A Study on Intra-lesional Excision of Keloids / 대한피부과학회지

ABSTRACT

BACKGROUND: Keloid is one of the most frustrating clinical problems in wound healing. There are numerous treatments for keloids such as surgical excision, steroid injection, radiation therapy, laser, silicone gel application and so on. Surgical excision of a keloid is generally not accepted as a first treatment of choice. However, there have been many reports of successful cosmetic results from specialized surgical treatments such as intra-lesional/intra- marginal excision with or without post surgical adjuvant treatments. OBJECTIVE: The aims of this study areto evaluate the effectiveness of intralesional excision of keloids, the optimal surgical conditions and the proper adjuvant therapy after surgery. METHODS: We analyzed the medical records and clinical photographs of 20 patients who underwent intra-lesional excision of their keloids and who had regular follow-ups for at least for 3 months. The clinical outcomes were assessed by three independent physicians based on their interpretation of the photographs before and after surgery with using a global assessment 5 point scale that ranged from bad, poor, fair and good to excellent. RESULTS: General surgical outcomes after intra-lesional excision the average improvement score was 4.05 after intra-lesional excision and adjuvant therapy. The average improvement score after intra-lesional excision was 4.71 for ear keloids and 2.83 for keloids in other areas (p=0.000). The average improvement score after intra-lesional excision was 5 for earlobe keloids and 4.42 for ear-helix keloids (p=0.014). The average improvement score was 3.92 for the steroid intra-lesional injection and topical silicone gel combination treatment group after intra-lesional excision and the average improvement score was 4.29 for the single topical silicone gel treatment group (p=0.858). CONCLUSION: Although surgery is not a first treatment of choice for the management of keloids, large recalcitrant keloids need massive surgical removal for faster clinical results. In this study, we found that surgery, and especially intra-lesional excision, is not an absolute contraindication for treating keloids and this is sometimes considered as the first treatment of choice, and especially for ear keloids. However, a more careful surgical approach is necessary for the case of keloids that develop in other areas. Further studies about the optimal surgical indications for keloids and the recommended adjuvant therapy after surgery are necessary.