title: Keloid pathogenesis and treatment.
abstract: BACKGROUND
  Keloid management can be difficult and frustrating, and the mechanisms underlying keloid formation are only partially understood.
  
  
  METHODS
  Using original and current literature in this field, this comprehensive review presents the major concepts of keloid pathogenesis and the treatment options stemming from them.
  
  
  RESULTS
  Mechanisms for keloid formation include alterations in growth factors, collagen turnover, tension alignment, and genetic and immunologic contributions. Treatment strategies for keloids include established (e.g., surgery, steroid, radiation) and experimental (e.g., interferon, 5-fluorouracil, retinoid) regimens.
  
  
  CONCLUSIONS
  The scientific basis and empiric evidence supporting the use of various agents is presented. Combination therapy, using surgical excision followed by intradermal steroid or other adjuvant therapy, currently appears to be the most efficacious and safe current regimen for keloid management.
authors.affiliation: Division of Dermatology, Department of Plastic Surgery, Georgetown University Medical Center, Washington, DC 20007, USA.
authors.forename: Ali
authors.initials: A
authors.lastname: Al-Attar
authors.forename: Sarah
authors.initials: S
authors.lastname: Mess
authors.forename: John Michael
authors.initials: JM
authors.lastname: Thomassen
authors.forename: C Lisa
authors.initials: CL
authors.lastname: Kauffman
authors.forename: Steven P
authors.initials: SP
authors.lastname: Davison
mesh_terms: D000963:Antimetabolites / Q000627:therapeutic use; D003094:Collagen / Q000378:metabolism; D003131:Combined Modality Therapy; D005109:Extracellular Matrix / Q000502:physiology; D005347:Fibroblasts / Q000502:physiology; D005472:Fluorouracil / Q000627:therapeutic use; D006801:Humans; D015552:Injections, Intralesional; D007372:Interferons / Q000627:therapeutic use; D007627:Keloid / Q000276:immunology / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology* / Q000628:therapy*; D053685:Laser Therapy; D011312:Pressure; D012176:Retinoids / Q000627:therapeutic use; D012629:Sebum / Q000276:immunology; D020034:Silicone Gels / Q000008:administration & dosage; D013314:Stress, Mechanical; D016212:Transforming Growth Factor beta / Q000502:physiology; D014222:Triamcinolone Acetonide / Q000008:administration & dosage
chemical_list: D000963:Antimetabolites; D012176:Retinoids; D020034:Silicone Gels; D016212:Transforming Growth Factor beta; D003094:Collagen; D007372:Interferons; D014222:Triamcinolone Acetonide; D005472:Fluorouracil