Abstract:Background
Intralesional corticosteroid administration (ICA) is a first-line treatment for keloids. However, its clinical results are still highly variable and often suboptimal. Treatment results may strongly be influenced by various operator dependent factors. The aim of this study is to map the details of ICA in keloids described in randomized controlled trials (RCTs), hence presenting the scientific practice of a first-line treatment for keloids in the best available evidence.
Summary
A systematic search… Show more
“…Triamcinolone is used 97% of the time, but the volume and concentration are highly variable, with maximum doses of 80 mg per session. 2 As we mentioned before, dexamethasone induces keloid regression via interaction with glucocorticoid receptors and suppresses endogenous VEGF and fibroblast proliferation, 7 but it must be administered to the most angiogenic parts of the keloid: the marginal areas at subepidermal level. This was our motivation to try mesotherapy (local intradermal therapy).…”
Section: Discussionmentioning
confidence: 99%
“…Currently, there is not a standardized protocol for this procedure, 2 and the technique is highly operator dependent. There is great variability in the number of treatment sessions, ranging from one to eight, with an average of four.…”
Section: Discussionmentioning
confidence: 99%
“…
thnicity has a significant influence on keloid formation, as individuals with skin of color develop keloids 15 times more frequently, particularly, those of African, Asian, and Hispanic descent, 1 with an incidence as high as 16%. 2 Cryotherapy, interferon, and verapamil have been described for the treatment of keloids but have inconsistent results in skin of color. The same happens with lasers, silicone gel, 5-fluorouracil, radiotherapy, bleomycin, imiquimod, photodynamic therapy, electrical stimulation, intralesional steroid injections, and surgery.
…”
mentioning
confidence: 99%
“…Ethnicity has a significant influence on keloid formation, as individuals with skin of color develop keloids 15 times more frequently, particularly, those of African, Asian, and Hispanic descent, 1 with an incidence as high as 16%. 2 …”
Summary:
The incidence of keloids in individuals with skin of color is as high as 16%. Intralesional steroid injection is recommended as a first-line treatment, even though the outcomes are often suboptimal. Histologically, the keloid epidermal layer is thicker than in normal skin, and the vascular density is higher in the marginal area at subepidermal level due to the elevated expression of vascular endothelial growth factor. Dexamethasone significantly suppresses this proangiogenic cytokine compared with Triamcinolone. We report the case of a 32-year-old phototype VI man with a 6-month-history of a keloid on the dorsum of his right hand that caused functional and cosmetic morbidity. We performed an intralesional injection of dexamethasone using a mesotherapy technique, that led to significant shrinking and complete recovery of range of motion after two sessions, with no regrowth at the 1-year follow-up. Mesotherapy is a safe and easy technique used in cosmetic medicine, which allows for a slower diffusion of dexamethasone and prolongs its pharmacological action, reducing the risk of local side effects. This technique has the potential to be standardized, but its main drawback is the need for proper sedation. Randomized clinical trials are required to further evaluate the clinical efficacy of dexamethasone mesotherapy.
“…Triamcinolone is used 97% of the time, but the volume and concentration are highly variable, with maximum doses of 80 mg per session. 2 As we mentioned before, dexamethasone induces keloid regression via interaction with glucocorticoid receptors and suppresses endogenous VEGF and fibroblast proliferation, 7 but it must be administered to the most angiogenic parts of the keloid: the marginal areas at subepidermal level. This was our motivation to try mesotherapy (local intradermal therapy).…”
Section: Discussionmentioning
confidence: 99%
“…Currently, there is not a standardized protocol for this procedure, 2 and the technique is highly operator dependent. There is great variability in the number of treatment sessions, ranging from one to eight, with an average of four.…”
Section: Discussionmentioning
confidence: 99%
“…
thnicity has a significant influence on keloid formation, as individuals with skin of color develop keloids 15 times more frequently, particularly, those of African, Asian, and Hispanic descent, 1 with an incidence as high as 16%. 2 Cryotherapy, interferon, and verapamil have been described for the treatment of keloids but have inconsistent results in skin of color. The same happens with lasers, silicone gel, 5-fluorouracil, radiotherapy, bleomycin, imiquimod, photodynamic therapy, electrical stimulation, intralesional steroid injections, and surgery.
…”
mentioning
confidence: 99%
“…Ethnicity has a significant influence on keloid formation, as individuals with skin of color develop keloids 15 times more frequently, particularly, those of African, Asian, and Hispanic descent, 1 with an incidence as high as 16%. 2 …”
Summary:
The incidence of keloids in individuals with skin of color is as high as 16%. Intralesional steroid injection is recommended as a first-line treatment, even though the outcomes are often suboptimal. Histologically, the keloid epidermal layer is thicker than in normal skin, and the vascular density is higher in the marginal area at subepidermal level due to the elevated expression of vascular endothelial growth factor. Dexamethasone significantly suppresses this proangiogenic cytokine compared with Triamcinolone. We report the case of a 32-year-old phototype VI man with a 6-month-history of a keloid on the dorsum of his right hand that caused functional and cosmetic morbidity. We performed an intralesional injection of dexamethasone using a mesotherapy technique, that led to significant shrinking and complete recovery of range of motion after two sessions, with no regrowth at the 1-year follow-up. Mesotherapy is a safe and easy technique used in cosmetic medicine, which allows for a slower diffusion of dexamethasone and prolongs its pharmacological action, reducing the risk of local side effects. This technique has the potential to be standardized, but its main drawback is the need for proper sedation. Randomized clinical trials are required to further evaluate the clinical efficacy of dexamethasone mesotherapy.
“…Moreover, for treatment of larger keloids or multiple keloids, one should consider that intralesional doses of more than 75 to 100 mg triamcinolone acetonide per session have been reported to induce adrenal suppression 12 and even lower doses of triamcinolone acetonide have been recommended as the maximum dosing per month. 13 Common adverse events caused by intralesional corticosteroids are atrophy (5%–75%) and telangiectasia (10%–80%), 14 which should be discussed with the patient before treatment.…”
BACKGROUND
Several therapeutic options are available for the treatment of keloids, but it remains unclear which treatment options are most commonly used by practitioners.
OBJECTIVE
To explore the prevailing treatment for different keloid phenotypes among dermatologists and plastic surgeons in the Netherlands.
METHODS
Members of the Dutch society for Plastic surgery and the Dutch society for Dermatology and Venereology were asked to participate. Questions elaborated on the treatment for a small and a large keloid on the mandibula and multiple keloids on the chest.
RESULTS
One hundred forty-three responses were obtained. Heterogeneity in treatment was extremely high for the small, large, and multiple keloids with 27, 35, and 33 various first choices, respectively. Intralesional corticosteroids were most often chosen for all 3 different keloid phenotypes. These were mostly (61%) administered as monotherapy for the small keloid and mostly combined with other treatments for the large keloid (19%) and multiple keloids (43%). Surgery was chosen regularly (22%) for the large keloid, mostly combined with intralesional corticosteroids (10%) or brachytherapy (8.4%).
CONCLUSION
Keloid treatment is very heterogeneous among dermatologists and plastic surgeons, even in a relatively small country as the Netherlands. Moreover, the treatment choice depends on the keloid phenotype.
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