Contemporary treatment of keloids: A 10-year institutional experience with medical management, surgical excision, and radiation therapy

• Published in: The American journal of surgery Vol. 221; no. 4; pp. 689 - 696
• Main Authors: Akinbiyi, Takintope, Kozak, Geoffrey M., Davis, Harrison D., Barrette, Louis-Xavier, Rios-Diaz, Arturo J., Maxwell, Russell, Tilahun, Estifanos D., Jones, Joshua A., Broach, Robyn B., Butler, Paris D.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2021; Elsevier Limited
• Subjects: Adult; Complication; Complications; Corticosteroid; Corticosteroids; Dermatologic Surgical Procedures; Drug dosages; Esthetics; Female; Gender; Humans; Keloid; Keloid - therapy; Male; Medical records; Middle Aged; Patients; Radiation; Radiation dosage; Radiation therapy; Radiotherapy Dosage; Radiotherapy, Adjuvant; Recurrence; Regression analysis; Retrospective Studies; Steroid hormones; Steroids; Steroids - therapeutic use; Surgery; MM; BED; Corticosteroid; Recurrence; SE; OR; Keloid; Surgery; Radiation; Complication; SE+RT; IQR
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2020.07.035

We evaluate a single center’s, decade-long experience utilizing 3 approaches to keloid treatment: corticosteroid medical management (MM), surgical excision (SE), and surgical excision + radiation therapy (SE + RT). Patients undergoing keloid treatment were identified (2008–2017). Outcomes were symptomatology/cosmesis for MM, and recurrence and complications for SE and SE + RT. Logistic regression was used to determine factors associated with recurrence and complications. 284 keloids (95 MM, 94 SE, 95 S E + RT) corresponded to patients with a median age of 39.1 (IQR: 26.1–53), 68.1% Black, and followed-up for 15.4 months (IQR: 5.6–30.7). For MM, 84.6% and 72.5% reported improvement in cosmesis and symptoms, respectively. SE and SE + RT recurrence were 37.2 and 37.9%, respectively. In adjusted analyses, higher radiation doses were associated with decreased recurrence whereas male gender (OR 3.3) and postoperative steroids (OR 9.5) were associated with increased recurrence (p < 0.01). There were more complications in the SE + RT group. MM resulted in at least some improvement. Recurrence rates after SE and SE + RT were similar. Female sex is protective, race does not affect outcomes. •The majority of medically managed patients experienced at least some improvement in symptomatology and cosmesis.•Surgical excision and surgical excision with radiotherapy had similar recurrence rates.•Higher radiation doses were associated with decreased recurrence.•Postoperative steroids (OR 9.5) and male sex (OR 3.3) were associated with increased recurrence.•Keloid locations on an extremity (OR 19.5) and larger surface area (OR 1.0) were associated with increased complications.