<prompt> First line tt for keloid is-Intralesional injection of steroidLocal steroidRadiotherapyWide excision  <response>: Intralesional injection of steroid Triamcinolone acetate is now recommended as the first line of tt for keloids Intralesional injection of Triamcinolone is also the tt of choice for intractable hypertrophic scars. Success is enhanced when it is combined with surgical excision Other modalities of tt used for keloids are:a Surgerysurgical excision alone leads to a high recurrance rate.there are fewer recurrances when surgical excision is combined with other modalities such as intralesional corticosteroid injection, topical application of silicone sheets or the use of radiation or pressure.surgery is recommended for debulking large lesions.b Radiation therapyit may produce unpredictable results and has obvious potential side effects including neoplastic degeneration; and has high recurrance rate when used alone.Silicone sheet applicationPressure applicationTopical retinoids 