How soon after excising a keloid do you inject kenalog?

I ran into this issue in clinic a few months ago when I started doing keloid excisions on patients' ears - there's some decent data in the following article for doing immediate kenalog injections without impairing wound healing.

Burusapat et al., PMID 34367855

When I possible, I prefer to shave and leave no suture behind. I inject with TAC at the time of the surgery. I wait a few weeks and then start topical imiquimod qohs x 6 weeks and have patients follow up then.

I inject K10 immediate after surgery and then at 3-4 week intervals. There is a theoretical risk of delayed wound healing but studies show the is likely the most effective way. Lately, I have been applying Aldara to auricular keloids after shave removal with great results.

Burusapat et al., PMID 3436...

I inject immediately post procedure then 2 weeks afterwards then monthly for 6 months. Then Q 8 weeks for 6 months. I require patients with ear keloids to have purchased pressure earrings prior to agreeing to do the procedure. I feel the use of these are very important.

Please see re: imiquimod. Klotz et al., PMID 31587416

Ear lobule keloids are for some reason easier targets. Great paper by David Ozog as far as injection with triam and timing.

Love Dr. @Dr. First Last's comment on pressure. I do the same.

In high risk areas (e.g. presternal), I will mix 2mg/Cc kenalog into the lidocaine I inject at time of surgery, then inject at 4 weeks, concentration altered depending on clinical findings.

Agree. Inject immediately after excising the keloid and then every 4-6 weeks for a few months. Look for signs of recurrence and if keloid is on the ears, then have them wear a keloid compression earring. If extremely large, then coordinate with adjuvant rad onc.

This all depends on demographics and sample size, but in my patients, I think I've only had one recurrence with intralesional steroids at the time of removal and repeated at one month. I've never added imiquimod or compression, and it likely wouldn't be worth it in my population given the extremely ...

I inject at the time of removal and one month later. I do not routinely use post op imiquimod unless they have had a previous recurrence.

I think that 2-4 weeks is safe and effective.