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Keloid Pathogenesis and Treatment

Al-Attar, Ali M.D., Ph.D.; Mess, Sarah M.D.; Thomassen, John Michael M.D.; Kauffman, C Lisa M.D.; Davison, Steven P. M.D., D.D.S.

Plastic and Reconstructive Surgery: January 2006 - Volume 117 - Issue 1 - p 286-300
doi: 10.1097/01.prs.0000195073.73580.46
Special Topic

Background: Keloid management can be difficult and frustrating, and the mechanisms underlying keloid formation are only partially understood.

Methods: Using original and current literature in this field, this comprehensive review presents the major concepts of keloid pathogenesis and the treatment options stemming from them.

Results: Mechanisms for keloid formation include alterations in growth factors, collagen turnover, tension alignment, and genetic and immunologic contributions. Treatment strategies for keloids include established (e.g., surgery, steroid, radiation) and experimental (e.g., interferon, 5-fluorouracil, retinoid) regimens.

Conclusion: The scientific basis and empiric evidence supporting the use of various agents is presented. Combination therapy, using surgical excision followed by intradermal steroid or other adjuvant therapy, currently appears to be the most efficacious and safe current regimen for keloid management.

Washington, D.C.

From the Department of Plastic Surgery and the Division of Dermatology, Georgetown University Medical Center.

Received for publication July 8, 2004; revised March 24, 2005.

Steven P. Davison, M.D., D.D.S., Department of Plastic Surgery, Georgetown University Medical Center, 1st Floor PHC Building, 3800 Reservoir Road, NW, Washington, D.C. 20007,

©2006American Society of Plastic Surgeons