Multimodal approach in the treatment of recurrent keloids: Surgery, triamcinolone and 5-FU injections, and PLT, a case-report.

Abstract

Introduction and importance: Keloids are benign fibroproliferative lesions with high recurrence rates and resistance to monotherapies. Their management remains challenging, especially in high-tension anatomical regions. This case report describes a successful multimodal approach combining surgery, intralesional injections, and polarized light therapy (PLT) for recurrent large keloids.

Case presentation: A 27-year-old male with a 10-year history of multiple keloids secondary to acne presented with three large recurrent lesions on the posterior trunk. He had undergone previous treatments including surgery, corticosteroid injections, cryotherapy, and CO₂ laser, with unsatisfactory outcomes. Surgical excision of all three keloids was performed, followed by layered closure using tension-adapted sutures. Postoperatively, intralesional injections of triamcinolone (40 mg/mL) and 5-fluorouracil (50 mg/mL) in a 1:1 ratio were administered in three monthly courses. Four sessions of PLT (400-3400 nm) were performed the day after each injection. The patient was followed for 9 months.

Clinical discussion: The combination therapy led to complete resolution of lesions with no recurrence. The patient reported high satisfaction, improved mobility, and cosmetic outcomes. Only mild depression at the injection site was observed. PLT may have contributed to tissue regeneration and inflammation reduction. Proper suture selection based on anatomical tension zones likely minimized mechanical recurrence risk.

Conclusion: This multimodal treatment combining surgery, pharmacological injection, and PLT offers an effective, safe approach to managing large, recurrent keloids. Further studies with extended follow-up and larger cohorts are needed to validate these findings.