Is keloid removal possible?

Treatment of Keloid Scars

Yes, keloids can be removed, but treatment must be carefully planned as they have a high recurrence rate (50-80%) and often require combination therapy for optimal outcomes. 1

Treatment Options Based on Keloid Size

Small Keloids (<2 cm)

• First-line treatment:
  • Silicone gel sheets
  • Intralesional corticosteroid injections (triamcinolone acetonide)
• Add cryotherapy if no response after 3-4 sessions

Medium-Sized Keloids (2-5 cm)

• Combination therapy:
  • Intralesional corticosteroids
  • 5-fluorouracil
  • Maintenance with silicone gel sheets and/or pressure therapy

Large Keloids (>5 cm) or Resistant Keloids

• Surgical excision followed by:
  • Immediate post-excision intralesional corticosteroid injection
  • Postoperative radiation therapy
  • Maintenance with silicone gel sheets and/or pressure therapy

Surgical Approaches and Adjuvant Therapies

Surgical excision alone results in recurrence rates approaching 80%, making adjuvant therapy essential 2. The most effective approaches combine multiple modalities:

1. Surgical excision with radiation therapy:

   • Has shown better outcomes than surgery with steroid injections
   • In a randomized prospective trial, only 12.5% of keloids recurred after surgery and radiation therapy, compared to 33% with surgery and steroid injections 2
   • Radiation is typically delivered at postoperative day 1 and 8 with a total dose of 16-18 Gy

2. Novel approaches for difficult cases:

   • For large keloids, tissue expander implantation beneath the keloid followed by intralesional excision has shown 94.7% success rate in carefully selected patients 3
   • Trepanation combined with superficial radiotherapy has been successful in treating facial keloids with no recurrence during a 3-year follow-up period 4

3. Biological and antineoplastic agents:

   • Interferon alpha-2b: 18% recurrence rate when applied to post-surgical excised keloids
   • Imiquimod 5%: Can lower recurrence rate on post-shaved keloids to 37.5% at 6 months and to 0% at 12 months 5

Important Considerations

• Location matters: Keloids on the ears and torso are particularly difficult to treat and have higher recurrence rates 1
• Long-term commitment: Treatment must be maintained for prolonged periods (months to years) 1
• Regular follow-up: Essential to detect and treat recurrences early 1
• Prevention: Patients with a history of keloids should avoid elective aesthetic procedures 1

Treatment Challenges

• No single treatment guarantees complete elimination of keloid scars
• Multiple treatment sessions are typically required before significant improvement is observed
• Psychological impact on patients can be significant due to the challenging nature of treatment and potential for recurrence

For optimal outcomes, a combination approach tailored to the specific characteristics of the keloid (size, location, previous treatment history) is essential, with a focus on preventing recurrence rather than just removing the existing keloid.