27925 Keloid treatment: A systematic review with a focus on antineoplastic therapies

The understanding of keloid pathogenesis and available treatment options is continuously evolving. An increasing body of evidence suggests that keloid genesis may be driven by an outpacing of tumor-promoting over tumor-suppressing elements. These recent revelations have prompted clinical trials assessing the utility of multiple antineoplastic treatment modalities in keloid management. To summarize published evidence on the efficacy, safety, and tolerability of antineoplastic keloid treatment modalities, we conducted a PubMed and Cochrane database search using the following terms: (keloid and treatment), and (keloid and antineoplastic and treatment). Multiple antineoplastic modalities are reviewed, including: radiation (brachytherapy), laser (pulse-dye, pulsed Nd:YAG, and CO2), chemotherapy (intralesional 5-FU, bleomycin, mitomycin), immunomodulators (interferon alpha-2B, imiquimod, collagen polyvinylpyrrolidone), anti-inflammatory agents (triamcinolone, hyperbaric oxygen), and ablative therapy (cryotherapy). The majority of reviewed modalities demonstrated significant clinical improvement either singularly or in combination with other agents. The greatest clinical response was shown with use of bleomycin, brachytherapy, and 5FU/triamcinolone combination, where an 87% reduction in scar volume, a mere 4.7% recurrence rate, and greater than 50% reduction in keloid size among 77.2% of study participants, were noted with each modality respectively. Interferon alpha-2B was the least supported modality, demonstrating inconclusive results. All modalities were largely well tolerated, with hyperpigmentation and pain being the most commonly reported adverse events. Although high-quality data for some modalities are lacking, the vast majority of antineoplastic based treatments for keloids have demonstrated efficacy and safety. Further large scale randomized controlled trials are required to confirm efficacy and establish long-term adverse events.