What is the Best Keloid Treatment?

Keloids can be very resistant to treatment. Treatment options can involve any of the following (and also involve combinations of the therapies listed below).
1. Steroid treatment - this usually requires multiple treatments. If the keloid is large enough this can leave excess skin after successful treatment. Steroid treatment can cause tissue atrophy and for african american skin or other darker skin types can also cause hypopigmentation.
2. Excision - While the mechanism for steroid formation is not fully understood wounds that have issues with contamination or infection may be at higher risk for keloid formation. Excising the keloid with a meticulous closure can effectively treat even keloids that have recurred.
3. Radiation - For extremely resistant or disfiguring keloids radiation therapy can be an effective mechanism to reduce recurrency rates in combination with surgical excision. I hope this helps.

These need a series of treatments including lasers, injections and sometimes surgery/radiation. Please see an expert. Best, Dr. Emer.

Thank you for your question and I am sorry that you have this concern. 
Keloid scars are a difficult condition to treat. Did you develop the keloid following a piercing or was it some other form of trauma? 
The options are based on a conservative approach initially and increasing the extent of intervention of the keloid depending on the result achieved. I break down the treatment options as follows:
In the first instance steroid injections are used. The theory behind steroid treatment is that it interacts in the wound healing pathway and interferes in collagen synthesis which is what is laid down to in healing wounds. An overgrowth of the scar results in a keloid scar forming. 
For small keloids, this can be quite effective. The injections are given into the keloid and you are seen at 8 weeks after injection. At this time, you might require further treatments. Most patients need atleast 3-4 injections for ear-lobe keloid scars.
IN addition, the use of silicone tape/ creams can help to reduce the scar. This needs to be worn/ applied for 23/ 24 hours of the day and treatment here is for a minimum of 9 months.
If they are resistant, then removal of the keloid and steroid injection is the next stage of treatment. The steroid can be given at the time of surgery or after the wound has healed. This again would require further steroid injections at regular intervals.
Compression dressings are very useful and tend to work well on ear-lobe keloids. These are placed wither after steroid injections or the surgery.
Cryptherapy has recently began to show some effective results in the treatment of keloids. This involves injection of the cryo into the keloid to aid intralesional injection. There are studies showing its effectiveness but it is still quite new in the treatment spectrum to know wha thte long term results would be. 
If despite this, the keloid still persists, or is increasing in size, then radiotherapy is a final option to try and reduce the scarring effect.
I hope this is helpful for you 
Kind regards 
Rohit Seth

Treatment of ear keloids can be a challenging problem, but can also be quite gratifying for the patient and surgeon when successful. Each patient is different, and for this reason, a visit with an experienced surgeon is recommended for an examination and personalized treatment plan.
In general, steroid injections can be very helpful for the treatment of keloids, both as a stand-alone treatment or as an adjunct to surgery. Steroid injections can be used pre-operatively to shrink the keloid and decrease the overall inflammatory pathway. They can also be used post-operatively to prevent the recurrence of the keloid.
Ultimately, many ear keloids do require surgical excision, which can often be performed under local anesthesia. In addition to steroid injections, pressure earrings can be helpful post-operatively to prevent recurrence. There are other medications that can be injected into the area as well, but are not used as commonly as steroids. 
Finally, in refractory cases, radiation therapy to the area can be effective, but this is generally reserved for patients with very extensive or recurrent keloids despite the treatments mentioned above.

some keloids respond well to corticosteroid injections, but others get too white in color. Some need excision and then corticosteroid injections and others can be frozen. There's no guarantee the keloid won't recur after treatment.

There are many treatments for keloids but the best treatment
really depends on the patient and their specific scar.  Most keloids are first treated by injecting a
steroid to reduce their substance and size. 
Once they are smaller and softer, scar excision or revision are
options.  In addition, radiation of the
keloid in combination with surgery may offer very good results in select
cases.  In lighter skins types one can
also consider intra-lesional cryotherapy. Your local board-certified
dermatologist or plastic surgeon should be able to review your specific needs
and make a plan of care that works best for you.

Keloids are difficult to treat, and often have a high recurrence rate. These scars are unsightly and frequently quite painful. Keloids are wide ropey scars with boarders that extend past their base base, and are often confuse d with hypertrophic scars that are wide and flat.Excison of keloids often leads to recurrence. Steroid injections are painful, and often require multiple injections with the possibility of atrophy of the underlying tissue with a resulting dent. Hypo-pigmentation is also possible , leaving a white spot.A technique know as CryoShape, which freezes the keloid from the inside out is a great improvement on past keloid treatments. With this treatment,  75-95 % of the keloid often 100% of facial keloids, can be removed with one treatment. Rate of recurrence is also much reduce with this technique.Yours,Jon M. Grazer, MD, MPH, FACS

Keloids are notoriously difficult to treat.  The most successful treatments are combination.  Depending on the size of the keloid, surgery may be first part.  Then adding steroid injections and compression to the regimen will further reduce the recurrence rate.  To further minimize the chance of the keloid coming back, you may even consider radiation therapy.  Good luck.

Often keloid treatments of the ears require a multi modality approach with the following therapies:


Surgical excision- In some cases the keloid must be excised because other therapies are not effective.  Surgery alone is rarely effective in managing keloids

Kenalog injections- Kenalog injections decrease the collagen response and help improve the chances of keloids from returning.

Pressure clip earrings- Pressure on the ears is thought to decrease the collagen injections

Silicone sheeting- Unknown mechanism of action but thought to place a negative charge on the scar to improve keloid response

5 FU injection- Can be used if above is not effective.

As others have noted, effective treatment of keloids can be very difficult.  The reason for this is that keloids are an abnormal response to injury, and area of scar tissue that grows beyond its natural boundaries.  On examination of a piece of Keloid tissue under a microscope, it looks substantially different than the average scar.  The initial phase of treatment is to slow the inflammation, ergo the use of several spaced injections.  The next option is to excise the scar surgically (50% recurrence rate) or to treat with radiation.  After excision, the area can be radiated and/or re-injected with steroid. Some Surgeons advocate placement of topical mitomycin and/or topical 5 flurouracil at the time of excision. Despite all of these options, keloids can and do recur.

The best treatment options for ear keloids are steroid injections and surgical revision.  There is always a risk with surgical removal that the keloid can return, but using steroid injections can limit that possibility.