Adjunct therapies to surgical management of keloids

BACKGROUND. The literature describing surgical treatments, with or without supplementary nonsurgical treatments for keloids, offers a confusing picture of widely variable ''success'' rates, recurrence rates, patient populations, and follow-up periods. OBJECTIVE. A review of the surgical treatment of keloids with emphasis on surgery combined with nonsurgical therapies is presented. RESULTS. Surgery alone leads to recurrence rates ranging from 45 to 100%. When surgery is combined with intradermal corti-costeroids the recurrence rate in the majority of studies falls below 50%. Surgery combined with button compression therapy on earlobes led to no recurrences. External radiation following excision, often combined with other therapies, has been associated with recurrence rates of less than 10%. Various lasers have been used in the treatment of keloids with great variability in the recurrence rate but in general result in similar recurrence rates as conventional surgery. As with cryodestruction, laser ablation recurrence rates often are improved when combined with other treatments. Interferon-alpha 2b injected after keloid excision demonstrated, in a small series of patients an 8% recurrence rate. CONCLUSION. Presently, it appears that a combined therapeutic approach offers the most propitious possibility for preventing keloid recurrence.