Treatment of Keloid Scars

Introduction to Keloid Scar Treatment

Microneedling with PRP (Platelet-Rich Plasma) is effective mainly for atrophic scars, but less effective for keloids, and not recommended as first-line treatment for established keloids 1

The American Academy of Pediatrics recommends that patients with a history of keloids should avoid elective aesthetic procedures, as keloid scars have a high recurrence rate (50-80%) and treatment must be maintained for prolonged periods (months to years) 2
No single treatment is completely effective for keloid scars, and combination therapy is often necessary, with the goal of preventing recurrence and promoting optimal outcomes 1

For small keloids (<2 cm), treatment should start with silicone gel sheets and intralesional corticosteroid injections, with cryotherapy added if there is no response after 3-4 sessions, as recommended by clinical guidelines 1
For medium-sized keloids (2-5 cm), combination therapy with intralesional corticosteroids and 5-fluorouracil should be used, with silicone gel sheets and/or pressure therapy added as maintenance, based on clinical evidence 1
For large keloids (>5 cm) or resistant keloids, surgical excision followed by intralesional corticosteroid injection, postoperative radiation therapy, and maintenance with silicone gel sheets and/or pressure therapy should be considered, as suggested by clinical guidelines 1

Regular follow-up is essential to detect and treat recurrences early, and prevention is fundamental in patients with a history of keloids, as emphasized by the American Academy of Pediatrics 2
Keloids on the ears and torso are particularly difficult to treat and have a higher recurrence rate, requiring careful consideration of treatment options 1
Treatments may require multiple sessions before significant improvement is observed, and no treatment guarantees complete elimination of the keloid scar, highlighting the need for ongoing management and follow-up 1