Keloid Scars: An Updated Review of Combination Therapies

Nicholas J Thornton, Benjamin A Garcia, Paige Hoyer, Michael G Wilkerson, Nicholas J Thornton, Benjamin A Garcia, Paige Hoyer, Michael G Wilkerson

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.

Keywords: combination therapy for keloid scars; combination therapy for keloids; combination treatment for keloids; combination versus monotherapy for keloids; keloid; keloid scar; keloid therapy; keloid treatment; treating keloids.

Conflict of interest statement

The authors have declared that no competing interests exist.

Copyright © 2021, Thornton et al.

References

    1. The keloid disorder: heterogeneity, histopathology, mechanisms and models. Limandjaja GC, Niessen FB, Scheper RJ, Gibbs S. Front Cell Dev Biol. 2020
    1. Keloids: a review of therapeutic management. Ekstein SF, Wyles SP, Moran SL, Meves A. Int J Dermatol. 2020
    1. A review of current keloid management: mainstay monotherapies and emerging approaches. Limmer EE, Glass DA. Dermatol Ther. 2020;10:931–948.
    1. Optimizing radiotherapy for keloids: a meta-analysis systematic review comparing recurrence rates between different radiation modalities. Mankowski P, Kanevsky J, Tomlinson J, et al. Ann Plastic Surge. 2017;78:403–411.
    1. Triamcinolone acetonide intralesional injection for the treatment of keloid scars: patient selection and perspectives. Morelli Coppola M, Salzillo R, Segreto F, et al. Clin Cosmetic Investigational Dermatol. 2018;11:387–396.
    1. A comparison of the effectiveness of triamcinolone and radiation therapy for ear keloids after surgical excision: a systematic review and meta-analysis. Shin JY, Lee JW, Roh SG, et al. Plastic Reconstruct Surg. 2016;137:1718–1725.
    1. Keloid pathogenesis and treatment. Al-Attar A, Mess S, Thomassen JM, et al. Plastic Reconstruct Surg. 1963;117:286–300.
    1. Radiation therapy in keloids treatment: history, strategy, effectiveness, and complication. Xu J, Yang E, Yu NZ, et al. Chin Med J. 2017;130:1715–1721.
    1. Outcomes of surgical excision with pressure therapy using magnets and identification of risk factors for recurrent keloids. Park TH, Seo SW, et al. Plastic Reconstruct Surg. 2011;128:431–439.
    1. Treatment of earlobe keloids by surgical excision and cryosurgery. Litrowski N, Boullie MC, Dehesdin D, et al. J Eur Acad Dermatol Venereol. 2014;28:1324–1331.
    1. Efficacy of 2 representative topical agents to prevent keloid recurrence after surgical excision. Shin JY, Yun SK, Roh SG, et al. J Oral Maxillofacial Surg. 2017;75:401.
    1. FDA Approves First Therapy for Treatment of Low-Grade Upper Tract Urothelial Cancer. U.S. Food and Drug Administration (FDA) (Press Release) [Apr;2021 ]; 2020
    1. Imiquimod mode of action. Schon MP, Schon M. . Br J Dermatol. 2007;157:8–13.
    1. Ablative CO 2 fractional resurfacing in treatment of thermal burn scars: an open‐label controlled clinical and histopathological study. El‐Zawahry BM, Sobhi RM, Bassiouny DA, et al. J Cosmetic Dermatol. 2015;14:324–331.
    1. Successful treatment of keloid with fractionated carbon dioxide (CO2) laser and laser-assisted drug delivery of triamcinolone acetonide ointment in an African-American man. Kraeva E, Ho D, Jagdeo J. J Drugs Dermatol. 2017;16:925–927.
    1. Effect of carbon dioxide laser ablation followed by intralesional steroids on keloids. Garg SA, Sao PP, Khopkar US. J Cutaneous Aesthetic Surg. 2011;4:2–6.
    1. Comparison of efficacy and safety of intralesional triamcinolone and combination of triamcinolone with 5-fluorouracil in the treatment of keloids and hypertrophic scars: randomised control trial. Khalid FA, Mehrose MY, Saleem M, et al. Burns. 2019;45:69–75.
    1. Intralesional cryosurgery and intralesional steroid injection: a good combination therapy for treatment of keloids and hypertrophic scars. Weshahy AH, Abdel Hay R. Dermatologic Therapy. 2012;25:273–276.
    1. The efficacy of surgical excision plus adjuvant multimodal therapies in the treatment of keloids: a systematic review and meta-analysis. Ellis M, Jones LR, Siddiqui F, et al. Dermatologic Surg. 2020;46:1054–1059.
    1. Keloid management: a retrospective case review on a new approach using surgical excision, platelet-rich plasma, and in-office superficial photon x-ray radiation therapy. Jones ME, Hardy C, Ridgway J. Adv Skin Wound Care. 2016;29:303–307.
    1. Hyperbaric oxygen therapy improves the effect of keloid surgery and radiotherapy by reducing the recurrence rate. Song K, Liu S, Zhang M, et al. J Zhejiang Univ Sci B. 2018;19:853–862.

Source: PubMed

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