A Triple Combination Therapy Using 2-mm Biopsy Punch for the Treatment of Multifocal Keloids

Abstract

BACKGROUND Keloid treatment is challenging. The surgical approach can be divided into complete excision versus partial excision. OBJECTIVE The current study aims to introduce our novel surgical approach of partial excision using a 2-mm punch biopsy device to treat refractory multifocal keloids in the trunk. MATERIALS AND METHODS This is a case series of 30 patients with refractory multifocal keloids treated with a triple combination therapy consisting of a punch-assisted partial excision and intralesional triamcinolone injections followed by immediate single fractional electron beam radiotherapy within 8 hours, postoperatively. The follow-up period was 12 months. The primary outcome was recorded as recurrence versus nonrecurrence or aggravation versus remission. The secondary outcome was patient satisfaction as assessed by the POSAS. RESULTS The recurrence or aggravation of keloid was not found without complications. Scores obtained from the POSAS patient scale showed that pain, itchiness, color, stiffness, thickness, and irregularity significantly improved. CONCLUSION Our novel surgical approach using a 2-mm punch biopsy device effectively treats refractory multifocal keloids once considered intractable. Triple combination therapy of partial excision using a 2-mm punch biopsy device, intralesional triamcinolone injections, followed by immediate single fractional electron beam radiotherapy, is a safe, efficacious, and more convenient protocol to treat this condition.

Efficacy of Immediate Postoperative Single Fractional 10 Gy Radiotherapy for Earlobe Keloids

“…All patients received a single dose of 10 Gy to the 93% to 95% isodose line, with a corresponding biologically equivalent dose of 20 Gy (α/β of 10). Alternatively, based on a large meta-analysis depicting keloids as late-responding tissue, the biologically equivalent dose (BED) was calculated as 60 Gy (α/β of 2), as previously described 7–10 …”

“…Alternatively, based on a large meta-analysis depicting keloids as late-responding tissue, the biologically equivalent dose (BED) was calculated as 60 Gy (α/β of 2), as previously described. [7][8][9][10]…”

The clinical efficacy of single-hole punch excision combined with intralesional steroid injection for nodular keloid treatment: a self-controlled trial

“…At present, non-invasive treatment methods include radiotherapy and intralesional steroid injection, among which intralesional steroid injection is relatively cheap and the curative effect is not necessarily worse than radiotherapy 12 – 15 .However, the above therapeutic effects are still limited and cannot meet the higher requirements of patients. Recently, there has been a report on the treatment of multiple keloids by minimally invasive porous resection combined with local injection, and the effect is remarkable 15 , 16 . Due to the fact that this method requires many holes to be drilled on the surface of the scar, resulting in significant trauma and slow recovery in the later stages, it may cause adverse effects on the patient.…”