Dr. Hilary Baldwin highlights her talk, "Keloids in 2025 ," at the 6th Annual Elevate-Derm Alliance Conference at the JW Marriott Water Street in Tampa, Florida.

In this video

In this conversation, Dr. Baldwin is candid about how much remains a mystery: why some piercings keloid and others don't, why earlobes are such a common site yet respond so much better to treatment. What she can explain is the biology — a keloid is a wound "stuck in the perpetual stage of healing," with too much collagen, too much glycosaminoglycans, not enough collagenase, and missing "stop signals" that would normally tell fibroblasts the hole is filled. She also stresses the practical importance of distinguishing keloids from hypertrophic scars, since keloids overgrow their footprint, favor richly pigmented skin, and are "way harder to treat" — a distinction the literature too often blurs.

On management, she walks through her limited no-cut arsenal: a 50/50 dilution of straight 5-FU and 40 mg/cc triamcinolone injected every two to four weeks, and intralesional cryotherapy — "a kebab of the keloid" — which she considers underused despite roughly 50% reduction after a single treatment. On the age-old question of whether to cut, she cuts when lesions are proud or pedunculated, walking a baseball-sized keloid off a small stalk in under five minutes, then treating the site as if she'd excised a keloid.

  • Keloid formation remains poorly understood — the only reliable prevention is piercing very early in life, since "after puberty, all bets are off."
  • Re-piercing a treated keloid carries about a 56% recurrence risk; if a patient insists, treat the site with intralesional steroid or interferon around the time of piercing.
  • Distinguish keloids from hypertrophic scars: keloids are puffier, overgrow their original footprint, favor richly pigmented skin, and are harder to treat — and beware literature that studies only earlobes.
  • For no-cut treatment, Dr. Baldwin favors a 50/50 mix of 5-FU and 40 mg/cc triamcinolone every 2–4 weeks, and underused intralesional cryotherapy (~50% reduction per session); pre-medicate for pain as the lesion thaws.
  • Cut when lesions are pedunculated — the stalk usually contains no keloid — but still inject steroid afterward, since re-traumatizing a keloid former is a risk.