Treating keloids with carbon dioxide lasers.

Abstract

The treatment of keloids is a frustrating problem for both patient and surgeon. Dr Hom presents an excellent review of the treatment options for keloids. In my practice, earlobe keloids are certainly the most c ommon t ype o f k eloid treated. I agree with Hom that the manner in which the keloid is excised has little to do with its risk of recurrence. Recurrence is mostly related to the compliance of the patient with a postoperative regime of intralesional steroid injections, pressure earrings, and/or silicone gel applications. Patients who are compliant with one or more of these follow-up treatments have acceptably low rates of recurrence. In my practice, I excise all keloids, including earlobe keloids, with a carbon dioxide laser 1 on a superpulse mode and then allow the wound to heal by secondary intention. The cosmetic result of secondary healing, even with broadbased earlobe keloids, is always excellent. If a hole in the earlobe is created by excision of a dumbbellshaped lesion, then the lateral portion of the earlobe is closed with Prolene sutures (Ethicon Inc, Somerville, NJ). The patient should keep the wound covered with petroleum jelly, and the wound will heal in 2 to 4 weeks, depending on the size of the wound. Steroid injections are then done monthly. I use triamcinolone at concentrations of 20 to 40 mg/mL, with a tendency to use 40 mg/mL for any palpable nodules. I have not used radiation in my practice, although I would try this in selected patients for whom more conventional methods have failed. Lack of compliance alone is not an indication for radiation. The physician needs to emphasize to the patient that excision of the keloid in itself is the least important part of treatment, while postoperative compliance is imperative. All patients eventually learn this, although for some it may take several recurrences.