Surgical Excision with Adjuvant Therapies in the Management of Keloids: A Systematic Review

Background and Objectives: Keloids are fibroproliferative disorders marked by excessive fibroblast activity, abnormal collagen deposition, and impaired wound healing. They are frequently associated with pain, pruritus, and significant aesthetic concerns, leading to reduced quality of life. Surgical excision alone is burdened by high recurrence rates, underscoring the need for effective adjuvant therapies. This systematic review aimed to assess the effectiveness of surgical excision combined with adjuvant physical and pharmacological therapies in keloid management, with particular emphasis on recurrence rates. Materials and Methods: The review was conducted in accordance with PRISMA guidelines. A systematic search of PubMed and Web of Science identified studies evaluating surgical excision of keloids with adjunctive therapies. Twenty-one studies involving more than 8627 patients met the inclusion criteria. Extracted data included study design, patient and lesion characteristics, treatment modalities, and recurrence rates. Due to marked heterogeneity among treatment protocols, a meta-analysis was not performed. Results: Among physical adjuvant therapies, postoperative brachytherapy showed the lowest recurrence rates (3.1-15%), outperforming radiotherapy and external-beam radiation therapy (14-29.3%). Compression therapy achieved recurrence rates of 10.66% and 14%, particularly effective in auricular keloids. Pharmacological adjuvant therapies demonstrated variable efficacy. Triamcinolone acetonide injections were associated with recurrence rates ranging from 6.6% to 33%, depending on the protocol. Adjuvant 5-fluorouracil reduced recurrence compared with surgery alone, whereas imiquimod 5% showed higher and less consistent recurrence rates. Combination pharmacological therapies consistently yielded better outcomes than monotherapy. Conclusions: Surgical excision combined with adjuvant therapy is the most effective strategy for keloid treatment. Multimodal approaches significantly reduce recurrence compared with surgery alone. However, substantial heterogeneity in lesion characteristics, treatment timing, and therapeutic protocols limits comparability between studies. Further high-quality, standardised clinical trials are needed to optimise management strategies and develop evidence-based guidelines.