A Review of Current Keloid Management: Mainstay Monotherapies and Emerging Approaches
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REVIEW
A Review of Current Keloid Management: Mainstay Monotherapies and Emerging Approaches Emily E. Limmer . Donald A. Glass II
Received: May 15, 2020 Ó The Author(s) 2020
ABSTRACT Commonly affecting those with skin of color, keloids are an aberrant wound response that leads to wound tissue expanding above and beyond the original cutaneous injury. Keloids are notoriously and particularly difficult to treat because of their tendency to recur after excision. The current standard of care is intralesional steroid (triamcinolone acetonide). However, because no therapy has yet proven to be fully curative, keloid treatments have expanded to include a number of options, from injections to multimodal approaches. This review details current treatment of keloids with injections (bleomycin, verapamil, hyaluronic acid and hyaluronidase, botulinum toxin, and collagenase), cryotherapy, laser, radiofrequency ablation, radiation, extracorporeal shockwave therapy, pentoxifylline, and dupilumab.
Keywords: CO2 laser; Cryotherapy; Intralesional injection; Keloid; Multimodal approach;
Digital Features To view digital features for this article go to https://doi.org/10.6084/m9.figshare.12624782. E. E. Limmer D. A. Glass II (&) Department of Dermatology, UT Southwestern Medical Center, Dallas, TX, USA e-mail: [email protected]
Pulse dye laser; Radiation; Radiofrequency ablation; Wound healing Key Summary Points Keloids are a pathologic response to cutaneous injury in which wound tissue grows beyond the inciting insult. Because keloids are prone to postexcisional recurrence, medical management plays an important role in keloid treatment. While the standard of care for keloids is intralesional steroid (triamcinolone acetonide), new and innovative therapeutic options offer the possibility to improve and tailor management to patient preferences and qualities. Expanding from triamcinolone acetonide alone, injection options now include bleomycin, verapamil, hyaluronic acid and hyaluronidase, botulinum toxin, and collagenase. Additional treatment options discussed include cryotherapy, laser, radiofrequency ablation, radiation, extracorporeal shockwave therapy, pentoxifylline, and dupilumab.
Dermatol Ther (Heidelb)
INTRODUCTION
INJECTIONS
Keloids are a pathologic response to cutaneous injury in which wound tissue grows above and beyond the inciting insult. These lesions disproportionally affect patients with skin of color, especially of African, Asian, and Hispanic backgrounds [1]. Keloids can be cosmetically disfiguring as well as symptomatically distressing, commonly causing pruritus, pain, and decreased quality of life [2]. The standard of care for keloids differs geographically; steroid-impregnated tape is the first-line treatment modality in Japan, while steroid (triamcinolone acetonide) injections are the treatment of choice in the USA [1, 3]. Other common treatments include silicone sheets, compression, intralesional administration of 5-fluorouracil, and excision. Anecdotal accounts report some improvement with
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