Occlusive Dressing Technique
Occlusive dressings may be used for the management of psoriasis or other recalcitrant rub a small amount of cream into the lesion until it disappears. Reapply the preparation leaving a thin coating on the lesion, cover with pliable nonporous film, and seal the edges. If needed, additional moisture may be provided by covering the lesion with a dampened clean cotton cloth before the nonporous film is applied or by briefly wetting the affected area with water immediately prior to applying the medication. The frequency of changing dressings is best determined on an individual basis. It may be convenient to apply Triamcinolone acetonide cream under an occlusive dressing in the evening and to remove the dressing in the morning (., 12-hour occlusion). When utilizing the12-hour occlusion regimen, additional cream should be applied, without occlusion, during the day. Reapplication is essential at each dressing change. If an infection develops, the use of occlusive dressings should be discontinued and appropriate antimicrobial therapy instituted.
As others have noted, effective treatment of keloids can be very difficult. The reason for this is that keloids are an abnormal response to injury, and area of scar tissue that grows beyond its natural boundaries. On examination of a piece of Keloid tissue under a microscope, it looks substantially different than the average scar. The initial phase of treatment is to slow the inflammation, ergo the use of several spaced injections. The next option is to excise the scar surgically (50% recurrence rate) or to treat with radiation. After excision, the area can be radiated and/or re-injected with steroid. Some Surgeons advocate placement of topical mitomycin and/or topical 5 flurouracil at the time of excision. Despite all of these options, keloids can and do recur.