Management of Complex Facial Keloid -- A Review of the Literature

Purpose: Keloids are noncontagious, pathologic, irregular deposits of collagen within an injured area and its boundaries. Only a few publications have described treatment of facial keloids, and there is obvious inconsistency regarding the treatment of facial keloids, specifically due to the high rate of recurrence and patient’s expectation of the results. Materials and Methods: We performed a literature review for more than 35 articles to draw attention to the management and treatment of facial keloids. Results: There are several surgical techniques for managing facial keloids. First involves simple surgical excision. Second strategy involves surgical excision of the keloid within the margin of the lesion, leaving keloid at the periphery to avoid violating the healthy tissue thus minimizing the recurrence. The third strategy involves simple surgical excision of the keloid followed by radiotherapy which appears to be the most effective treatment of the keloids. A fourth technique involves simple surgical excision of the keloid followed by steroid injection. A fifth technique involves excision of the keloid and using the keloid skin for resurfacing or as a skin flap to cover the surgical defect followed by HBO treatment. A sixth technique involves excision of the keloid followed by using Cryopreserved Placental Membrane. There are also non-surgical strategies to manage keloids. The first involves Intralesional injection with a mixture of 5-fluorouracil and Betamethasone and the second involves hydration and compression therapy. Conclusions: Facial keloids are very difficult to manage. In addition, they may develop complications including infections. It is imperative to make all attempts to prevent keloid formation, as the management regardless of modality, often leads to recurrence.