The problem with keloids

Researchers found in a retrospective study of 297 surgically excised keloids with superficial radiation therapy around the excision site that only 3% (n = 9), recurred during an average 6-month follow-up, according to a research letter published November 2018 in the online peer-reviewed journal SKIN, The Journal of Cutaneous Medicine.

Study author Brian Berman, M.D., Ph.D., says that he’s cautiously optimistic that superficial radiation could be a game-changing therapy for preventing recurrence of the scars. But a longer-term, prospective study is needed to help confirm results, according to Dr. Berman, professor emeritus, Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine.

The Problem With Keloids

Dr. Berman says the first thing he addresses with patients who come in with keloids is whether they really want their keloid removed.

“That’s the crucial question because if I can convince the patient that he or she would be satisfied with getting rid of the symptoms and signs—the itching, burning, maybe flattening of the keloid a little—there is a whole set of treatments for that,” he says. “It’s the patients that say they’ll only be satisfied if the keloid is gone that one would have to use a surgical procedure to remove the keloid. Clearly those procedures are pretty straightforward. The issue and problem is that in the literature the recurrence rate of the keloid after you remove it is in the range of 71%.”

For those patients who decide not to have keloids excised, the standard of care is to inject the scars with a corticosteroid. That, Dr. Berman says, decreases itching and burning and tends to make the keloid softer and flatter.

“Rarely will the keloid completely go away and virtually never will it look completely like normal skin. That’s why we use superficial radiation therapy after the keloidectomy, in order to reduce the high recurrence rate,” says Dr. Berman, a consultant with Sensus Healthcare, the company that makes the SRT-100 device that Dr. Berman and colleagues used in the study. The SRT-100 device is FDA approved for the treatment of keloids.

Superficial radiation appears to have a lower recurrence rate than what Dr. Berman says is the next best thing: cutting out a keloid, suturing it and injecting it with a steroid.

“In our hands, if you do that and wait a year, the recurrence rate was about 50%,” he says.

Superficial Radiation Therapy for Keloids 

When Dr. Berman uses superficial radiation therapy post-keloidectomy, he tries to irradiate a 5 mm margin around the excision site — the suture line — starting the day after the excision.