Management of Keloids in the United States, 1990–2009: An Analysis of the National Ambulatory Medical Care Survey

BACKGROUND: Keloids can cause significant morbidity during wound healing, but the most common current treatment practices for keloids are not well-established. OBJECTIVE: To determine the main treatments used for keloids in the United States and demographics of patient visits for keloids. METHODS: The National Ambulatory Medical Care Survey for 1990-2009 was queried for visits with a diagnosis of keloids. Leading medical and procedural treatments, patient demographic characteristics, physician specialties, reasons for visit, and comorbidities were assessed. RESULTS: There were an estimated 427,500 visits per year for keloids, with a slight decline in frequency of visits over time (p = .001). Triamcinolone was the leading medical treatment, and excision or destruction of a lesion was the leading procedural treatment. Sixty-two percent of patients were female, and 23.7% were African American. Mean age was 36.6. Dermatologists managed slightly more than half of visits, and plastic surgeons were second most used. CONCLUSIONS: Keloids are managed using a variety of treatments, primarily triamcinolone and excision or destruction of a lesion. High-quality evidence is lacking for the efficacy of most existing keloid treatments. New treatments that improve on the present standard of care would improve outcomes.