Keloids are notoriously difficult to treat — single-modality approaches frequently fail or produce recurrence. Korean dermatology has developed combination protocols that significantly improve outcomes for keloid and hypertrophic scarring. This guide covers the diagnostic distinction, treatment options, and combination strategies used in Korean clinics.
Keloid vs. hypertrophic scar — distinction matters
Hypertrophic scar
- Stays within boundaries of original wound.
- May regress over months to years.
- Less aggressive treatment may suffice.
- Better prognosis.
Keloid
- Extends beyond original wound boundary.
- Does not regress spontaneously.
- Recurs after simple excision.
- Genetic predisposition; common in darker skin types.
- Higher-risk anatomical sites: chest, shoulders, ear lobes, jawline.
Treatment options used in Korean clinics
Intralesional steroid (triamcinolone)
- First-line for most keloids and hypertrophic scars.
- Concentration 10–40mg/ml, adjusted by lesion thickness.
- Series of injections every 4–6 weeks.
- Reduces collagen synthesis and inflammation.
- Side effects: atrophy, telangiectasia, hypopigmentation.
- Pricing — ₩50,000–₩150,000 per session.
Fractional laser
- Fractional CO2 or Er:YAG creates micro-channels.
- Stimulates remodeling.
- Often combined with topical or injected drug delivery.
- Series of 3–6 treatments at 4–8 week intervals.
- Pricing — ₩200,000–₩500,000 per session.
Cryotherapy
- Liquid nitrogen for smaller keloids.
- Surface or intralesional needle delivery.
- Combined effectively with steroid injection.
- May cause pigmentation changes.
- Pricing — ₩100,000–₩300,000 per session.
Surgical excision
- For large or refractory keloids.
- High recurrence risk if used alone (50%+).
- Must be combined with adjuvant therapy.
- Adjuvants: post-op steroid injection, radiation (limited use), pressure therapy.
- Pricing — ₩500,000–₩2,000,000 depending on size.
Pulsed dye laser (Vbeam)
- For erythematous, vascularized keloids.
- Reduces redness and may flatten lesion.
- Series of treatments.
- Pricing — ₩200,000–₩400,000 per session.
Silicone gel/sheets
- First-line prevention and adjuvant treatment.
- Worn 12–24 hours daily for 2–3 months.
- Reduces hydration loss; modulates collagen.
- Inexpensive; can be used at home.
Korean combination protocols
Korean dermatologists rarely use single-modality treatment for established keloids. Common combinations:
Standard combination
- Intralesional triamcinolone every 4–6 weeks.
- Fractional laser between steroid sessions.
- Silicone sheet at home throughout.
- Series of 6–10 sessions over 6–12 months.
Aggressive combination
- Intralesional triamcinolone + 5-fluorouracil mixture.
- Cryotherapy at sessions 1, 3, 5.
- Fractional laser at sessions 2, 4, 6.
- Vbeam for vascular component.
- Continuous silicone sheet.
Surgical combination protocol
- Pre-op steroid injections to reduce inflammation.
- Surgical excision with intra-marginal closure.
- Post-op steroid injection at 2–4 weeks.
- Continued steroid series for 6–12 months.
- Silicone sheet from suture removal.
- Pressure therapy for ear keloids.
Anatomical considerations
Ear keloids
- Common from piercing.
- Surgical excision + post-op steroid + pressure earrings (continuous).
- Pressure earrings worn 12+ hours daily for 3+ months.
Chest/shoulder keloids
- Highest-risk areas; aggressive treatment required.
- Avoid surgical excision unless necessary.
- Long-term combination therapy.
- Patient counseling on tension and recurrence.
Acne keloids (back, jawline)
- Treat underlying acne first.
- Series of intralesional steroid.
- Fractional laser for textural improvement.
- Long-term acne control essential.
What patients should expect
- Slow improvement over 6–12 months.
- Multiple sessions required.
- Some keloids respond better than others.
- Recurrence risk continues even after improvement.
- Long-term maintenance often necessary.
- Prevention of new keloids in genetically susceptible patients.
What doesn\'t work alone
- Surgical excision without adjuvant therapy (50%+ recurrence).
- Single-modality treatment for large or recurrent keloids.
- Generic "scar creams" for established keloids.
- Dermabrasion or harsh resurfacing (can worsen).
Cost reality across full course
- Steroid injection series: ₩300,000–₩900,000 over 6–10 sessions.
- Combination laser + steroid: ₩1,200,000–₩3,000,000.
- Surgical excision protocol: ₩2,000,000–₩6,000,000 including adjuvant series.
- Long-term maintenance: ₩200,000–₩500,000 annually.
The Korean approach
Korean dermatology favors combination therapy from the outset rather than progressive single-modality failure. The patients who get good outcomes are those who commit to multi-session protocols with realistic timelines. The patients who pursue quick fixes or single-modality treatments for established keloids are reliably disappointed. Match the protocol to the lesion characteristics and patient genetics, commit to the timeline, and combine modalities — that is what produces sustained improvement.