Cryotherapy is useful, but only for smaller lesions, such as those resulting from acne. First-line options include silicone sheeting, pressure treatment, and corticosteroid injections, but all of these require exemplary adherence and follow-up. The large number of treatment options is a reflection of the poor quality of research on this topic, with no single proven best treatment or combination of treatments. 1, 7 – 9, 12 – 21 Both conditions respond to the same therapies, but hypertrophic scars are easier to treat. Keloid and hypertrophic scar therapy is challenging and controversial ( Table 2). Limited clinical trials have failed to demonstrate lasting improvement of established keloids and hypertrophic scars with onion extract topical gel (e.g., Mederma) or topical vitamin E. Intralesional verapamil, fluorouracil, bleomycin, and interferon alfa-2b injections, and topical imiquimod 5% cream (Aldara) are reasonable, but less studied, alternatives to corticosteroids for treatment and postoperative prevention of keloids. When first-line treatments for keloids and hypertrophic scars fail, combination therapy (surgery, silicone sheeting, and corticosteroid injections) is an effective second-line option. Pressure dressings or garments are effective for prevention of hypertrophic scars, especially in burns. Silicone elastomer sheeting is a noninvasive, but time-intensive, first-line option for prevention and treatment of keloids and hypertrophic scars. Intralesional corticosteroid injections for prevention and treatment of keloids and hypertrophic scars are a practical first-line approach for the family physician. Despite the popularity of over-the-counter herb-based creams, the evidence for their use is mixed, and there is little evidence that vitamin E is helpful.Ĭryotherapy is useful for smaller lesions (e.g., acne keloids) and in combination with other techniques. Intralesional verapamil, fluorouracil, bleomycin, and interferon alfa-2b injections appear to be beneficial for treatment of established keloids. Alternative postsurgical options for refractory scars include pulsed dye laser, radiation, and possibly imiquimod cream.
Surgical removal of keloids poses a high recurrence risk unless combined with one or several of these standard therapies. Cryotherapy may be useful, but should be reserved for smaller lesions. Evidence supports silicone sheeting, pressure dressings, and corticosteroid injections as first-line treatments. Once established, however, keloids are difficult to treat, with a high recurrence rate regardless of therapy.
KEYLORD SCARRING SKIN
Keloid formation often can be prevented if anticipated with immediate silicone elastomer sheeting, taping to reduce skin tension, or corticosteroid injections. High-risk trauma includes burns, ear piercing, and any factor that prolongs wound healing. Sternal skin, shoulders and upper arms, earlobes, and cheeks are most susceptible to developing keloids and hypertrophic scars. Patients at high risk of keloids are usually younger than 30 years and have darker skin. Keloids and hypertrophic scars represent an exuberant healing response that poses a challenge for physicians.
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