Scars and keloids.

Despite the disfigurement and symptoms from these abnormal wound responses, the literature offers little consensus about appropriate therapy. Few prospective blinded studies have been performed to compare therapeutic options. Multiple therapies have been reported. Most physicians agree with Kelly's emphasis on the importance of prevention. All effort should be directed to avoid or to minimize any stimuli that could promote an abnormal wound response in predisposed individuals. Treatment must be carefully selected for appropriate lesions. Hypertrophic scars may be surgically corrected, but other measures such as intralesional corticosteroid injection, pressure therapy, cryotherapy, and other topical treatments may be useful. These scars have a different clinical course than do keloids. Published recurrence rates for keloid treatment are lowest for the combination of surgery and radiation. Although some keloids may respond to intralesional steroid injection, keloid tissue must be removed and the resulting wound must be treated to minimize the risk of recurrence.