Background: Keloids remain one of the most challenging conditions in cutaneous wound
healing, marked by complex pathophysiology and notoriously high recurrence rates.
Although a universally accepted standard of care is still lacking, recent advances
have significantly improved our understanding and management of this fibrotic disorder.
Recent Advances: Emerging evidence highlights genetic predisposition, prolonged inflammatory
response, and aberrant fibroblast activity as key contributors to keloid formation.
Current therapeutic approaches focus on multimodal strategies, including intralesional
corticosteroids, cryotherapy, radiation therapy, and chemotherapy. Intralesional triamcinolone
remains a first-line treatment, while chemotherapy agents like 5-fluorouracil and
vincristine have shown promising efficacy in refractory cases. Surgical excision,
often combined with adjuvant therapies such as radiation, is considered for large
or recurrent lesions.
Clinical Implications: Given the high recurrence rate, patient-centered, evidence-based
treatment algorithms are essential. Stratifying keloids into categories enables tailored
interventions. Both established and emerging treatments are now evolving toward more
personalized and less invasive approaches to improve outcomes and patient satisfaction.
Conclusion: Multimodal, individualized treatment approaches—guided by lesion morphology,
anatomical location, treatment history, and patient factors—are essential for optimizing
outcomes. Emerging therapies are expanding the therapeutic arsenal, offering additional
strategies for resistant or recurrent cases. Moreover, the integration of molecular
and genetic insights is paving the way for the development of targeted therapies,
which may ultimately transform keloid treatment into a more precise and effective
discipline. Future studies should focus on large-scale trials to establish standardized,
data-driven treatment guidelines for keloids.
