Non-surgical approaches to keloids: optional or obligatory?
Objectives: Keloid disorder (KD) is one the most difficult-to-treat human illnesses. Although keloids can occur at any age, they tend to develop more rapidly during and after puberty. Epidemiology and age of onset of keloid has not been properly studied.
With highly variable and diverse clinical presentation, patients with KD are in need of different treatment options that would address each unique clinical scenario. Although localized treatments may be proper for patients with early and limited stage KD, patients with more advanced stages of KD are in need of systemic treatments.
Introduction: The armamentarium for treatment of KD is limited to suboptimal methods, with minimal data to guide treatment pathways and no systemic treatment options.
Treatment strategy starts with establishing treatment goals which often vary from patient to patient. With our limited understanding of its pathophysiology, and the lack of academic and industry interest, most treatment options that are used to treat keloid patients have been borrowed from other areas of medicine.
Materials / method: The most important aspect of treating keloid patients is “do no harm”.
Intralesional Steroid (ILS) Injection is the most commonly used treatment modality for KD, however repeated injections can lead to worsening of keloids in about 17% of patients.
Lasers are among the most commonly used tools in day-to-day practice of dermatology. Although there are several reports about the utility and efficacy of laser treatment in keloid lesions, there is data suggesting that laser treatments can lead to worsening of keloids in about 20% of patients.
Results: Surgical removal of keloids is known to lead to very high rate of recurrence and worsening of keloids in a large number of patients.
Efficacy of cryotherapy in treatment of keloids has been reported by various authors. Cryotherapy is highly effective in the treatment of ear keloids as well as bulky and tumoral keloidal lesions.
Conclusion: At the current time, the author advises against surgery, radiation therapy and laser treatments for early-stage keloids. These recommendations are data-driven and are aimed to reduce the risk for iatrogenic worsening of the keloids.
Author’s presentation will cover various clinical aspects of KD as well as treatment strategy and non-surgical interventions such as cryotherapy and intralesional chemotherapy.
