Answer:
The nonsurgical management of keloids can be broadly subdivided into two major groups, physical and pharmacologic. Examples of physical forms of treatment include radiotherapy, ultrasound, cryotherapy, pressure, and laser. Varying degrees of success have been reported. Most studies conclude that there is no role for x-ray therapy alone in treating established keloids. Pressure has been used and, when applied day and night for 4 to 6 months, has been shown to be beneficial in reducing abnormal scarring. Laser therapy has been used but there are insufficient data to support its use. Pharmacologic management takes many forms but the most common agents used are intralesional steroids. Results in the literature show significant objective response to treatment to range from 31% to 100% but side effects include atrophy, depigmentation, and telangiectasia. Other pharmacologic agents include penicillamine, retinoic acid, dextran sulfate, antineoplastic agents, adhesive zinc tapes, and silicone gels. Good response rates, from 65% to 86%, have been reported in studies of topical silicone sheeting, although the mechanism by which the silicone produces its effect remains unclear. Recently, interferon-gamma (in hypertrophic scars) and interferon-a2b (in keloids) suggest beneficial effects on the resolution of these lesions.
The therapeutic management of hypertrophic scars and keloids includes occlusive dressings, compression therapy, intralesional corticosteroid injections, cryosurgery, excision, radiation therapy, laser therapy, interferon therapy, and other promising, lesser known therapies directed at collagen synthesis. Although the most commonly used occlusive dressings include silicone-based materials, the anti-keloidal effect is the result of the occlusion and hydration effect rather than the silicone itself. Pressure devices, through local tissue hypoxia, have proven effective in reducing scar height. Intralesional steroids decrease the connective tissue components and scar volume.