What is the best cream for treating keloids?

Best Treatments for Keloids

For treating keloids, the most effective topical approach is clobetasol propionate 0.05% cream under silicone dressing occlusion, which shows equal efficacy to intralesional triamcinolone injections with fewer adverse effects. 1

First-Line Topical Treatments

Silicone-Based Products

• Silicone gel sheeting is recommended as a first-line topical treatment for keloids
• Apply silicone sheets or gel directly to the keloid for 12-24 hours daily
• Mechanism: Creates occlusion, hydration, and may regulate fibroblast activity
• Benefits: Non-invasive, minimal side effects, suitable for home treatment

Corticosteroid Creams Under Occlusion

• Clobetasol propionate 0.05% cream under silicone dressing occlusion shows comparable efficacy to intralesional injections 1
• Application protocol:
  • Apply thin layer of clobetasol propionate 0.05% cream to keloid
  • Cover with silicone sheet/dressing
  • Apply daily for at least 12 weeks
• Advantages: Fewer adverse effects than injections (less skin atrophy, hypopigmentation, and telangiectasia)
• Particularly beneficial for patients with needle phobia or low pain threshold

Second-Line Topical Options

Pressure Therapy

• Compression garments or earrings (for earlobe keloids)
• Must deliver 24-30 mmHg pressure for at least 18 hours daily
• Most effective when combined with silicone products
• Particularly useful for ear keloids following piercing

Topical Retinoids

• Tretinoin cream has shown modest benefit in keloid management 2
• Can be used as an alternative when other topical treatments fail
• May provide additional benefits for skin texture and pigmentation
• Apply once daily, typically at night

Combination Approaches for Better Results

For Small Keloids (<2 cm)

1. Start with silicone gel sheets or clobetasol under occlusion
2. If inadequate response after 4-6 weeks, consider adding pressure therapy
3. For persistent keloids, consider intralesional triamcinolone acetonide (TAC) injections (10-40 mg/mL) every 3-4 weeks 3

For Larger Keloids (>2 cm)

1. Consider combination therapy with TAC + 5-FU or TAC + cryotherapy 3
2. Surgical options may be necessary, followed by immediate prophylactic measures

Special Considerations for Earlobe Keloids

• Combination therapy is superior to monotherapy for earlobe keloids 3
• Surgical excision followed by immediate intralesional TAC is a common approach
• Avoid ear piercing in individuals with history of keloids 3
• If piercing is performed, immediate prophylactic measures such as pressure, silicone, or TAC should be considered 3

Treatment Pitfalls to Avoid

• Monotherapy is generally less effective than combination approaches
• Discontinuing treatment too early (minimum 3-6 months needed)
• Failing to address underlying causes (tension, inflammation)
• Not considering patient factors (skin type, location of keloid, history of keloids)
• Using treatments contraindicated for certain areas (e.g., cryotherapy should be avoided on ears) 3

Patient Education Points

• Keloid treatment requires patience and consistency
• High recurrence rates (40-100%) when treated with single modalities 3
• Realistic expectations about complete resolution vs. improvement
• Importance of continued treatment even after visual improvement
• Prevention strategies for those prone to keloid formation

For optimal results, consistent application of the recommended topical treatment (clobetasol under silicone occlusion) for at least 12 weeks is necessary, with consideration of combination therapy for resistant cases.