OBJECTIVE Keloid scars have been treated in many ways, with varying success. A wide variety of treatments, all in current usage, indicate that no treatment has been shown to be markedly superior to the others. Following the successful treatment of scars using the pulsed dye laser, and with the more traditional intralesional steroid injection, a pilot study was undertaken using a combination of these treatments. METHODS Recalcitrant keloid scars of 10 patients were managed with a combined treatment modality of pulsed dye laser (PDL) and intralesional steroid. RESULTS Seven of the patients benefited in terms of the raised nature of the scars being improved by 60%, erythema improved by 40%, and pain/itching by 75%. Three of the patients, who had presternal scars, had no benefit. CONCLUSIONS Pretreatment with PDL facilitated steroid injection by making the scar oedematous and therefore softer. In addition, we speculate that the benefits of this combined modality are summative, not just adjunctive. This study demonstrates that this treatment is effective for the treatment of keloid scars when other treatments have been unsuccessful.