Question 1

What is the first-line treatment for a keloid?

Accepted Answer

Intralesional corticosteroid injection (typically triamcinolone) remains the standard first-line treatment for most keloid scars.

Question 2

When is surgery indicated?

Accepted Answer

Surgical excision is considered for keloids that have failed conservative treatment, are causing functional impairment, or are too large for injection alone. Surgery is almost always combined with an adjuvant therapy (intralesional steroid, radiation, or cryotherapy).

Question 3

How effective is post-surgical radiation?

Accepted Answer

Adjuvant radiation has produced the lowest recurrence rates in multiple published studies, often below 20% at one to two year follow-up. It is not universally available and not appropriate for every anatomic site or patient.

Question 4

Can lasers flatten a keloid?

Accepted Answer

Lasers used alone produce modest results for keloid flattening. They are more commonly used as part of multimodal protocols, including laser-assisted drug delivery.

Question 5

How long does keloid treatment take?

Accepted Answer

Months to years. Intralesional injection series typically run every four to six weeks for several sessions. Follow-up after surgery is multi-year.

Question 6

What’s the recurrence rate?

Accepted Answer

Highly variable by treatment modality and anatomic site. Excision alone: high (often >50%). Excision plus radiation: low (often <20%). Discuss specific numbers with your dermatologist.

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