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John S. Rhee, MD, MPH

Arch Facial Plast Surg. 2007;9(2):139-140.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

As an avid proponent of evidence-based medicine, I read with great interest the recent article by Leventhal et al.¹ I laud the efforts of the authors for their diligent work in compiling much of the existing literature on this topic. However, I disagree with the authors in their methods, interpretation of the results, and the appropriateness of using meta-analysis for this group of studies.

The supposition that a keloid has a 50% likelihood of improvement by chance alone is arguably erroneous. We do not fully understand the natural history of keloids, but clinical experience tells us that the rate of spontaneous improvement for this disease process is closer to 0% than 50%. More important, the use of meta-analysis on this heterogeneous group of studies is truly like comparing apples to oranges. The conclusion that "there was no statistically significant difference between treatments"^1(p362) is particularly misleading. . . . [Full Text of this Article]

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