4. Effects of keloid properties on treatment efficacy 96 ABSTRACT Background: The efficacy of keloid treatment in randomized studies is highly variable. However, no systematic review has been performed to evaluate the effect of different keloid properties on treatment efficacy. Objective: to identify clinically relevant keloid properties, that may influence treatment efficacy. Methods & Materials: An electronic database search was conducted. Two reviewers independently selected randomized controlled trials (RCTs) and performed a methodological quality assessment using the Cochrane risk-of-bias 2.0 tool. Results: 1520 studies were screened, and 16 RCTs, involving 1113 patients, were included. We found lower efficacy in older keloids (n=3), keloids located on the chest, extremities, pinna, and shoulder (n=3), larger keloids (n=2), lower baseline VSS score (n=1), and keloids with history of recurrence (n=1). Overall, the majority of studies had a high risk of bias. Conclusion: Only a minority of studies specifically addressed keloid properties, which makes comparisons between studies challenging. Our results suggest that keloid location, - duration prior to treatment, -size, -history of recurrence, and -severity are clinically relevant keloid properties that affect treatment efficacy. Further studies are crucial to corroborate our findings, establish a clinically relevant keloid classification, and ultimately develop an evidence-based treatment algorithm that takes these properties into account.
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