Selective therapy (cryo or scalpel) combined with multimodal therapy for treating keloids

Keloids are less responsive to any single treatment modality; hence, there is a need for combination therapy that can yield satisfactory outcomes.

The present study assessed efficacy and safety of combination therapy-surgical excision or cryotherapy and intralesional corticosteroids along with 5-fluorouracil [IL (S + 5-FU)] injection, followed by silicone gel sheet (SGS) under compression therapy in the treatment of keloids.

This was a retrospective, observational study comprising 21 clinically diagnosed keloid patients. All patients were treated with the stated combination therapy. Data about demographic, lesions, procedural characteristics, and treatment outcomes were reported.

Of 21, 11 (52.4%) patients were treated with liquid nitrogen (LN₂) cryotherapy, and 10 (47.6%) patients were treated with surgical excision. Mean age was 30.8 ± 7.6 (range: 14-44) years with slight male (52.4%) predominance. A mean surface area of keloid lesion was 96.8 ± 170.5 cm³. The most frequently involved site was auricle (8 [38.1%] patients). Patients received the following types of treatments: intralesional LN₂ cryotherapy (6 [28.6%]), intralesional excisional surgery (6 [28.6%]), surface LN₂ cryotherapy (5 [23.8%]), and extralesional excisional surgery (4 [19.0%]). Complications of recurrence (2 [9.5%]), secondary infections (2 [9.5%]), persistent postinflammatory hypopigmentation (1 [4.8%]), and atrophic scarring with postinflammatory hyperpigmentation (1 [4.8%]) were reported. After a study period of 2.5 years, 100% cure rate was achieved.

Combination therapy of surgical excision or cryotherapy and IL (S + 5-FU), followed by SGS under compression, was safe and effective in treating keloids.