Overview of Keloid Treatment Options

Learn about the different treatment options for keloid scars.

There are a number of treatment options available to remove or improve the appearance of keloid scars. When deciding which treatment option (or combination of) is best for a patient, doctors will look at the following factors:³

You know you want it cats! Sisal fabric!

Keloid location
Size
Depth
Patient age

In addition, the doctor will review what treatments have already been attempted.³

First-line treatments include:¹⁷

Cryotherapy
Silicone sheeting
Compression therapy
Corticosteroid injections (10-40 mg/mL directly into the keloid)

If these are unsuccessful, second-line treatment options may be attempted. Injections are always into the keloid, and many of these second-line treatments are actually a combination of therapies:^3,¹⁷

5-Fluorouracil (50 mg/mL)
Bleomycin tattooing (1.5 IU/mL)
Compression therapy
Cryotherapy followed by corticosteroid injections
Interferon alpha-2b (1.5 million IU) after surgery
Onion extract gels
Pulsed dye laser (alone or with other therapies)
Radiation (alone or after surgery)
Retinoic acid
Surgery followed by corticosteroid injections and silicone sheeting
Surgery followed by verapamil (2.5 mg/mL) injections and silicone sheeting
Tacrolimus

For small keloids, steroid injections directly into the scar are believed to be most effective; for larger keloids a combination of surgery and other treatment is typically recommended.^11,¹⁸

	Rate of Occurrence or Recurrence	% Patients with + Response		Possible Adverse Side Effects
Surgery	50-100%¹⁷	100%	Recurrence rates much lower for AKN⁽ⁱ⁾.	High recurrence rate and may come back worse.²
Compression therapy		90-100%¹⁷	Especially effective on earlobe keloids.²	Daily treatment over many months.²
Cryotherapy⁽ⁱⁱ⁾	0%³	50-76%^17,²¹	Painful; best used for smaller scars only.²	Hypopigmentation with darker skin, skin atrophy, infection.^2-3,¹⁷
with steroid injections	0%¹⁷	84%¹⁷		Reduced side effects when combined.¹⁷
LASER THERAPIES
Argon laser	45-93%³			Hypopigmentation with darker skin.²⁶
Carbon dioxide (CO₂) laser	39-92%³			Hypopigmentation with darker skin.²⁶
with steroid injections	25-74%³
with interferon alpha-2b	34%³
Nd YAG laser	53-100%³			Hypopigmentation with darker skin.²⁶
Pulse dye laser (PDL) 585		57-83%⁸		Hypopigmentation with darker skin.²⁶
with steroids and 5-FU		70%¹⁷
TOPICAL CREAMS AND DRESSINGS
Silicone gel sheets		50-100%¹⁷
after surgery	25-36%¹⁷	0-75%¹⁷
Topical retinoic acid		20-100%³		Rash, skin atrophy, and photosensitivity.³
Topical imiquimod after surgery	0-28.6%^3,¹⁷			Hyperpigmentation and irritation.^3,¹⁷
INJECTIONS
Corticosteroid injections (10-40 mg/mL)	9-50%¹⁷		Injections are painful.¹⁷	Skin atrophy, hypo-pigmentation, sores.¹⁷
with surgery	20%	92%		As above.
with surgery & silicone sheets	12.5%¹⁷	88%¹⁷		As above.
with surgery, PDL, & 5-fluorouracil		70%¹⁷		Same as individual treatment modes but reduced.⁵
with 5-fluorouracil	15%²¹	92%		Same as individual treatment modes but reduced.⁵
with cryotherapy		84%¹⁷		Hypopigmentation, but other side effects reduced.¹⁷
with interferon alpha-2b		100%³
5-Fluorouracil (5-FU) intralesional injections	47%³	88%¹⁷	More expensive than steroids; painful.²¹	Sores, dark red blotches hyperpigmentation,.^17,²¹
after surgery	19%²¹			As above.
Interferon alpha-2b injections^(iv)			Costly; intense pain at injection site.²	Flu-like symptoms.^2,⁸
after surgery (1.5 million IU)	8-19%¹⁷	30-50%¹⁷		As above.
after CO₂ laser ablation	33%³			As above.
Verapamil injections	0%¹⁹	100%¹⁹	Less painful than steroids.²	Fewer side effects than steroid shots.²
after surgery and with silicone sheets	36%³	90%¹⁷
with surgery & pressure earrings	0%³	52%³
Bleomycin tattooing (1.5 IU/mL)	15%³	88-92%¹⁷	Risk of side effects † with systemic doses of 200+.¹⁷	Hair loss, hyper-pigmentation, pulmonary fibrosis.¹⁷
RADIATION THERAPY⁽ⁱⁱⁱ⁾
Monotherapy	50-100%^8,¹⁶	10-94%⁸		Skin color changes, rash,†risk of cancer, stunted growth in children.¹⁷
with surgery	9-72%²¹	72-92%⁸		As above.
High-dose-rate brachytherapy	13.6%¹⁶			As above.
after surgery	4.7-12%^3,¹⁶	88-94%¹⁶		As above.
Irridium 192 interstitial irradiation after surgery	21%¹⁶			As above.
Some authorities believe that AKN is not a true keloidal condition but rather a separate condition with hypertrophic scarring. Recommended for smaller keloids only, of all types, because of increased risk of adverse side effects. Typically only recommended for keloids resistant to other therapies because of increased risk of adverse side effects. Interferon alpha-2b was ineffective at low dosage levels and when injected intraoperatively.

Disclaimer: This website is not intended to replace professional consultation, diagnosis, or treatment by a licensed physician. If you require any medical related advice, contact your physician promptly. Information presented on this website is exclusively of a general reference nature. Do not disregard medical advice or delay treatment as a result of accessing information at this site. Just Answer is an external service not affiliated with Keloid.com.