Keloid Scars: An Updated Review of Combination Therapies

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.

Updates on keloid scar pathogenesis, assessment and treatment modalities

“…Prevention is the responsibility of both patient and physician or surgeon equally [2] . Prevention and treatment modalities of keloid are summarized in tables (2, 3) [4,18] . Table (2): Current treatment strategies for hypertrophic scars and keloids [4] Categories -585-nm pulsed dye laser: 6.0-7.5 J/cm2 (7 mm spot) or 4.5-5.5 J/cm2 (10 mm spot) -1064-nm Nd:YAG laser: 14 J/cm2…”

“…Common side effects of corticosteroids injections are pain, atrophy and hypopigmentation. Combined intra-lesional TAC and cryotherapy are now considered the first line treatment of nonauricular keloids [18] . 2) Cryotherapy: It acts in media as liquid nitrogen that affects microvasculature leading to cell damage and tissue anoxia.…”

“…Multiple sessions are needed to improve the keloid scar with interval of a month at least, however high recurrence rates occur at one year. Main side effects of laser are pain, erythema and hypopigmentation [18,9] . Fractional CO 2 is efficient as TAC but it needs many sessions and longer period to give the effect compared to it.…”

“…It is the best option for ear keloids where recurrence rates are less by 70-95% but also need strict application 12 hours per day for 6 month at least at a pressure of 24 mmHg, otherwise it may cause necrosis if pressure is more than 30 mmHg [9] . Surgical therapy followed by compressive therapy is now considered as first line treatment of auricular keloids [18] . 6) 5-Fluorouracil (5-FU): It's an antineoplastic agent that has the ability to interfere with DNA synthesis and cell proliferation which in turn inhibits fibroblast proliferation and also enhances apoptosis of fibroblasts without tissue necrosis [20] .…”

Infected auricular keloid secondary to attempted self-amputation of a gauge earring

“…Other treatment options may include occlusive dressings, radiation, laser therapy, cryotherapy and pharmacotherapy (eg, corticosteroids, 5-fluorouracil, imiquimod). 7…”