Keloidoscope: in search for the ideal treatment of keloids

Abstract

Although keloids were recognised in the Smith Papyrus of ancient times, the precise definition, cause and management have remained elusive. Several forms of treatment have been used with varying success. Objectives This study assesses and compares the value of intralesional steroid (Triamcinolone acetonide 40mg/ml), cryotherapy and cryotherapy with intralesional steroid in the treatment of keloids. Methodology 33 patients were studied, 11 each in the three arms and the volume of the keloids was recorded using wax patterns of alginate impressions of the keloids to note the change in size postoperatively. Results The best average percentage response was observed is patients who received both Cryotherapy (CRY) and Intralesional Steroid (ILS) (69.02%) followed by patients who received only intralesional steroid (43.98%). Among the patients who received only cryotherapy, the average percentage response was only 39.24%. 72.73% patients who received intralesional steroid with cryotherapy showed more than 50% improvement (good response) while only 9.09% patients who received intralesional steroid alone and cryotherapy alone showed similar improvement. Conclusion In patients with keloids good response can be obtained with CRY with ILS as compared to ILS alone and CRY alone.

Evaluating the Therapeutic Success of Keloids Treated With Cryotherapy and Intralesional Corticosteroids Using Noninvasive Objective Measures

“…37,40 An interindividual controlled study with 10 patients using calipers and digital photography was performed to determine the effect of cryotherapy and corticosteroid injections in keloids. 25 A more objective assessment method was used in a study of 33 patients 35 : they took a wax pattern of alginate impressions of each keloid to observe changes in volume and surface of the keloids. Patients were treated only once with either cryotherapy or corticosteroid injections alone or their combination.…”

“…27,33 Although combination of cryotherapy and intralesional triamcinolone acetonide represents a frequently used technique for the treatment of keloids and has been highlighted as a promising approach in current guidelines, only 4 studies exist on its combination. 25,[34][35][36] All of them confirmed the effectiveness of intralesional corticosteroids combined with cryotherapy, but none of them applied modern objective measurement methods to assess the therapeutic success. Furthermore, treatment regimens varied, and patients were evaluated before and at the end of treatment, without information on treatment progress.…”

Intralesional Corticosteroid Administration in the Treatment of Keloids: A Scoping Review on Injection Methods

“…NS, not specified. factor of 20 [6,7,10,12,[17][18][19][20][21][22] (Table 1). Whereas one study reported to inject 0.1 mL of TAC 10 mg/mL (dose: 1 mg TAC) per cm 2 of keloid [12], other studies reported to inject 0.5 mL of TAC 40 mg/mL (dose: 20 mg TAC) per cm 2 of keloid [6,18,19].…”

“…The maximum dose administered per session was mentioned in twelve (32%) studies and varied from 20 to 80 mg (Table 1). The total number of treatment sessions varied from one [20] to eight [11,13,16], with the median being four sessions. Reported treatment intervals differed from weekly [16,23] to monthly [15,17,[24][25][26][27].…”

“…The syringe size was only specified in four studies, being 1 mL [11,16,35,36]. Seven (18%) studies reported the use of an insulin syringe, without mentioning its size [6,18,20,23,28,31,37] (Table 1).…”