Physician discusses several treatment options for dealing with keloids

MIAMI — A physician here at South Beach Symposium 2017 discussed current and newly emerging treatments for the reduction of keloids, keloid recurrence and keloid scars.

Brian Berman, MD, PhD, reviewed more than a dozen studies and found an average recurrence rate of 71.2% following keloid excision.

Brian Berman, MD, PhD

The first treatment option Berman reviewed was imiquimod 5% cream. According to two studies in which patients applied the cream once daily for 2 months immediately after their keloid excisions, one group of 11 patients had no recurrences at 6 months and one group of 15 patients had one recurrence. Possible adverse events seen in other studies included hyperpigmentation in nine out of nine patients with skin types IV and V and a burning sensation that required three out of 25 patients to postpone treatment.

Superficial radiation therapy has had similar reduction of recurrence rates following excision. In his own practice, Berman treated 51 patients with a total of 62 lesions 24 hours after keloid excision. He used what he refers to as a biologically effective dose of 30 SRT. There were no recurrences at 1 year follow-up and the most frequent adverse event was transient hyperpigmentation.

Skin tension offloading devices are another treatment options.

“I think we all know about how scars under tension cannot look so great,” Berman said. “But it turns out there is a kinase called focal induced kinase that actually gets activated by physical tension on the wound. And this kinase, when it gets activated, releases inflammatory signaling and also increases collagen production, leaving scars looking worse.”

The skin tension offloading devices were found to significantly improve overall aesthetic appearance by patients (P = .02) and investigators (P = .001) using the Patient and Observer Scar Assessment Scale, according to a study.

Other possible treatments that physicians should consider include intralesional cryotherapy, ingenol mebutate gel, silicone scar gel and self-drying, film-forming silicone. – by Talitha Bennett

References: Berman B. Future Treatment and Prevention of Scars. Presented at: South Beach Symposium 2017; Feb. 9-12; Miami Beach, Florida.

Disclosure: Healio.com was unable to determine whether Dr. Berman has a direct financial interest in the products discussed in this article or if he is a paid consultant for any companies mentioned.