A 2023 prospective ultrasound study of 1,610 Black and African American women aged 23 to 35 in the Detroit area reported that 16 percent of the 1,230-woman fibroid-free analysis subgroup had ever had keloids, and 47 percent had ever had either keloids or hypertrophic scars (Langton et al., F&S Science 2023; PMID 37028513). A 2024 systematic review and meta-analysis of 13 studies on intralesional treatment of keloids and hypertrophic scars found that combining intralesional triamcinolone with 5-fluorouracil produced more than three times the treatment efficacy of triamcinolone alone, and a telangiectasia side-effect rate roughly one-quarter of monotherapy (Mavilakandy et al., Plastic and Reconstructive Surgery 2024; PMID 37337341).
The prevalence evidence is strong. The treatment evidence is mixed, with the 2013 Cochrane review on silicone gel sheeting carrying a verbatim authors' caveat that "the poor quality of research means a great deal of uncertainty prevails" (O'Brien and Jones, Cochrane Database of Systematic Reviews 2013; PMID 24030657). Read against each other, the prevalence and treatment-evidence layers point a Black reader at a stepwise clinical pathway, not a single recommended treatment.
The prevalence layer is the strong evidence
The Langton 2023 study enrolled 1,610 Black and African American women aged 23 to 35 in the Detroit area between 2010 and 2012, then followed the 1,230 fibroid-free participants through ultrasound surveillance. Sixteen percent of those 1,230 women reported a history of keloids; 47 percent reported either keloids or hypertrophic scars; 24 percent developed incident uterine fibroids during follow-up (PMID 37028513). The study's primary research question was whether keloid history predicts later fibroid development; the authors reported "little shared susceptibility for these two types of fibrotic conditions," which is its own clinically useful finding.
What the study confirms for the keloid question specifically is the absolute Black-women prevalence: roughly one in six Black women has had a keloid at some point. The number reflects self-report in a research-cohort setting, not clinical diagnosis. It anchors the everyday clinical experience that keloid is not a niche dermatologic finding for Black patients; it is a routine clinical reality.
The frequently cited "5-to-15-times-higher rate in Black populations versus white populations" framing has older sourcing and lacks recent prospective-cohort confirmation across both populations. We are not citing the comparative ratio in this piece because we cannot point at a current primary source that establishes it at that precision. The Langton 16-percent absolute prevalence is the figure we can stand behind.
The treatment evidence is mixed by modality
Three modalities show up across the peer-reviewed evidence base, with different evidence quality.
Silicone gel sheeting. A 2013 Cochrane systematic review by Lisa O'Brien and Daniel Jones examined 20 randomized trials covering 873 participants aged 1.5 to 81 across the prevention and treatment indications. The review found that silicone gel sheets produced a significant scar-thickness reduction and about three and a half times the color-improvement rate compared with no treatment (PMID 24030657). The authors paired this finding with their own evidence-quality assessment: "the poor quality of research means a great deal of uncertainty prevails." The treatment is non-invasive and inexpensive, and the prevention-side evidence in particular is, in the review's own framing, weak. Silicone gel sheeting is reasonable as a first-line move on a fresh or small keloid; the evidence does not support promising specific outcome rates.
Intralesional triamcinolone monotherapy. Intralesional steroid injection is the long-standing dermatologic standard for established keloids that have not responded to topical management. The 2024 Mavilakandy meta-analysis is the strongest comparative evidence on this question.
Combination intralesional triamcinolone plus 5-fluorouracil. The Mavilakandy 2024 meta-analysis examined 13 studies (12 randomized controlled trials and 1 nonrandomized study) comparing combination intralesional therapy against monotherapy. The combined regimen produced more than three times the objective treatment efficacy of triamcinolone alone, and the telangiectasia side-effect rate dropped to roughly a quarter of the monotherapy rate (PMID 37337341). The combination also outperformed 5-fluorouracil monotherapy. For an established keloid that has failed silicone gel and warrants intralesional injection, the 2024 evidence supports asking the dermatologist about the combination regimen rather than triamcinolone alone.
Excision plus adjuvant. For large or treatment-refractory keloids, surgical excision is followed by adjuvant therapy (intralesional steroid post-excision, radiation, or sustained pressure dressing) to reduce the well-documented recurrence rate. The recurrence-rate evidence is older and more variable than the intralesional combination evidence; ask any candidate surgeon what their post-excision adjuvant protocol is.
Three named dermatology voices
Dr. Temitayo Ogunleye, MD, is Professor of Clinical Dermatology at Penn Medicine, in the Dermatology department, with practice locations at the University City campus in Philadelphia and at Woodbury Heights, New Jersey. Her practice focus on skin-of-color dermatology makes her a primary voice for this clinical question.
Dr. Susan C. Taylor, MD, is the founder of the Skin of Color Society and the senior US academic-dermatology voice on Black-skin treatment evidence.
Dr. Andrew F. Alexis, MD, MPH, is Vice-Chair for Diversity and Inclusion in the Department of Dermatology at Weill Cornell Medicine and a long-running voice on combination intralesional therapy and other interventions for hypertrophic scarring in skin of color.
What the evidence does not yet tell us
Three things the peer-reviewed record does not currently pin down at primary-source precision. First, the specific Black-versus-white-population prevalence ratio for keloid scarring; the older 5-to-15-times-higher framing is widely cited but lacks recent prospective-cohort comparator data we can stand behind. Second, the optimal post-excision adjuvant for high-risk patients; the comparative trial evidence between adjuvant intralesional steroid, adjuvant radiation, and prolonged pressure dressing is not at meta-analysis maturity. Third, the longer-term cosmetic and quality-of-life outcomes from any of these treatments; most trial endpoints sit at three to twelve months post-treatment, not five years out.
A reader who wants a precise comparative ratio or a definitive long-term cosmetic outcome is looking for evidence the literature does not currently supply at that precision. The pathway above is what the peer-reviewed evidence does support.
What you can do this week
Three clinical-pathway moves and one prevention move.
Fresh or small keloid (less than three months since the wound healed). Silicone gel sheeting is the reasonable first move. Over-the-counter silicone gel sheets are inexpensive and the Cochrane evidence supports trial use, with the explicit caveat about evidence quality. Apply per package directions and reassess at six to eight weeks. If the lesion thickness has not changed or has progressed, escalate.
Established keloid that has not responded to silicone gel. Schedule a dermatology consult specifically about intralesional therapy. Ask the dermatologist whether they offer the combination intralesional triamcinolone plus 5-fluorouracil regimen the 2024 Mavilakandy meta-analysis supports, or only triamcinolone monotherapy. The combination regimen requires a clinician trained in mixed-injection technique; not every general dermatology practice offers it.
Large or treatment-refractory keloid. Surgical excision followed by adjuvant therapy. Ask the candidate surgeon what their post-excision adjuvant protocol is and what their published or in-practice recurrence rate is for that protocol. The adjuvant choice (steroid injection, radiation, pressure dressing) depends on lesion location, patient history, and clinic capability.
Prevention move for high-risk individuals. A documented keloid history, a first-degree relative with keloids, or a previously identified high-risk wound location (chest, shoulders, earlobes, jawline) all raise the prior probability for a new keloid forming after a routine wound. Pressure dressings on healing wounds can reduce recurrence. Avoiding optional ear piercings, surgical procedures, or other elective wound-creating events at high-risk locations is the most direct prevention move; the evidence on prevention through silicone-gel pretreatment of routine surgical incisions is mixed.
To find a Black or skin-of-color dermatologist near you: the Skin of Color Society Find a Doctor directory indexes member dermatologists with documented practice focus on darker skin tones. The Black Health provider directory lists dermatologists with verified licenses and NPIs filtered for Black clinicians; our piece on why finding a Black doctor is harder than it should be covers the workforce numbers behind the search difficulty across specialties.
Citations
Langton CR, Gerety M, Harmon QE, Baird DD. Keloids, hypertrophic scars, and uterine fibroid development: a prospective ultrasound study of Black and African American women. F&S Science. 2023;4(2). PMID 37028513.
O'Brien L, Jones DJ. Silicone gel sheeting for preventing and treating hypertrophic and keloid scars. Cochrane Database of Systematic Reviews. 2013;(9):CD003826. PMID 24030657.
Mavilakandy AK, Vayalapra S, Minty I, Parekh JN, Charles WN, Khajuria A. Comparing Combination Triamcinolone Acetonide and 5-Fluorouracil with Monotherapy Triamcinolone Acetonide or 5-Fluorouracil in the Treatment of Hypertrophic Scars: A Systematic Review and Meta-Analysis. Plastic and Reconstructive Surgery. 2024. PMID 37337341.
