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

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 was performed on PubMed, Ovid MEDLINE, Ovid EMBASE and CENTRAL. Eligible studies were RCTs including patients with keloids treated with intralesional corticosteroids. Treatment and study design related data were charted on a predefined form. Thirty-eight RCTs were included for data extraction. Triamcinolone acetonide was used in 37 (97.4%) studies. Dosing per cm2 could only be compared among ten (26%) studies, and varied from 1 to 20 mg. The maximum dose per session varied from 20 to 80 mg. Anesthetics were administered locally and orally in seven and one RCT(s). Treatment intervals varied from weekly to monthly, with four weeks most frequently (50%) used. Needle size was reported in eleven (29%) studies and varied from 26 to 30-gauge. Syringe size was specified in four (11%) studies, being 1 mL. The injection level was described in eleven (29%) studies. Blanching as endpoint was reported in ten (26%) studies. Outcome measures varied widely, from height, surface area or volume, to Vancouver Scar Scale, Patient and Observer Scar Assessment Scale, pain and itch scores, patient satisfaction and different efficacy rates. Only six studies had a follow-up of ≥6 months. Recurrence was identified in two studies with 18 weeks and 1 year of follow-up. Adverse events were reported in 25 (66%) studies. Key messages There is incomplete reporting and substantial heterogeneity in many aspects of ICA and study design among RCTs. This scoping review underscores the urgent need for standardization of treatment protocol and study design to enhance and uniform research conduct among keloid studies.

Dexamethasone Mesotherapy: An Alternative for Keloid Treatment in Hispanic Skin

“…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).…”

“…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.…”

“…

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.

…”

“…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 …”

Current Practice in Keloid Treatment: a Survey of Dutch Dermatologists and Plastic Surgeons

“…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.…”