It must be noted however, that response does not denote cure, and changes such as flattening, softening or an overall decrease in size may be considered a response. This may essentially mean trading a keloid for a hypertrophic scar. Studies of surgery plus steroid injection had results no better than steroid injection alone. Yet, for large lesions, one may be able to produce a smaller controlled lesion by combining these methods. Pressure therapy alone or as an adjunct to surgery effectively flattens and softens lesions.
Compliance is a problem.
Pressure earrings are convenient, but pressure dressing covering other areas of the head or neck are bulky and awkward. YAG prevents keloid recurrence unless combined with local steroid therapy. In summary, the clinical diagnosis of keloids is based upon persistence for greater than six months and spread beyond the site of original trauma. Histology of keloids reveals thick collagen bundles, abundant ground substance, few fibroblasts, and few if any foreign body reactions. Prevention must be the primary therapy.