4. Effects of keloid properties on treatment efficacy 100 Keloid duration prior to treatment Twelve studies involving 811 patients investigated keloid duration prior to treatment.3-14 Three studies reported higher efficacy in younger keloids compared to longer existing keloids.7,9,12 Rani et al. reported higher efficacy in younger keloids (<2 years), however, without performing sub-analysis per treatment group (intralesional triamcinolone acetonide (il TCA); il 5-FU; il TCA + cryotherapy; surgical excision + topical imiquimod).12 The two other studies did not report a specific cut-off point for duration, but reported significantly higher efficacy in younger keloids treated with respectively Nd:YAG laser- or cryotherapy.7,9 The remaining studies found no significant correlation.3,4,6,8,10,11,13,14 Keloid location Seven studies involving 440 patients investigated keloid location.7, 9, 12, 13, 15-17 One study found significantly higher ‘cure rates’ for keloids treated with il TCA that were located on the cheek, forehead, submandibular area and lip compared to the pinna, while no subanalysis was reported for keloids treated with excision and radiotherapy.15 Belie et al. reported higher efficacy for keloids located on the trunk compared to the extremities after treatment with il TCA or il verapamil.16 Rani et al. reported higher efficacy for keloids located on the earlobes, face and back, compared to the chest and shoulders, without a sub-analysis per treatment group (il TCA; il 5-FU; il TCA + cryotherapy; surgical excision + topical imiquimod).12 The other studies found no significant correlation.9,14,15,17 Keloid size Three studies involving 195 patients investigated keloid size.3,5,8 Two studies reported higher efficacy in smaller keloids ( <1 cm² and <5 cm³) compared to larger keloids, after respectively contact cryosurgery or il 5- fluorouracil.3,5 The other study found no significant difference between smaller and larger keloids.8
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