Silicone gel sheets and silicone occlusive dressings have been used with varied success in the treatment of keloids. The sheets can be worn for as long as 24 h/d for up to 1 year, with care to avoid contact dermatitis and skin breakdown. Mechanical compression dressings have long been known to be effective forms of treatment of keloid scars, especially with ear lobe keloids. Compression devices are usually custom-made for the patient and are most effective if worn 24 h/d. Pharmacological therapy has long been a mainstay and relatively effective first-line therapy of treatment of keloids, either as sole treatment or in combination with other therapies. Simple excisional surgery should involve the least amount of soft tissue handling to minimize trauma; Recurrence rates with surgery alone range from 45-100%. The combination of surgical excision with other modalities, such as corticosteroid injection, steroid injection with pressure dressing, x-ray therapy, interstitial radiation, single fraction radiation, teletherapy radiation, and brachytherapy have revealed relatively good results, with 5-year recurrence rates reported from 8-50%. consult Dermatologist...