Clinical Treatment of Keloids

medicine

Background: Keloids represent benign fibroproliferative conditions that arise during wound healing. They are defined by the overproduction of extracellular matrix and a propensity to grow beyond the initial boundaries of the injury. These lesions are associated with symptoms such as pain and itching, lead to cosmetic deformities, and contribute to psychosocial distress. Their clinical management remains difficult, as single- modality treatments are frequently linked to high rates of recurrence, and a universally accepted optimal treatment protocol has not been established. Objective: We conducted a systematic assessment of the clinical evidence—including randomized trials, cohort studies, and systematic reviews—regarding keloid treatments. Our goal was to consolidate findings on therapeutic efficacy, recurrence rates, adverse effects, and to outline recommendations for combined treatment strategies. Methods: A systematic literature review was conducted utilizing PubMed, Embase, Scopus, and the Cochrane Library for studies published between January 2000 and September 2025. The search focused on various keloid interventions such as surgical excision, intralesional injections (e.g., corticosteroids, 5-fluorouracil, bleomycin, verapamil, interferon, botulinum toxin), cryotherapy, silicone and pressure dressings, laser and radiotherapy modalities, topical treatments (imiquimod, mitomycin C), and novel molecular/gene-based therapies. Relevant data were collected on study methodology, participant numbers, treatment details, efficacy outcomes (including reduction in scar volume/height and symptom improvement), recurrence frequency, and reported adverse effects. Results: Our analysis of 68 qualifying clinical studies—comprising randomized trials, cohort studies, and systematic reviews—confirmed that intralesional triamcinolone injections are a common first-line treatment, demonstrating reliable symptom relief and reduction in scar volume. However, recurrence following monotherapy remains frequent. Evidence indicates that combined regimens—such as excision followed by radiotherapy, excision with intralesional corticosteroids, or corticosteroid injections combined with 5- fluorouracil or bleomycin—achieve significantly lower recurrence rates compared to solitary excision. Adjunctive use of silicone gel/sheeting and pressure therapy proves beneficial, particularly for ear keloids. Laser treatments, including pulsed dye and fractional CO₂ lasers, are effective in reducing redness, improving flexibility, and decreasing thickness. Novel agents directed at the TGF‑β/Smad pathway and RNA interference mechanisms exhibit encouraging results in preliminary and early-stage clinical trials. Conclusions: A definitive monotherapy for keloids remains elusive. The most favorable results are achieved through multimodal, personalized treatment plans. The most robust evidence supports the use of adjuvant radiotherapy post-excision and combination intralesional pharmacotherapy for minimizing recurrence. Future research should prioritize randomized controlled trials with standardized outcome measures and extended follow-up periods, with molecularly targeted therapies representing a key investigative frontier.

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