Keloids: Etiology, and Management by Excision and Intensive Prophylactic Radiation

Julius Jadassohn's classification of keloids into the "true" (spontaneous) and "false" (traumatic) variety¹would seem unduly meticulous to modern dermatologists, but most of them would still subscribe to his statement that excision followed by irradiation is the treatment of choice. Flurries of interest in such procedures as infiltration with hyaluronidase, corticotropin (ACTH), and hydrocortisone; freezing; dermabrasion, and others have ended largely in disappointment. Little has been published since Belisario's detailed review of the literature in 1957²(except for Kelley and Pinkus's article on tetrahydroxyquinone, which is mainly for inoperable cases³) to warrant special mention here. In Belisario's series of 114 lesions, excision and irradiation preceded by infiltration with hyaluronidase (150 units per ml.), hydrocortisone (25 mg. per ml.), or both, gave better results than excision and irradiation alone. Of 30 cases treated in this way, 17 achieved a cosmetically sat