Objective To explore the effect of different concentrations of triamcinolone acetonide combined with keloid excision in the treatment of keloid. Methods A total of 120 keloid patients admitted to Ping'an Street Community Health Service Center from May 2023 to May 2025 were selected, and they were divided into the control group and the study group by the random number table method, with 60 patients in each group. Both groups were treated with keloid excision. The control group was combined with low-concentration triamcinolone acetonide, and the study group was combined with high-concentration triamcinolone acetonide. The Vancouver Scar Scale (VSS) score, pain score, scar area, clinical efficacy and adverse reactions were compared between the two groups. Results After treatment, the scores of thickness, vascular distribution, color, softness and total score in the two groups were lower than those before treatment, and those in the study group were lower than those in the control group (P <0.05). The pain score and scar area in the two groups after treatment were lower than those before treatment, and those in the study group were lower than those in the control group (P <0.05). The total effective rate of treatment in the study group was 98.33%, which was higher than 88.33% in the control group (P <0.05). The incidence of adverse reactions in the study group was 8.33%, which was higher than 6.67% in the control group, but the difference was not statistically significant (P >0.05). Conclusion High-concentration triamcinolone acetonide combined with keloid excision has better efficacy, which can effectively improve the severity of symptoms in keloid patie nts, reduce scar area, relieve pain, and is conducive to diseas e prognosis, without increasing the risk of adverse reactions.