Background: Managing difficult hypertrophic scars and keloids can be challenging. Current concepts in the treatment of such lesions is variable and extensive. Topical Imiquimod, an immunomodulator, obtained FDA approval in 1997 and has been used successfully for treating a variety of skin pathologies ranging from squamous cell carcinomas to condylomata of the skin. We report on a case series of 9 patients with severe recurrent keloid scars (ranging from 3 cm to 30 cm) that underwent surgery followed by application of topical imiquimod to prevent recurrence.

Methods: 9 patients with persistent recurrent keloid scar to the head and neck region underwent routine surgical excision, injection of triamcinolone to the wound edges followed by healing by secondary intention. From day 2 topical Imiquimod was applied to the wound edges 3 times per week until the wound had completely healed.

Results: Patients were examined post-operatively at regular intervals and signs of recurrence were recorded. Complications and local skin reactions were noted. Only 1 patient developed a recurrence 5 months post-operatively. None of the patients developed toxicity, 2 patients returned to hospital due to bleeding. Pain was troublesome in 2 patients and 1 patient developed hyper pigmentation of the scar. An Itchy scar was another reported side effect in a few patients.

Conclusion: Topical Imiquimod appears to be a safe and effective treatment modality for the management of extensive recurrent keloid. Our case series provides evidence to support the use of topical Imiquimod although larger studies are needed.