Treatment Options for Keloid Scars
Intralesional triamcinolone acetonide (10-40 mg/mL) is the first-line treatment for keloids, with higher concentrations (40 mg/mL) recommended for established lesions. 1
First-Line Therapy: Intralesional Corticosteroids
- Triamcinolone acetonide remains the most commonly used and evidence-based first-line treatment for keloids. 1
- Concentrations of 40 mg/mL are specifically recommended for keloids (as opposed to lower concentrations for hypertrophic scars). 1
- Monitor for local adverse effects including skin atrophy, pigmentary changes, telangiectasias, and hypertrichosis. 1
- With repeated injections, assess for systemic corticosteroid absorption. 1
Adjunctive and Alternative Therapies
Silicone-Based Products
- Silicone gel sheeting or liquid silicone gel should be applied for at least 4 hours daily, with best results achieved at 12+ hours per day. 2
- Treatment improves color, thickness, and elasticity in both hypertrophic scars and keloids regardless of scar maturity. 2
- Liquid silicone gel (applied twice daily) offers advantages for irregular surfaces, facial areas, and upper chest where sheeting is difficult to apply or socially unacceptable. 3
- Begin treatment as soon as an itchy red streak develops in a maturing wound. 4
- Silicone sheeting demonstrates 85% improvement rates when worn at least 12 hours daily. 4
Combination Approaches
- Silicone gel sheeting combined with intralesional corticosteroids is effective for minor keloids. 3
- Combination therapy generally offers better results with higher patient satisfaction compared to monotherapy. 5
Emerging and Alternative Options
- Imiquimod upregulates interferons that inhibit collagen production by fibroblasts. 1
- Cryotherapy may cause keloid formation as a complication, limiting its use in keloid-prone individuals. 6
- Other emerging therapies include bleomycin, verapamil, botulinum toxin, laser therapy, and radiotherapy, though evidence is less robust. 5, 7
Critical Prevention Strategy
- Prevention is the best strategy for individuals with known keloid tendency or family history. 1
- Counsel patients with personal or family history of keloids about avoiding any procedures causing skin trauma. 1
- Watch for infections in healing wounds, treating with standard topical or systemic antibiotics as needed. 1
Common Pitfalls to Avoid
- Do not use cryotherapy as primary treatment in keloid-prone patients, as it may paradoxically induce keloid formation. 6
- Avoid silicone sheeting on infected or macerated skin; liquid silicone gel may be better tolerated. 3
- Do not rely on surgical excision alone, as keloids frequently recur without adjunctive therapy. 5