Analysis of Risk Factors and Exploration of Treatment for Infected Keloid

To identify independent risk factors for keloid infection and explore optimal therapeutic strategies for infected keloids.

A retrospective study included 131 keloid patients (26 infected, 105 non-infected) from two hospitals (July 2021-January 2025). Univariate and multivariate logistic regression analyses screened infection-related risk factors. Efficacy was compared among infected patients treated with complete surgical excision + radiotherapy (n= 12), intralesional injection + radiotherapy (n= 10), and local resection of infectious focus + injection + radiotherapy (n= 4). Outcomes included Patient and Observer Scar Assessment Scale (POSAS), infection recurrence, keloid recurrence, and complications.

Multivariate logistic regression analysis identified maximum lesion diameter, disease duration and family history of keloids as independent risk factors for keloid infection (all P< 0.05). For infected keloids, the injection group had significantly higher 6-month/12-month POSAS scores, infection recurrence rate (50.0% vs. 0.0%), and keloid recurrence rate (60.0% vs. 16.7%) than the surgery group (all P< 0.05), with all infection recurrences accompanied by keloid recurrence. The local resection group showed 0% infection recurrence and 50.0% keloid recurrence, with no severe complications.

Keloid patients with large lesions, long disease duration, or positive family history are at high infection risk and require active monitoring. For infected keloids, complete surgical excision + adjuvant radiotherapy is preferred after inflammation control, offering superior long-term efficacy and low recurrence. Local resection + injection + radiotherapy is a feasible alternative for large/inoperable lesions but demands long-term follow-up due to relatively high keloid recurrence.

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