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Abstract

Background: Keloid is a benign fibroproliferative skin disorder characterized by excessive collagen deposition resulting from abnormal wound healing that extends beyond the original wound margins. It is particularly challenging to treat, especially in areas with high mechanical tension and skin stiffness, such as the mandibular region, which is associated with increased risk of persistence and recurrence. Combination therapy has shown superior outcomes in reducing recurrence and improving keloids.

Case Illustration: A 41-year-old male with a post-acne keloid on his right mandible underwent surgical management using the suprakeloidal flap method followed by intralesional triamcinolone acetonide (TAC, 10 mg/mL, 20 mg) and intense pulsed light (IPL, 40 J/cm2, 560-590 nm) at 2-week intervals. The initial response was favorable, with a reduction in lesion size and a reduction in the modified Vancouver Scar Scale (mVSS) score from 12 to 7 within one month. However, discontinuation of therapy resulted in keloid recurrence at six months.

Discussion: Suprakeloidal flap removes the proliferative fibrous core of the lesion, thereby reducing the bulk and mechanical tension at the wound site. Adjunctive intralesional TAC suppresses fibroblast activity and collagen synthesis, while IPL may provide additional benefit by improving scar erythema and vascular components.

Conclusion: Combination therapy with suprakeloidal flap, intralesional TAC, and IPL shows early clinical improvement. However, recurrence after treatment discontinuation highlights the need for sustained therapy and long-term maintenance strategies.

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