{ "schema_version": 1, "kind": "condition", "id": "keloid-scar", "name": "Keloid and Hypertrophic Scar", "category": "chronic", "sources": "International Advisory Panel on Scar Management: Clinical recommendations on scar management 2014 · NICE CKS: Scars 2021 · Egyptian National Drug Formulary - Endocrine System 2024 (triamcinolone monograph, intralesional route) · Gold MH et al., Updated international clinical recommendations on scar management, part 2, Dermatol Surg 2014 (full text at laserplast.org) · Wang R et al., intralesional verapamil for keloid and hypertrophic scar, Int Wound J (PMC) · Hypertrophic Scarring Keloids - StatPearls - NCBI Bookshelf - disease-level clinical article (keloid-scar-full.txt)", "review_status": "reviewed", "verified_against": "Gold MH et al., Updated international clinical recommendations on scar management, part 2, Dermatol Surg 2014 (full text at laserplast.org) · Egyptian National Drug Formulary - Endocrine System 2024 (triamcinolone monograph, intralesional route) · Wang R et al., intralesional verapamil for keloid and hypertrophic scar, Int Wound J (PMC) · No dose - referral pathway, no medicine given in primary care · Hypertrophic Scarring Keloids - StatPearls - NCBI Bookshelf - disease-level clinical article (keloid-scar-full.txt)", "verified_date": "2026-08", "treatments": [ { "id": 1087, "generic": "Silicone", "line": 1, "is_adjunct": false, "form": "topical", "strength_mg": null, "adult_dose": "Apply silicone gel or sheeting to clean dry scar, worn at least 12 hours a day and ideally continuously for 24 with twice-daily washing", "adult_duration": "At least 1 month, usually a 2-month course, with review at 8-12 weeks for a keloid", "dose_source": "Gold MH et al., Updated international clinical recommendations on scar management, part 2, Dermatol Surg 2014 (full text at laserplast.org)", "rationale": "Occlusive sheeting or gel that hydrates the stratum corneum and reduces the mechanical and inflammatory stimulus driving fibroblast collagen production, softening and flattening the scar. First-line non-invasive option before considering injections.", "cautions": [ "First-line non-invasive therapy for prevention and management of hypertrophic scars and early keloids.", "Do not apply to open wounds, unhealed surgical incisions, or broken skin.", "Ensure skin is clean and dry before application to prevent skin maceration or contact dermatitis." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Apply silicone gel or sheeting twice daily to affected scar area in children for 3-6 months.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "SCAR NOT GEL 30 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "LEVEN > VIDA TECH", "price_egp": 555.0, "pack_count": null, "unit_price": null, "strength_mg": 30000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "SCAR NOT GEL 30 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "LEVEN > VIDA TECH", "price_egp": 555.0, "pack_count": null, "unit_price": null, "strength_mg": 30000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "SCAR NOT 15 MG 15GRAM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "LEVEN > VIDA TECH", "price_egp": 330.0, "pack_count": null, "unit_price": null, "strength_mg": 15.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "keloid-scar" }, { "id": 1088, "generic": "Triamcinolone", "line": 1, "is_adjunct": false, "form": "injection", "strength_mg": 40.0, "adult_dose": "Dilute first. Egypt sells triamcinolone only as a 40 mg/mL intramuscular ampoule; the 10 mg/mL intralesional presentation the formulary lists is not on the register. Dilute with lidocaine or saline to 10-20 mg/mL for the body and 5-10 mg/mL for the face - that is 1 part ampoule to 1, 3 or 7 parts diluent. Inject into the scar mass, not under it, every 4-6 weeks", "adult_duration": "Repeat every 4-6 weeks for up to 3-6 sessions", "dose_source": "Egyptian National Drug Formulary - Endocrine System 2024 (triamcinolone monograph, intralesional route)", "rationale": "Intralesional corticosteroid injected directly into the scar mass to suppress fibroblast proliferation and collagen synthesis, flattening established keloids. First-line invasive treatment once non-invasive measures like silicone have failed.", "cautions": [ "Never inject the ampoule neat into a facial keloid. The only strength sold here is 40 mg/mL and the face wants 5-10 - undiluted it causes skin atrophy, a permanent depressed patch, and telangiectasia.", "First-line invasive treatment for established active keloids and refractory hypertrophic scars.", "Inject strictly intralesionally; extravasation into surrounding subcutaneous tissue causes skin atrophy, telangiectasia, and hypopigmentation.", "Multiple injections over several months are often required; recurrence rate remains 30-50% if used as monotherapy.", "The formulary's own intralesional figures are 20-60 mg into the lesion, distributed as repeated 20-40 mg injections for a large one, and one to four injections in total. Those are milligrams delivered, not concentration - both have to be right." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Intralesional injection in children (5-10 mg/mL) reserved for resistant keloids under specialist dermatology oversight.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "PHARCOCINOLONE 40MG/ML I.M AMP.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "CHEMIPHARM > PHARCO B", "price_egp": 8.0, "pack_count": null, "unit_price": null, "strength_mg": 40.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "AMCINOL 40MG/ML I.M AMP.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SIGMA TEC", "price_egp": 11.0, "pack_count": null, "unit_price": null, "strength_mg": 40.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "EPIRELEFAN 40MG/ML I.M AMP.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EIPICO", "price_egp": 38.0, "pack_count": null, "unit_price": null, "strength_mg": 40.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "SYNTHECORTIN 40MG/ML I.M AMP.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MUP", "price_egp": 54.0, "pack_count": null, "unit_price": null, "strength_mg": 40.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "keloid-scar" }, { "id": 1090, "generic": "Referral & safety-netting (no drug therapy)", "line": 1, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": null, "adult_duration": null, "dose_source": "No dose - referral pathway, no medicine given in primary care", "rationale": "Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.", "cautions": [ "RED FLAG - Malignant mimickers and infections must be excluded before steroid therapy as steroids are contraindicated.", "A thickened, hyperpigmented, keloid-like plaque may be cutaneous scleroderma; treating it as a scar misses an underlying systemic disease.", "Dermatofibrosarcoma protuberans and other cutaneous malignancies can look exactly like a keloid.", "If the diagnosis is in any doubt, obtain a biopsy before treating.", "Keloids and hypertrophic scars should be managed with a dermatologist, to prevent further enlargement and the functional disability these scars can cause." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": null, "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "keloid-scar" }, { "id": 1089, "generic": "Verapamil", "line": 2, "is_adjunct": false, "form": "injection", "strength_mg": 2.5, "adult_dose": "Intralesional injection of 2.5 mg/mL (0.5-2 mL per session) injected directly into keloid tissue every 3-4 weeks", "adult_duration": "Repeat every 3-4 weeks for up to 4-6 sessions", "dose_source": "Wang R et al., intralesional verapamil for keloid and hypertrophic scar, Int Wound J (PMC)", "rationale": "Calcium-channel blocker injected directly into keloid tissue as an add-on alongside, or an alternative to, intralesional corticosteroid; it does not replace corticosteroid as the first-line invasive option, but suppresses fibroblast collagen synthesis with a lower risk of the skin atrophy steroids can cause.", "cautions": [ "Alternative intralesional therapy that inhibits collagen synthesis with lower risk of tissue atrophy compared to corticosteroids.", "Monitor for localized erythema, burning, or systemic hypotension if large volumes are injected.", "The dose rests on the trial literature. The scar-management guideline does not mention verapamil anywhere." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Intralesional verapamil in pediatric keloids under specialist dermatology advice.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "IZOPTOMIL 2.5MG/ML 5 AMP. FOR I.V. INJ.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MEMPHIS > ARAB DRUG COMPANY (ADCO)", "price_egp": 17.5, "pack_count": null, "unit_price": null, "strength_mg": 2.5, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "keloid-scar" } ] }