Patient-reported outcomes for keloids: a systematic review

INTRODUCTION: Keloids are exuberant responses to cutaneous wound healing. Many research studies utilize keloid recurrence, scar thickness, and objective physician-reported data as outcome measures. Patients may have different perceptions and evaluations of treatment success from physicians, however. This review discusses available patient-reported outcome measures for keloids, as well as patient-reported outcomes across current treatment modalities. EVIDENCE ACQUISITION: A literature search of PubMed, Ovid/Medline, and EMBASE was conducted from inception to April 2018. Studies involving the evaluation of keloids with at least one patient-reported outcome measure were included. EVIDENCE SYNTHESIS: 30 relevant studies were identified. Topics included patient-reported outcome measures, health-related quality of life, and treatment options such as: topical treatments, intralesional treatments, cryotherapy, postsurgical intralesional treatments, postsurgical pressure therapy, postsurgical radiotherapy, and postsurgical brachytherapy. The Patient and Observer Scar Assessment Scale (POSAS) was used by 21 (70%) of the included studies. Patient component scores did not correlate well with observer component scores in 7 studies using the POSAS, with 4 studies having significantly worse patient scores. Quality of life in keloid patients was significantly worse compared to controls in 3 studies. Multimodal treatment options generally received more positive patient-reported outcomes. CONCLUSIONS: Patient-reported outcomes provide valuable insights into the perceptions, treatment goals, and quality of life of keloid patients. Development of more patient-reported outcome measures specific to keloids, especially those that incorporate both scar and quality of life assessments, may help refine our current understanding of keloid management.