Aim: This prospective study aimed to determined efficiency, safety of topical zinc oxide adhesive tape (Zn-Tape) as 1st line of keloid therapy and adjuvant use of corticosteroid or surgery as 2nd line and zinc oxide, corticosteroid & surgery as 3rd line for unresponding cases. 
Methods: Fifty-three patients were recruited from Plastic & Reconstruction Surgery Unit, King Abdulaziz University 
Hospital, Jeddah, Saudi Arabia (2000-2005). All patients applied Zn-tape as monotherapy if no improvement a combination therapy of Zn-Tape with corticosteroid or surgical or both was started. Pre- and post-treatment scar (height, pliability, erythema, pigmentation, pruritus) and patient satisfaction values were scored and compared. 
Results: 34.0% of patients responded to monotherapy (Zn-Tape), 34.0% needed ditherapy (Zn-tape & corticosteroid; Zn-tape & surgery), 32.0% required tritherapy (Zn-Tape, surgery & corticosteroid). With Zn-Tape & surgery and with Zn-Tape, corticosteroid & surgery improvement was 100%, patient satisfaction was 88.9% with Zn-Tape & surgery. Best improvement of itching was noticed with Zn-Tape; pigmentation, erythema, size with Zn-Tape & surgery; pliability, flattening with ZnTape, corticosteroid & surgery. Recurrence rate was 5.7%. 
Conclusions: Zn-Tape is effective when used as monotherapy with low recurrence. In unresponsiveness cases to Zn-Tape 
addition of corticosteroid or surgery or both proven to be effective