Keloid Treatment Guidelines

First-Line Treatment

The American College of Dermatology recommends intralesional triamcinolone acetonide (10-40 mg/mL) as the standard of care for keloid treatment, with higher concentrations (40 mg/mL) recommended for thicker or more resistant keloids 1
Injections are typically administered every 3-4 weeks until the keloid flattens or symptoms improve 1
Monitor for local adverse effects including skin atrophy, pigmentary changes, telangiectasias, and hypertrichosis with repeated injections 1

For cryotherapy application, apply liquid nitrogen with a cotton-tipped applicator for 15-20 seconds until 1-2 mm of circumferential skin around the lesion appears frozen 2
Allow to thaw for 20-60 seconds, then repeat the freeze step 2
Repeat the entire process at 3-week intervals until healing occurs 2
When combined with intralesional steroids, use a shorter application of liquid nitrogen (no second freeze step) and inject the steroid after the whitened skin normalizes in color 2

Prevention is critical for individuals with personal or family history of keloids, and caution patients about any procedures that cause skin trauma 1
Consider prophylactic treatment for high-risk patients undergoing surgery 3
Avoid cryotherapy on eyelids, tip of nose, lips, mucous membranes, cartilaginous structures, or superficial nerves 3
Use cryotherapy with caution in patients with darker skin as both hypo- and hyperpigmentation can result 2
Monitor for secondary infections, which can be treated with standard topical or systemic antibiotics 1
Imiquimod has been noted to be effective in treating keloids in some cases 4