Scars & Keloids (Treatments for raised or thickened scars)

Threshold

Clinical interventions and treatments including Triamcinolone Injections for scars and keloids are not routinely funded.

Surgical revision of scars and keloids which are expected only to improve appearance, with no impact on function, will not be funded.

Scars and keloids revision will only be considered after 18 months have elapsed since the original trauma (to allow completion of the natural healing process) and where ALL the following criteria are met:

• The scar/keloid is ragged and protrudes more than 5mm and is more than 5cm in diameter.

AND

• The scar/keloid is causing a demonstrable functional problem, interfering with activities of daily living, or causing physical disability due to e.g. contraction, tethering or recurrent breakdown.

AND

• The functional problem is likely to be resolved with surgical revision of the scar.

Note: Where scars meet the criteria above and are the result of self-harm, treatment will only be funded when there has been a minimum period of three years where there has been no self-harm and where there is a supporting report from a psychiatrist or psychologist indicating that the behaviour would be unlikely to recur.

Dermatafibrosarcoma Protuberans (DFSP) can be wrongly diagnosed as a keloid and consider referral if the lesion is altering in appearance. If there is any diagnostic doubt then the patient should be referred for a diagnostic opinion. Referral does not imply treatment if the secondary care clinician is satisfied that the diagnosis is a keloid.

Exemptions

Patients under 18 years of age with significant scarring to the face and ears are exempt from this policy.

Scars interfering with function following burns/trauma, serious scarring of the face and severe post-surgical scarring are exempt from this policy.

Cases for Individual Funding Consideration

On a case to case basis, patients might be eligible for medical or very rarely surgical intervention, in consideration of their exceptionality. The requesting clinician must provide information to support the case for being considered an exception, by submitting an individual funding request.