Clinical and Therapeutic Predictors of Keloid Recurrence: Outcomes in a European Cohort of 206 Patients

<b>Background/Objectives:</b> Keloids are fibroproliferative scars with high postsurgical recurrence rates and limited high-quality data from European populations. Current treatment guidelines recommend multimodal management; however, real-world practice often varies, and therapeutic efficacy in Western cohorts remains insufficiently characterized. This study aimed to analyze determinants of keloid recurrence and evaluate the impact of postoperative treatments within one of the largest Middle-European keloid cohorts to date. <b>Methods:</b> In this retrospective single-center study, 206 patients treated for at least one keloid between 2010 and 2024 were analyzed. Patients received either conservative therapy or surgical excision with or without postoperative treatments, including intralesional triamcinolone (TAC), irradiation, silicone, compression, and laser therapy. Recurrence-free survival was assessed using Kaplan-Meier estimation, univariate analysis and multivariate Cox proportional hazards modeling. <b>Results:</b> Male sex, specific anatomical sites (ear and thorax), and ethnicity (Black/African, Asian, and Middle Eastern/Arab patients) showed significant associations with more recurrences. Univariate analyses indicated higher recurrence rates in patients treated with TAC or laser therapy, whereas irradiation, compression, and silicone showed no significant effect. Multi-component analysis revealed distinct patient clusters differing in recurrence burden and treatment patterns, and multivariate analysis showed that laser therapy remained associated with increased recurrence risk, whereas TAC, irradiation, silicone, and compression demonstrated modest protective trends. Combined use of the four latter modalities was associated with a non-significant trend to lower recurrence hazard (HR 0.75). <b>Conclusions:</b> This large European cohort highlights substantial demographic variability and heterogeneity in postoperative treatment strategies. Multimodal adjuvant therapy-particularly combinations of TAC, irradiation, silicone, and compression-may reduce recurrence risk, whereas laser-treated cases likely reflect confounding by indication.