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Treatment of Keloids

There are a number of treatment options available to remove or improve the appearance of keloid scars. When deciding which treatment option (or combination of) is best for a patient, doctors will look at the following factors:3

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  • Keloid location
  • Size
  • Depth
  • Patient age

In addition, the doctor will review what treatments have already been attempted.3

First-line treatments include:17

If these are unsuccessful, second-line treatment options may be attempted. Injections are always into the keloid, and many of these second-line treatments are actually a combination of therapies:3,17

For small keloids, steroid injections directly into the scar are believed to be most effective; for larger keloids a combination of surgery and other treatment is typically recommended.11,18

Rate of Occurrence or Recurrence

% Patients with + Response

 

Possible Adverse Side Effects

Surgery

50-100%17

100%

Recurrence rates much lower for AKN(i).

High recurrence rate and may come back worse.2

Compression therapy

 

90-100%17

Especially effective on earlobe keloids.2

Daily treatment over many months.2

Cryotherapy(ii)

0%3

50-76%17,21

Painful; best used for smaller scars only.2

Hypopigmentation with darker skin, skin atrophy, infection.2-3,17

with steroid injections

0%17

84%17

 

Reduced side effects when combined.17

LASER THERAPIES

Argon laser

45-93%3

   

Hypopigmentation with darker skin.26

Carbon dioxide (CO2) laser

39-92%3

   

Hypopigmentation with darker skin.26

with steroid injections

25-74%3

     

with interferon alpha-2b

34%3

     

Nd YAG laser

53-100%3

   

Hypopigmentation with darker skin.26

Pulse dye laser (PDL) 585

 

57-83%8

 

Hypopigmentation with darker skin.26

with steroids and 5-FU

 

70%17

   
TOPICAL CREAMS AND DRESSINGS

Silicone gel sheets

 

50-100%17

   

after surgery

25-36%17

0-75%17

   

Topical retinoic acid

 

20-100%3

 

Rash, skin atrophy, and photosensitivity.3

Topical imiquimod after surgery

0-28.6%3,17

   

Hyperpigmentation and irritation.3,17

INJECTIONS

Corticosteroid injections (10-40 mg/mL)

9-50%17

 

Injections are painful.17

Skin atrophy, hypo-pigmentation, sores.17

with surgery

20%

92%

 

As above.

with surgery & silicone sheets

12.5%17

88%17

 

As above.

with surgery, PDL, & 5-fluorouracil

 

70%17

 

Same as individual treatment modes but reduced.5

with 5-fluorouracil

15%21

92%

 

Same as individual treatment modes but reduced.5

with cryotherapy

 

84%17

 

Hypopigmentation, but other side effects reduced.17

with interferon alpha-2b

 

100%3

   

5-Fluorouracil (5-FU) intralesional injections

47%3

88%17

More expensive than steroids; painful.21

Sores, dark red blotches hyperpigmentation,.17,21

after surgery

19%21

   

As above.

Interferon alpha-2b injections(iv)

   

Costly; intense pain at injection site.2

Flu-like symptoms.2,8

after surgery

(1.5 million IU)

8-19%17

30-50%17

 

As above.

after CO2 laser ablation

33%3

   

As above.

Verapamil injections

0%19

100%19

Less painful than steroids.2

Fewer side effects than steroid shots.2

after surgery and with silicone sheets

36%3

90%17

   

with surgery & pressure earrings

0%3

52%3

   

Bleomycin tattooing

(1.5 IU/mL)

15%3

88-92%17

Risk of side effects with systemic doses of 200+.17

Hair loss, hyper-pigmentation, pulmonary fibrosis.17

RADIATION THERAPY(iii)

Monotherapy

50-100%8,16

10-94%8

 

Skin color changes, rash,†risk of cancer, stunted growth in children.17

with surgery

9-72%21

72-92%8

 

As above.

High-dose-rate brachytherapy

13.6%16

   

As above.

after surgery

4.7-12%3,16

88-94%16

 

As above.

Irridium 192 interstitial irradiation after surgery

21%16

   

As above.

  1. Some authorities believe that AKN is not a true keloidal condition but rather a separate condition with hypertrophic scarring.

  2. Recommended for smaller keloids only, of all types, because of increased risk of adverse side effects.

  3. Typically only recommended for keloids resistant to other therapies because of increased risk of adverse side effects.

  4. Interferon alpha-2b was ineffective at low dosage levels and when injected intraoperatively.

Disclaimer: This website is not intended to replace professional consultation, diagnosis, or treatment by a licensed physician. If you require any medical related advice, contact your physician promptly. Information at Keloids.com is exclusively of a general reference nature. Do not disregard medical advice or delay treatment as a result of accessing information at this site.