Surgical excision with a scalpel, primary closure, followed by local steroid injection is the best treatment for a keloid.
The optimal management of keloids continues to be an enigma for surgeons. The best modality of treatment has been debated for many years. Keloids occur after dermal trauma, surgery, insect bites, or acne, resulting in excessive connective tissue formation. Keloids are different from hypertrophic scars in that keloids grow beyond the boundaries of the original wound area. During the healing process, it is clinically difficult to determine if a scar will develop into a keloid or hypertrophic scar. Keloids gradually grow into large, raised amorphous masses that can cause pruritus, pain, and disfigurement. Histologically, keloids consist of dense dermal connective tissue with randomly oriented collagen fibers. The etiological factors that determine how a scar becomes a keloid remain unknown. Familial predisposition and immunological causes have been implicated.
Hom DB. Treating the Elusive Keloid. Arch Otolaryngol Head Neck Surg. 2001;127(9):1140-1143. doi:10.1001/archotol.127.9.1140