A comparative study of various modalities in the treatment of keloids

Aggarwal, Archit; Ravikumar, BC; Vinay, K N; Raghukumar, Sonia; Yashovardhana, DP

doi:10.1111/ijd.14069

Cited by 40 publications

(63 citation statements)

References 33 publications

(44 reference statements)

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“…Counterintuitively, an intralesional combination of triamcinolone 40 mg/ml mixed 1:1 with hyaluronidase 1500 IU/ml was also found to reduce keloid height to at most 1 mm in 11/16 lesions (68.75%, similar to 12/16 lesions (75%) with 40 mg/ml intralesional administration of triamcinolone alone). The authors state that this could be due to a synergistic effect of triamcinolone with hyaluronidase, as this mixture with a final triamcinolone concentration of 20 mg/ml was as efficacious as 40 mg/ml alone [12]. While the case report cites potential anti- inflammatory properties of hyaluronic acid shown previously in animal studies of tendons, this does not fully explain why an implied reduction in hyaluronic acid with hyaluronidase would lead to similar results [19].…”

Section: Hyaluronic Acid and Hyaluronidasementioning

confidence: 88%

“…The results of this trial are particularly significant because of its study design that featured intra-patient control; half of the scar was injected with verapamil and half with triamcinolone [10]. In a third study, intralesional injection of verapamil was again found to be inferior to triamcinolone with verapamil having a complete clearance rate of 0% (0/15) versus 75% for triamcinolone (12/16) [12]. An additional study similarly found no evidence of efficacy for intralesional administration of verapamil; it did not reduce height nor pigmentation, and showed a minimal reduction in pliability [13].…”

Section: Verapamilmentioning

confidence: 98%

“…Support of these results was found in a comparison of triamcinolone, triamcinolone and hyaluronidase, verapamil, RF, and RF with triamcinolone. Triamcinolone with hyaluronidase and RF with triamcinolone were found to have the highest clearance rates (75%), although RF ablation carried an increased rate of adverse effects such as atrophy, ulceration, and depigmentation [12]. In summary, although complications could pose an increased risk with this treatment, optimization should be sought, as this treatment has been shown to be effective.…”

Section: Radiofrequency (Rf) Ablationmentioning

confidence: 99%

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A Review of Current Keloid Management: Mainstay Monotherapies and Emerging Approaches

Limmer

Glass

2020

Dermatol Ther (Heidelb)

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Commonly affecting those with skin of color, keloids are an aberrant wound response that leads to wound tissue expanding above and beyond the original cutaneous injury. Keloids are notoriously and particularly difficult to treat because of their tendency to recur after excision. The current standard of care is intralesional steroid (triamcinolone acetonide). However, because no therapy has yet proven to be fully curative, keloid treatments have expanded to include a number of options, from injections to multimodal approaches. This review details current treatment of keloids with injections (bleomycin, verapamil, hyaluronic acid and hyaluronidase, botulinum toxin, and collagenase), cryotherapy, laser, radiofrequency ablation, radiation, extracorporeal shockwave therapy, pentoxifylline, and dupilumab.

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Section: Hyaluronic Acid and Hyaluronidasementioning

confidence: 88%

Section: Verapamilmentioning

confidence: 98%

Section: Radiofrequency (Rf) Ablationmentioning

confidence: 99%

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A Review of Current Keloid Management: Mainstay Monotherapies and Emerging Approaches

Limmer

Glass

2020

Dermatol Ther (Heidelb)

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“…So radiofrequency has emerged as an influential dermatosurgical procedure in recent years. Alone when used as intralesional modality, it has not very good results as reported by Aggarwal et al 5 but when used along with intralesional triamcinolone acetonide has excellent results. This technique was adopted from Gupta et al 3 Also, this technique is tedious, time consuming, require technical expertise, mild painful and more material is required, which hikes the cost of procedure.…”

Section: Discussionmentioning

confidence: 78%

Comparative evaluation of therapeutic efficacy and safety of intralesional triamcinolone acetonide injection vs intralesional radiofrequency with intralesional triamcinolone acetonide in treatment of keloids

Kaushal

Kumar

Brar

et al. 2020

Dermatologic Therapy

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Management of keloid is difficult, so there is always a need for adequate and effective therapy. In this study, we explored and compared the efficacy and synergistic effect of combined intralesional radiofrequency (RF) and intralesional triamcinolone acetonide (TAC) with intralesional triamcinolone acetonide alone in the treatment of keloids. Sixty patients with keloid were divided in two groups of 30 patients each. In both groups total six sittings every 3 weeks and post treatment follow-up every 6 weeks was done. In group A, intralesional TAC was given. In group B, intralesional radiofrequency followed by triamcinolone was injected. In this study, there were 29 males and 31 females. In groups A and B, 73.4% and 80% of the patients, respectively, achieved grade 4 improvement at the end of 33 weeks, but there was greater mean POSAS score decline in group B in comparison with group A at each visit compared to baseline. Six patients in group A while three in group B showed recurrence. Side effects were equal in number in both groups Thus both the studied modalities of treatment produced equal efficacy and safety but with less recurrence in group B.

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“…The treatment in four studies continued for a maximum of eight sessions (24 weeks or 6 months) or until the scar was completely flattened whichever occurred earlier. [14][15][16]29 However, the treatment in one study only continued for a maximum of six sessions. 28 Four parameters of VSS (height, vascularity, pliability, and pigmentation) were reported as outcome measures in all studies.…”

Section: Study Characteristicsmentioning

confidence: 99%

Efficacy and safety of verapamil vs triamcinolone acetonide for keloids and hypertrophic scars: A systematic review and meta‐analysis

Liu

Yang

Deng

et al. 2020

Dermatologic Therapy

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The treatment of keloids and hypertrophic scars remains a challenge. Although triamcinolone acetonide (TAC) is one of the most common and effective treatments for keloids and hypertrophic scars, TAC is not effective in some patients, and some may even experience adverse outcomes. Verapamil might be considered a safe alternative to TAC. The aim of this study was to compare the efficacy and safety of verapamil and TAC for the treatment of keloids and hypertrophic scars. Three databases (Medline, EMBASE, and CENTRAL database) were electronically searched from 1997 to December 2019. Article selection was limited to randomized controlled trials (RCTs) and controlled clinical trials (CCTs). Two authors independently assessed the selection of studies, risk of bias, and extracted the data. Mean differences (MDs) were computed for continuous variables, risk ratios (RRs) were computed for dichotomous variables, and 95% confidence intervals (CIs) were calculated for both assessments. Five RCTs were included, comprising a total of 215 patients (273 scars). Vancouver Scar Scale (VSS) parameters (such as height, vascularity, pliability, and pigmentation) were reported as the outcome measures and provided detailed values in four studies. No significant differences were observed between verapamil and TAC in the reduction of height (MD 0.57, 95% CI −0.94 to 2.08, P = .46), vascularity (MD 0.30, 95% CI −0.42 to 1.02, P = .41), pliability (MD 0.67, 95% CI −1.12 to 2.47, P = .46), and degree of pigmentation (MD 0.14, 95% CI −0.41 to 0.69, P = .61). Adverse outcomes were reported in four studies. The results showed that the incidence of telangiectasia and skin atrophy that used verapamil was significantly lower than that for TAC. Concerning the treatment of keloids and hypertrophic scars, even though verapamil was safer than TAC, TAC worked faster than verapamil. Furthermore, we did not find any clear evidence that verapamil was more or less effective than TAC. Considering the high degree of safety of verapamil, we suggest that verapamil might be used as an alternative treatment when TAC results in adverse outcomes.

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A comparative study of various modalities in the treatment of keloids

Cited by 40 publications

References 33 publications

A Review of Current Keloid Management: Mainstay Monotherapies and Emerging Approaches

A Review of Current Keloid Management: Mainstay Monotherapies and Emerging Approaches

Comparative evaluation of therapeutic efficacy and safety of intralesional triamcinolone acetonide injection vs intralesional radiofrequency with intralesional triamcinolone acetonide in treatment of keloids

Efficacy and safety of verapamil vs triamcinolone acetonide for keloids and hypertrophic scars: A systematic review and meta‐analysis

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