Keloids

A response to this post.
Can your really achieve a good clinical/cosmetic response in keloids with OS/P?. Does size or location matter? Any experiences?
Mirko.
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Mirko,
I looked.  A review of the literature done 2 years ago showed evidence for cryo or cryo + intralesional steroids poor quality evidence. .   (J Plast Reconstr Aesthet Surg. 2008;61(1):4-17. Epub 2007 Jul 19.)  One small n study since then that was prospective and randomized showed the combination better than cryo alone.  J Cosmet Dermatol. 2007 Dec;6(4):258-61. 
My preference has been to inject intralesional steroids in small amounts of 0.1 to 0.2 ml of 1:1 triam 40 mg/ml and Bupivacaine or Xylo with multiple injection points using a 27-30 g needle on an every 2-3 week basis until desired result.  Anecdotally this works very well.  As a result of the above evidence, I'll now try a pre-cryo with 10-15 seconds of freeze prior to injecting.  FYI, I am now using a Jet injector (Madajet) for intralesional steroid placement in the Procedure Clinic - takes seconds for multiple injections and blows it in nicely intralesionally with less pain. 
I have excised large keloids previously.  Post operative steroid into wound margins beginning at suture removal 1-2 weeks after excision with tight wrapping for 18+ hours per day probably/may/anecdotally reduces recurrence.  A low tension closure is key (since as you've seen on some people with excisions with higher tension closures which weren't undermined, they get keloids whether they are prone to them or not).  Topical steroids (high potency), imiquimod and tacrolimus, and a host of other immune modulators have also been studied to inhibit alpha-2-macroglobulin which is a collagenase inhibitor and thus increase collegenase activity (blah blah technical blah blah).  Cheap works, so stick with steroids until someone proves that one of these others is clearly superior.
Steve