Keloid scar management based on its degree of activation, a case study

Introduction: Keloids are pathological scars that occur due to an abnormal response to trauma that produces an excessive proliferation of fibroblasts. Keloid treatment is difficult to manage due to their high recurrence rates. Multiple alternatives have been used as treatment, although none is totally effective. Clinical Case: A 24-year-old male patient that presents with large keloids in the cervical region and back. He is initially treated with intralesional corticosteroids achieving lesion inactivation. Subsequently, the keloid is treated surgically with associated laser therapy, with very good results. Discussion: There are multiple therapeutic alternatives available, both medical and surgical, for keloid treatment. Despite this, keloid management continues to be a challenge due to its high recurrence rates. In our experience, we suggest initially using modalities that inactivate the keloid (silicone patches, pressotherapy, and intralesional corticosteroids), and later other therapeutic alternatives such as surgery, radiotherapy, and laser, to reduce the risk of reactivation. The inactivity of the keloid is evidenced by a decrease in associated symptoms, and, clinically, by a decrease in the size and vascularity of the scar. Conclusion: Multiple studies validate combined therapy as the best option for the treatment of keloids. We suggest differentiating whether the keloid is active or inactive in order to discern what type of therapy to use.