What are the treatment options for keloids?

Scar keloids are abnormal, fibroproliferative skin lesions that extend beyond the original wound boundaries and do not regress spontaneously. Treatment is challenging due to their high recurrence rate—often exceeding 50% after monotherapy—and requires a multimodal, individualized approach. First-line therapy typically involves intralesional corticosteroid injections (e.g., triamcinolone acetonide 10–40 mg/mL), administered every 4–6 weeks for 3–6 months, which reduce inflammation, collagen synthesis, and fibroblast proliferation. For refractory or recurrent keloids, combination regimens significantly improve outcomes: corticosteroid injections paired with cryotherapy, pulsed-dye laser (PDL) therapy (targeting microvasculature and reducing erythema and thickness), or surgical excision followed by immediate postoperative radiotherapy (e.g., superficial X-ray or electron beam, 15–20 Gy total dose delivered within 24–48 hours of surgery) markedly lowers recurrence risk. Other evidence-supported options include silicone gel sheeting or occlusive pressure therapy (worn ≥12 hours daily for ≥3 months), topical imiquimod 5% cream (an immune response modifier), and newer agents such as intralesional 5-fluorouracil (5-FU) or verapamil. Patient counseling is essential—emphasizing realistic expectations, strict sun protection to prevent hyperpigmentation, avoidance of unnecessary trauma or piercing in predisposed individuals, and long-term follow-up given the propensity for late recurrence.