Therapies for upper arm keloids include surgical excision followed by postoperative radiotherapy, silicone tape stabilization and steroid plaster.

The objective of a recent study published in Plastic and Reconstructive Surgery was to propose a universally accepted therapeutic strategy for upper-arm keloids.

The present study enrolled all consecutive patients with single upper-arm keloids who underwent keloid excision followed by tension-reducing suturing, multiple z-plasties and postoperative radiotherapy between 2013 and 2016—in the keloid/scar specialist clinic at the Department of Plastic, Reconstructive and Aesthetic Surgery of Nippon Medical School. Only keloids that arose from the small injury produced during Bacillus Calmette-Guérin vaccination were selected. The postsurgical radiotherapy regimen was 18 Gy administered in 3 fractions over three days. Radiotherapy was followed by tension-reducing wound self-management with silicone tape and, if required, steroid plaster.

Overall, 38 patients with 38 lesions were recruited – two lesions (5.3%) recurred. Both recurrences were successfully treated by concomitant steroid plaster and steroid injection. Patients with recurrence were significantly more likely than the nonrecurrence patients to have multiple keloids. Contrastingly, the two groups did not differ in terms of original keloid size.

Therefore, it was concluded that upper-arm keloids can be successfully treated by customized plans that involve appropriate surgical modalities – including multiple z-plasties; postoperative radiotherapy (18 Gy/3 fractions/3 d); and postoperative wound/scar self-management with silicone tape and steroid plaster.

Source: Plastic and Reconstructive Surgery. Global Open. 2019 Nov 27;7(11):e2496. doi: 10.1097/GOX.0000000000002496.