Keloid Scars: An Updated Review of Combination Therapies

Overview

Journal Cureus

Specialty Biomedical Engineering

Date 2021 Feb 5

PMID 33542883

Citations 9

Authors

Nicholas J Thornton

Benjamin A Garcia

Paige Hoyer

Michael G Wilkerson

Affiliations

Soon will be listed here.

Abstract

Keloid scars are a common yet poorly understood complication of wound healing that can cause a diminished quality of life. Currently, there is little agreement amongst the medical community regarding the best treatment modality for keloids. For this reason, we have created an updated review of the most successful combination therapies for keloid scars and compared their efficacy based on rates of recurrence following treatment. Additionally, these combination therapies have been compared with intralesional triamcinolone acetonide corticosteroid (TAC), which is considered the mainstay monotherapy for keloids. All combination therapies included in our review were shown to produce superior outcomes than TAC monotherapy. We have also found that certain combination therapies are known to produce superior results when used in specific anatomic locations. Intralesional TAC plus intralesional cryotherapy appeared to have the most promising results for non-auricular keloids, and the authors suggest considering this as a first-line treatment. Additionally, the use of surgical excision plus compression therapy achieved superior results for auricular keloids and should be considered first-line for keloids in these locations.

Citing Articles

Surgical Excision and Radiotherapy for Giant Keloids in Auricula: A Case Report.

Boesoirie S, Winastuti R, Permana A, Yudistira N, Gatera V, Boesoirie M Int Med Case Rep J. 2025; 18():33-40.

PMID: 39817051 PMC: 11733165. DOI: 10.2147/IMCRJ.S496531.

Pharmacotherapy for Keloids and Hypertrophic Scars.

Murakami T, Shigeki S Int J Mol Sci. 2024; 25(9).

PMID: 38731893 PMC: 11083137. DOI: 10.3390/ijms25094674.

The clinical efficacy of single-hole punch excision combined with intralesional steroid injection for nodular keloid treatment: a self-controlled trial.

Liu B, Lin H, Zhang M Sci Rep. 2024; 14(1):9793.

PMID: 38684804 PMC: 11058828. DOI: 10.1038/s41598-024-60670-x.

Successful Treatment of Recurrent Earlobe Keloid Through Removal of Concealed Underlying Epidermoid Cysts: A Case Report.

Yi J, Park J, Kim J, Oh B, Jung J Cureus. 2023; 15(9):e44602.

PMID: 37795062 PMC: 10546951. DOI: 10.7759/cureus.44602.

Keloid Development After Fine Needle Aspiration of the Thyroid: A Rare Case and Review of Management Strategies.

Holder S, Malvan-Iyalla A, Arfan S, Basani V, Tiesenga F Cureus. 2023; 15(7):e42359.

PMID: 37621840 PMC: 10445297. DOI: 10.7759/cureus.42359.

References

Song K, Liu S, Zhang M, Liang W, Liu H, Dong X . Hyperbaric oxygen therapy improves the effect of keloid surgery and radiotherapy by reducing the recurrence rate. J Zhejiang Univ Sci B. 2018; 19(11):853-862. PMC: 6238115. DOI: 10.1631/jzus.B1800132. View

Schon M, Schon M . Imiquimod: mode of action. Br J Dermatol. 2007; 157 Suppl 2:8-13. DOI: 10.1111/j.1365-2133.2007.08265.x. View

Khalid F, Younas Mehrose M, Saleem M, Yousaf M, Mujahid A, Rehman S . Comparison of efficacy and safety of intralesional triamcinolone and combination of triamcinolone with 5-fluorouracil in the treatment of keloids and hypertrophic scars: Randomised control trial. Burns. 2018; 45(1):69-75. DOI: 10.1016/j.burns.2018.08.011. View

Ellis M, Jones L, Siddiqui F, Sunkara P, Ozog D . The Efficacy of Surgical Excision Plus Adjuvant Multimodal Therapies in the Treatment of Keloids: A Systematic Review and Meta-Analysis. Dermatol Surg. 2020; 46(8):1054-1059. DOI: 10.1097/DSS.0000000000002362. View

El-Zawahry B, Sobhi R, Bassiouny D, Tabak S . Ablative CO2 fractional resurfacing in treatment of thermal burn scars: an open-label controlled clinical and histopathological study. J Cosmet Dermatol. 2015; 14(4):324-31. DOI: 10.1111/jocd.12163. View

Shin J, Yun S, Roh S, Lee N, Yang K . Efficacy of 2 Representative Topical Agents to Prevent Keloid Recurrence After Surgical Excision. J Oral Maxillofac Surg. 2016; 75(2):401.e1-401.e6. DOI: 10.1016/j.joms.2016.10.009. View

Shin J, Lee J, Roh S, Lee N, Yang K . A Comparison of the Effectiveness of Triamcinolone and Radiation Therapy for Ear Keloids after Surgical Excision: A Systematic Review and Meta-Analysis. Plast Reconstr Surg. 2016; 137(6):1718-1725. DOI: 10.1097/PRS.0000000000002165. View

Ekstein S, Wyles S, Moran S, Meves A . Keloids: a review of therapeutic management. Int J Dermatol. 2020; 60(6):661-671. PMC: 7940466. DOI: 10.1111/ijd.15159. View

Limmer E, Glass 2nd D . A Review of Current Keloid Management: Mainstay Monotherapies and Emerging Approaches. Dermatol Ther (Heidelb). 2020; 10(5):931-948. PMC: 7477022. DOI: 10.1007/s13555-020-00427-2. View

10.

Park T, Seo S, Kim J, Chang C . Outcomes of surgical excision with pressure therapy using magnets and identification of risk factors for recurrent keloids. Plast Reconstr Surg. 2011; 128(2):431-439. DOI: 10.1097/PRS.0b013e31821e7006. View

11.

Jones M, Hardy C, Ridgway J . Keloid Management: A Retrospective Case Review on a New Approach Using Surgical Excision, Platelet-Rich Plasma, and In-office Superficial Photon X-ray Radiation Therapy. Adv Skin Wound Care. 2016; 29(7):303-7. PMC: 4915758. DOI: 10.1097/01.ASW.0000482993.64811.74. View

12.

Garg G, Sao P, Khopkar U . Effect of carbon dioxide laser ablation followed by intralesional steroids on keloids. J Cutan Aesthet Surg. 2011; 4(1):2-6. PMC: 3081479. DOI: 10.4103/0974-2077.79176. View

13.

Xu J, Yang E, Yu N, Long X . Radiation Therapy in Keloids Treatment: History, Strategy, Effectiveness, and Complication. Chin Med J (Engl). 2017; 130(14):1715-1721. PMC: 5520560. DOI: 10.4103/0366-6999.209896. View

14.

Kraeva E, Ho D, Jagdeo J . Successful Treatment of Keloid With Fractionated Carbon Dioxide (CO2) Laser and Laser-Assisted Drug Delivery of Triamcinolone Acetonide Ointment in an African-American Man. J Drugs Dermatol. 2017; 16(9):925-927. View

15.

Mankowski P, Kanevsky J, Tomlinson J, Dyachenko A, Luc M . Optimizing Radiotherapy for Keloids: A Meta-Analysis Systematic Review Comparing Recurrence Rates Between Different Radiation Modalities. Ann Plast Surg. 2017; 78(4):403-411. DOI: 10.1097/SAP.0000000000000989. View

16.

Limandjaja G, Niessen F, Scheper R, Gibbs S . The Keloid Disorder: Heterogeneity, Histopathology, Mechanisms and Models. Front Cell Dev Biol. 2020; 8:360. PMC: 7264387. DOI: 10.3389/fcell.2020.00360. View

17.

Litrowski N, Boullie M, Dehesdin D, De Barros A, Joly P . Treatment of earlobe keloids by surgical excision and cryosurgery. J Eur Acad Dermatol Venereol. 2013; 28(10):1324-31. DOI: 10.1111/jdv.12282. View

18.

Weshahy A, Abdel Hay R . Intralesional cryosurgery and intralesional steroid injection: a good combination therapy for treatment of keloids and hypertrophic scars. Dermatol Ther. 2012; 25(3):273-6. DOI: 10.1111/j.1529-8019.2012.01456.x. View

19.

Al-Attar A, Mess S, Thomassen J, Kauffman C, Davison S . Keloid pathogenesis and treatment. Plast Reconstr Surg. 2006; 117(1):286-300. DOI: 10.1097/01.prs.0000195073.73580.46. View

20.

Morelli Coppola M, Salzillo R, Segreto F, Persichetti P . Triamcinolone acetonide intralesional injection for the treatment of keloid scars: patient selection and perspectives. Clin Cosmet Investig Dermatol. 2018; 11:387-396. PMC: 6063260. DOI: 10.2147/CCID.S133672. View