Comparative Efficacy and Recurrence of Combination Therapies in Keloid Management: A Systematic Review and Network...

Combination therapies are increasingly recognized in keloid management, which has been challenging due to high recurrence and variable individual responses. This Network Meta-Analysis (NMA) aimed to identify the most effective combinations with the lowest recurrence rates.

The protocol was registered in PROSPERO (CRD42024594922). Relevant Randomized Controlled Trials (RCT) evaluating all combination therapies for keloid were extracted from Cochrane, PubMed, and Scopus, until January 7, 2025.

A total of 1398 cases from 22 RCTs comparing different treatment combinations for keloid were included. The NMA revealed that only combinations involving Triamcinolone Acetonide (TAC) and 5-Fluorouracil (5-FU) displayed significantly higher efficacy than TAC monotherapy: TAC + 5-FU + Pulsed Dye Laser (PDL) (RR 2.98; 95% CI: 1.26 to 7.02) and TAC + 5-FU (RR 1.43; 95% CI: 1.05 to 1.93). The lowest recurrence rates were found in TAC + bleomycin (RR 0.04; 95% CI: 0.00 to 0.84) and TAC + 5-FU + brachytherapy (RR 0.23; 95% CI: 0.07 to 0.73). No other combinations showed statistically significant differences. Funnel plot analysis revealed no publication bias.

Combination therapies, particularly TAC + 5-FU with PDL or brachytherapy, and TAC + bleomycin, outperform TAC alone in efficacy and recurrence reduction. These findings support tailored, multimodal approaches for optimal keloid management and improved patient outcomes.