Those who have received keloid injections often say, "It's too painful," and many complain that "it came back after treatment." Both can be naturally explained by understanding the nature of keloid tissue and the mechanism of action of the injection components. Based on extensive clinical experience, I will explain step-by-step why it is painful, why it recurs, and what approach is needed to reduce recurrence.
What ingredients are in keloid injections?
The main component of keloid injections is steroid, specifically a type that forms precipitates. The name is Triamcinolone. There is a reason for specifically using this component:
- Precipitates form at the injected lesion site.
- These precipitates slowly dissolve over several months, acting on the surrounding tissue.
- Therefore, systemic side effects are relatively few.
If other steroids are used, they spread systemically immediately, leading to greater systemic effects than desired local effects, and often weaker effects on the lesion itself. This is why Triamcinolone is used for keloid injections.
The real reason why injections are so painful
Many people think the pain comes when the needle penetrates the skin, but that moment is not particularly painful. The real pain comes from elsewhere.
Keloids are tissues where collagen fibers are densely packed. Therefore, the injection solution does not penetrate easily. When force is applied to push the medication in, it has to push through the collagen fibers, and the pain caused by the tearing of these fibers is why the injection is painful.
The most basic way to reduce pain is to administer the injection gently. Injecting quickly and forcefully can momentarily tear the tissue, increasing pain, while injecting calmly can significantly reduce pain.
Why do keloids keep recurring?
Keloids have a high recurrence rate. However, they do not always recur. The core of recurrence lies in the fact that the exact cause of keloids is not yet clearly understood.
Steroid injections work by breaking down collagen fibers that have been excessively produced. This makes the lesion appear to subside and improve. However, since it only dissolves the existing outcome rather than eliminating the cause, injections alone are often insufficient to prevent recurrence.
There is another problem. If injections are repeated, the dosage tends to increase, and even if absorption is slow, repeated treatments can increase the risk of steroid-related side effects.
Why use injections and lasers together?
There are several globally standardized keloid treatments, the most common being steroid injections, followed by vascular lasers. Steroid injections have the advantage of being inexpensive and easily accessible, but they have clear limitations as mentioned earlier.
To reduce recurrence, it is necessary to block the blood vessels that supply nutrients to the keloid. This is the role of the vascular laser. To summarize:
- Vascular lasers block the blood vessels that excessively produce collagen.
- Existing keloid tissue is broken down with steroid injections.
- Combining both can reduce the injection dosage and simultaneously lower the risk of recurrence.
Overall, it is considered better to combine laser and injection treatments to reduce the injection dosage, rather than relying solely on steroid injections for a long period.
How long is treatment, and how is recurrence managed?
The criterion for ending treatment is when the redness of the keloid has almost disappeared. The raised parts in the early stages flatten relatively quickly, but if treatment is stopped while redness remains, the likelihood of recurrence is very high. Sufficient treatment until the redness disappears significantly reduces the recurrence rate.
The speed at which redness fades varies greatly from person to person. Some see it disappear relatively quickly, while for others, it takes many sessions over a long period. In any case, since one stage is completed only when the redness is gone, consistent treatment until then is important.
After treatment is complete, it is advisable to carefully monitor for recurrence. If you feel it clumping up again or itching, it could be an early sign of recurrence, and treating it quickly at this stage is much easier. For prevention, it helps to avoid creating skin injuries, manage common causes like acne well, and carefully consider cosmetic surgeries.
Results may vary by individual, and accurate diagnosis and treatment are determined after consultation.
Written by Sang-Joo Lee, Chief Director (Yonsei Star Dermatology) · Medical Staff Introduction · Last reviewed 2026-06-04