckley’s own patient information.
| Treatment | Efficacy | Recurrence | Main side effects | Best for |
|---|---|---|---|---|
| Intralesional cryosurgery | Moderate to high | Low | Loss of pigment, pain, oozing and swelling for a few weeks | Medium and large keloids, 1–3cm |
| Steroid injections | Moderate | Moderate | Skin thinning, small red veins, lightening of the skin | Small scars under 1cm, less than 2 years old |
| Silicone sheets | Mild | High | Minimal; occasional mild irritation | Preventing a scar progressing; small scars under 2 years old |
| Cryosurgery | Moderate to high | Low | Loss of pigment, pain, oozing and swelling for a few weeks | Small to medium scars, up to 2cm |
| Radiosurgical excision | High | High unless combined with another treatment | Surgical scar, pain afterwards, risk of infection | Keloids with a narrow base |
| Combination treatments | Highest of any approach | Lower than single treatments | Depends on the combination used | Most scars, particularly larger or recurring ones |
| Laser | Reduces redness, not size | Moderate | Minimal; little or no downtime | Red, itchy scars on lighter skin |
| Imiquimod cream | Useful for preventing recurrence | Reduced when used after excision | Redness, peeling, mild itching | After surgical removal of a keloid |
| Cosmetic camouflage | Conceals rather than treats | Not applicable | None; suitable for sensitive skin | Small flat scars, and residual marks after treatment |
| Superficial X-ray therapyBy referral | Good at preventing recurrence after surgery | Low when used after excision | Few; painless, no needles or downtime | Actively growing or recurring keloids after excision |
| Bleomycin and 5-FUBy referral | High | Low | Ulceration, pigment changes, pain at the injection site | Resistant scars that have failed other treatments |
Reading that table honestly
The best results usually come either from cryosurgery alone or from a combination of treatments. No treatment fully removes a scar. What these treatments reduce is the size, redness, itch and pain, leaving a smaller and less conspicuous scar behind.