The well-accepted standard of care for the treatment of an existing keloid is intralesional injection of a glucocorticosteroid. Unfortunately, this treatment is associated with some drawbacks, including the pain of injection, development of hypopigmentation or depigmentation, and residual erythema. Once the keloid is symptom-free and has flattened or softened, the residual erythema may be addressed with pulsed dye laser treatments. Dermatologists try to avoid excising keloids because recurrence is common after excision (51%–100% after 1 year), and sometimes keloids that recur are even larger than the original lesion. Based on the knowledge that glucocorticoid injections can be an effective treatment for keloids, and both patient and physician frustration with the lack of a highly effective, reproducible keloid treatment, a focus of research has been on minimizing recurrences after keloid excision by intralesional injection of a glucocorticosteroid at excision sites. However, the effectiveness of this approach is not supported by the literature.
There may be a new option: injection of a modified gelatin hydrocolloid scaffold at the time of surgery. This approach has been reported to significantly reduce the rate of recurrence of keloid development post keloidectomy, and is approved in Europe and Canada to optimize the appearance of post-surgical scars in patients without a diathesis for developing keloids. Manipulation of stem cell–like, keloid precursor cells within keloids holds future promise in reducing the development of keloidal scarring.
- Updated International Scar Management Recommendations: Part 1–Evaluating the Evidence
- Updated International Clinical Recommendations on Scar Management: Part 2–Algorithms for Scar Prevention and Treatment
Brian Berman MD, PhD