A combination of nonoperative treatment modalities used for treatment of keloids

Abstract

Keloid is one abnormal wound healing that occurs commonly in predisposed individuals. Many treatment modalities have been tried, either alone or in variety, including surgical removal, laser therapy, radiation therapy, silicone cream or gel application, cryosurgery, and intralesional injection of various agents. These treatment options have been practiced with largely transient and limited success. In the present study, the present authors prospectively assessed the efficacy of combination methods of the treatment of recalcitrant keloid. One hundred fifty-one sites of keloids in 122 patients were chosen, age of patients varied between 15 and 60 years, size of scar more than 2 cm(2) with pain, itch, or other discomfort, and duration of more than 2 years. Keloids were treated with combination methods of lasers and (32) P radiation on originating scars. One hundred eleven of 151 evaluated sites scored "excellence" and 40 belonged to "effectiveness". These patients demonstrated local control and have remained free of local recurrence for more than 2 years. In addition, there were only 21 and 32 sites with pigmentation and depigmentation, respectively. Over the past 5 years, we established a treatment protocol combining laser with (32) P-patch contact brachyradiotherapy, which represents a safe and effective option in the treatment of keloids.

Comparison of the Effectiveness of Phosphorus 32 Application and 10 Mg/Cc Triamcinolone Acetonide Intralesional Injection on Keloid

“…The radionuclide was applied a month after the laser. 7 Yan's study result was similar to this study (76.9%), despite the fact that in this study did not combine the therapy with laser.…”

“…There are several therapies for the treatment of keloid, such as laser, silicone gel, excision, interferon, corticosteroid intralesional injection, radiation, cryotherapy, and 5-fluorouracil injection, or combination. 4,7 Corticosteroid injections are the first choice therapy for keloid with TA as the most commonly used corticosteroid. The concentration have arbitrarily varied from 10 to 40 mg/cc.…”

“…7,9 32 P is a radionuclide that emits β particles continuously, resulting in death of fibroblasts and inhibit the proliferation of fibroblasts. 7,10 This is easy to use, noninvasive, painless, as well as convenient for the patients. 11,12 This application can cause mild side effects, such as hypopigmentation, edema, erosion, erythema, ulceration, dermatitis, and hyperpigmentation.…”

“…This difference is probably caused by variations in the duration of radiation (range from 20-59 hours) in Vivante's study and also by the fact that some of the lesions had received previous treatment using intralesional injection of TA or 5-fluorouracil. Another study conducted by Yan et al 7 revealed 69% of effectiveness in 151 keloid lesions using 32 P application in 72-96 hours and when combined with CO 2 laser. The radionuclide was applied a month after the laser.…”

“…10 This process causes a decrease in number of fibroblasts, collagen synthesis. 7 Vivante et al 9 conducted a study in six keloid lesions applied with 32 P with most of the lesions had experience flattening of more than 50% in a week and become 70% in the fourth week. One lesion had complete remission after 2 months of therapy.…”