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Open Access
CC BY 4.0 · Arch Plast Surg 2026; 53(01): 015-027
DOI: 10.1055/a-2698-3574
Cosmetic
Review Article

Comprehensive Update on Keloid Management

Authors

  • Michael H. Tirgan    ‡

    1   Keloid Research Foundation, New York, New York, United States

  • Qi Yin   ‡

    2   Department of Dermatology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands

  • Albert Wolkerstorfer

    2   Department of Dermatology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands

  • Barbu Gociman

    3   Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, United States

  • Tae Hwan Park 

    3   Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, United States
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Abstract

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. 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. 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. 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.

Keywords

keloid - fibroblast - chemotherapy - cryotherapy - radiation therapy

Contributors' Statement

Conceptualization, writing--review and editing: all authors.

Supervision: T.H.P.

All authors contributed to the creation of the manuscript and met the criteria for authorship.


Ethical Approval

This work did not require IRB approval.


Informed Consent

Written informed consents were obtained for all of the clinical images and videos used for this manuscript.


‡ These authors contributed equally to this article.




Publication History

Received: 05 March 2025

Accepted: 07 September 2025

Accepted Manuscript online:
11 September 2025

Article published online:
30 January 2026

© 2026. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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