Keloid Management and Treatment Techniques

Keloids are benign fibroproliferative scars characterised by excessive collagen deposition beyond the boundaries of an original wound. They pose a significant aesthetic and functional burden worldwide, with elevated incidence in individuals of darker phototypes. Management requires a multimodal strategy in order to achieve durable control and minimise recurrence. First-line approaches often combine surgical excision with intralesional corticosteroids or antimetabolite injections to suppress fibroblast proliferation. Adjuvant physical therapies such as radiotherapy, pressure dressings and silicone sheeting are routinely employed to modulate wound biomechanics and reduce extracellular matrix overproduction. Laser ablation and cryotherapy offer alternatives for refractory lesions, while emerging molecular interventions targeting pathways such as mTOR and transforming growth factor-β signalling are under investigation. Despite the array of available options, recurrence rates remain high, underscoring the need for personalised protocols that integrate clinical risk factors—such as anatomical site and previous treatment history—with objective scar assessment scales. Recent advances emphasise combination regimens that shorten treatment courses, improve patient compliance and yield superior cosmetic and functional outcomes. Ongoing research continues to refine radiation dosing schedules and develop novel topical and injectable agents, driving incremental gains in therapeutic efficacy.

Research from Nature Portfolio

A self-controlled trial evaluated the efficacy of single-hole punch excision combined with intralesional steroid injection for nodular keloids. Fifty patients with bilateral symmetrical lesions received punch excision plus steroid injection on one side and steroid injection alone on the other. The combination arm achieved an 86% overall response rate, significantly higher than the 66% observed with injection monotherapy, and demonstrated a recurrence rate of 22% versus higher rates in controls. Lesion severity measured by the Vancouver Scar Scale decreased more rapidly in the combination group, reducing the total number of injections required. Importantly, the combined approach was well tolerated, with no significant adverse events, indicating that targeted tissue removal followed by corticosteroid delivery can shorten treatment duration and enhance scar regression.

Keloid Management and Treatment Techniques publication trend

The graph below shows the total number of articles in keloid management and treatment techniques across all publications each year (not limited to Nature Index journals).

Technical terms

Keloid: A pathological scar characterised by persistent fibroblast activation and excessive collagen deposition extending beyond the original wound margins.

Intralesional steroid injection: Local delivery of corticosteroids directly into scar tissue to inhibit inflammation and collagen synthesis.

Punch excision: Surgical removal of a lesion using a circular blade to extract tissue cores, allowing precise defect control.

High-dose-rate interventional radiotherapy: A radiotherapy technique delivering a high radiation dose in brief, tightly fractionated sessions via an internal or surface applicator.

Rhenium-188 therapy: Topical application of a beta-emitting radionuclide to deposit cytotoxic radiation within superficial keloid tissue.

Vancouver Scar Scale (VSS): A clinical tool for assessing scar characteristics—pliability, height, vascularity and pigmentation—to quantify treatment response.

References

1. The clinical efficacy of single-hole punch excision combined with intralesional steroid injection for nodular keloid treatment: a self-controlled trial. Scientific Reports (2024).
2. Keloid treatments: an evidence-based systematic review of recent advances. Systematic Reviews (2023).
3. Post-operative KEloids iRradiation (POKER): does the surgery/high-dose interventional radiotherapy association make a winning hand?. La radiologia medica (2024).
4. Alternative treatment for recurrent keloids: initial clinical experience with Rhenium-188 using a specialized device. European Journal of Nuclear Medicine and Molecular Imaging (2025).