Treating the Elusive Keloid

Abstract

Hypothesis: Surgical excision with a scalpel, primary closure, followed by local steroid injection is the best treatment for a keloid. BACKGROUND

Treatment of keloids and hypertrophic scars with dermojet injections of bleomycin: a preliminary study

“…These lesions occur after a variety of cutaneous injuries, including surgery, 2 burns, 3 dermal trauma, 4 and acne, 5 and some even arise spontaneously 6 . Keloids and HS can cause physical disfigurement, restricted range of motion, bothersome symptoms, and psychological problems, and yet there is no consensus in the literature regarding appropriate therapy 7–9 . Several treatment modalities, such as intralesional (IL) injections of corticosteroids 10,11 or 5‐fluorouracil, 12 surgical excision, 13 cryotherapy, 14 radiotherapy, 15 pressure therapy, 16 silicone gel sheeting, 17 and laser treatment, 18 have been used with variable success.…”

Keloid Banding Using Suture Ligature: A Novel Technique and Review of Literature

“…Presently, many clinically guided treatments for keloid scar removal exist while the preference of one treatment over the other is generally dictated by the clinical experience of the surgeon. Simple surgical excision and postoperative steroidal injection are the most common forms of keloid treatment 3 . Of these, intralesional steroidal injection with triamcinolone remains the most widely used treatment with an efficacy of over 80% according to early studies; although recurrence is still observed 4,29 .…”

“…Simple surgical excision and postoperative steroidal injection are the most common forms of keloid treatment. 3 Of these, intralesional steroidal injection with triamcinolone remains the most widely used treatment with an efficacy of over 80% according to early studies; although recurrence is still observed. 4,29 Intralesional steroidal injections are believed to inhibit fibroblast proliferation and collagen synthesis, and increase collagenase production.…”

“…Current clinical investigations support surgical excision, meticulous closure, postoperative steroidal injections, and postprocedural pressure dressings in the treatment of keloid tissue formation 3 . These various techniques rely on reduction of wound tension, inhibition of the inflammatory process, and direct alteration of the tissue microenvironment.…”

“…Current clinical investigations support surgical excision, meticulous closure, postoperative steroidal injections, and postprocedural pressure dressings in the treatment of keloid tissue formation. 3 These various techniques rely on reduction of wound tension, inhibition of the inflammatory process, and direct alteration of the tissue microenvironment. However, a universal approach in keloid therapy has yet to be identified and a shift has been made towards multimodal approaches involving up to three separate treatment strategies in the treatment scar formation.…”