Background: Keloids are benign fibro-proliferative dermal tumours defined by excessive collagen deposition that extends beyond the confines of the original wound. They are characterised by an aggressive, non-regressing growth pattern and high recurrence rates following treatment, posing significant therapeutic challenges in dermatological practice. Objectives: To compare the therapeutic efficacy of intralesional steroid (ILS) and intralesional cryotherapy (ILC) in the treatment of keloid scars, and to document the adverse effect profiles of both modalities. Materials and Methods: A prospective, randomised, open-label comparative study was conducted at the Department of Dermatology, Venereology and Leprosy, SRM Medical College Hospital and Research Centre, from March 2016 to August 2017. Of 102 enrolled patients, 89 completed the study (Group A – ILS, n=45; Group B – ILC, n=44). Injections were administered at three-weekly intervals for a maximum of 15 weeks. Scar height was assessed using the double scale method. Statistical analysis employed IBM SPSS v23.0; significance was set at p≤0.05. Results: Males constituted 55.1% of participants; the dominant age group was 21–30 years (42.7%). The chest was the most common site (51.7%). Complete flattening was achieved in 73.3% (Group A) versus 61.4% (Group B) at week 15 (p=0.231). Keloids of ≤1 year duration responded equally (100% in both groups), whilst those of >1 to ≤4 years showed statistically superior response to ILS (94.1% vs 62.5%, p=0.028). Hypopigmentation was significantly more frequent in Group A (26.6% vs 9.1%, p=0.028); blistering and necrosis occurred exclusively in Group B. Conclusion: Intralesional steroid demonstrates superior efficacy in keloids of intermediate chronicity, while intralesional cryotherapy carries fewer overall adverse effects. Keloid chronicity should guide modality selection in clinical practice.