Ann Plast Reconstr Surg | Volume 7, Issue 2 | Research Article | Open Access

Keloids: A Retrospective Review and Treatment Algorithm

Pooja SY, Kevin MK, Jordan G, Andres M, Carisa MC and Damon SC*

Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, USA

*Correspondance to: Damon S Cooney 

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Introduction: Keloids cause substantial functional and psychological impairment, but effective treatment remains elusive. This study comparatively investigated treatment efficacy and recurrence rates associated with a variety of pharmacologic and procedural treatments intended to remove or reduce keloid scars.
Methods: We retrospectively reviewed patients aged 18 to 100 years with documented keloid diagnoses at our institution between January 1st, 2017 to January 1st, 2019. Study outcomes included improvement in keloid-related pain and pruritis, volumetric scar improvement, and keloid recurrence rates.
Results: 214 patients encompassing 391 scars met inclusion criteria. Most patients were African American (n=118, 55%), and the most common scar etiologies were surgery (n=125, 32%) and burns (n=117, 30%). Most keloids were on the head/face (n=106, 27%) and the chest/abdomen (n=78, 20%). Thirty-five percent (n=75) of patients failed treatment prior to presenting at our institution. Volumetric improvement 15 months post-treatment was greatest in burn-related keloids treated with laser therapy and intralesional steroid injection (80% with improvement, p<0.01) and for surgical scars treated with surgical excision and intralesional injection (63% with improvement, p=0.03); recurrence rates were similarly lower in these etiology/treatment pairings [burn scar recurrence: 30% (p=0.03); surgical scar recurrence: 26% (p=0.01), compared to 75% and 68% with intralesional injections alone, respectively]. These data were used to develop a management algorithm by scar etiology to optimize keloid treatment/minimize recurrence.
Conclusion: By compiling retrospective data from our dedicated keloid clinic, we identified a treatment algorithm that optimizes keloid volume reduction and minimizes recurrence rates, based on scar etiology. Such pathways can help to standardize keloid treatment


Keloid; Recurrence rates; Laser therapy; Intralesional injections; Surgical excision


Pooja SY, Kevin MK, Jordan G, Andres M, Carisa MC, Damon SC. Keloids: A Retrospective Review and Treatment Algorithm. Ann Plast Reconstr Surg. 2023; 7(2): 1108..

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