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.
It is not clear if or how additional epidural, paraspinal, or intra-articular steroid injections may increase the risk of fungal infection or contribute to a recurrence of infection in patients who received injections with the contaminated product and who are currently asymptomatic. Steroids are immunosuppressive and it is possible they could increase risk in patients with sub-clinical infection; however, the duration of infection risk resulting from prior exposure to a contaminated steroid product is still unknown. Providers should discuss the need for additional injections with their patients.