**Core Concept**
Keloids are a type of raised, thickened scar tissue that can form after skin injury, often extending beyond the original wound boundaries. Treatment of keloids aims to prevent further growth, reduce their size, and alleviate symptoms such as itching or pain.

**Why the Correct Answer is Right**
Intralesional steroid injections are considered a first-line treatment for keloids due to their effectiveness in reducing inflammation and suppressing the growth of collagen, a key component of scar tissue. The steroid injection directly targets the keloid tissue, reducing its size and preventing further growth. This method is preferred over topical steroids, as it provides a more localized and potent effect. Intralesional steroid injections can be repeated every 4-6 weeks to maintain the desired effect.

**Why Each Wrong Option is Incorrect**
**Option A:** Topical steroids can be used as an adjunctive treatment to help reduce inflammation and itching associated with keloids. However, they are not as effective as intralesional steroid injections in reducing the size of the keloid.

**Option C:** Excision, or surgical removal, of a keloid can lead to recurrence, as the underlying factors contributing to the keloid's growth are not addressed. This method may be considered in cases where the keloid is causing significant symptoms or cosmetic concerns.

**Option D:** Radiotherapy is not typically used as an initial treatment for keloids, as it carries risks of radiation-induced skin damage and cancer.

**Clinical Pearl / High-Yield Fact**
It is essential to note that treatment of keloids should be initiated early, ideally within the first few months after the wound has healed. This increases the likelihood of successful treatment and reduces the risk of recurrence.

**Correct Answer:**
✓ Correct Answer: B. Intralesional steroid.