Actual Situation and Future Challenges of Keloid Medical Care based on Nationwide Questionnaire Survey

Abstract

In order to investigate the actual conditions of keloid treatment, we conducted a national questionnaire survey by mailing questionnaires to the main training facilities of dermatology and plastic and reconstructive surgery nationwide. We received responses from 79 dermatology facilities and 58 facilities of plastic and reconstructive surgery (total response rate: 77.0%). In terms of the number of patients, 70% of the facilities for dermatology have less than 10 keloid cases per year, whereas 80% of the facilities for plastic and reconstructive surgery have more than 10 keloid cases. As for treatment plan, more than 80% of the facilities for both dermatology and plastic and reconstructive surgery answered that they used the conservative treatment first and observe the patients' changes in their condition in the outpatient clinic. Surgery and postoperative radiotherapy were performed in 20 dermatology facilities (25.5%), and 49 plastic and reconstructive surgery ones (84.4%). For the implementation of conservative treatment, steroids (topical therapy/pasting/intralesional injections), oral tranilast, and compression therapy were used equally and frequently in both types of facilities. Comments on problems of keloid treatment/future challenges/the need for comprehensive treatment guidelines were received from 42 facilities nationwide. Based on the information obtained about keloid practice, expertise on conservative treatment and accurate determination of therapeutic effects are necessary to achieve fast cure. Depending on the course, it is also important to operate at the optimal time if surgery is necessary or to refer the patient to a specialized facility. In order to establish an appropriate medical care system for keloid patients, the creation of comprehensive treatment guidelines for keloid is desired in the future.