Intralesional corticosteroid administration in the treatment of keloids: a survey among Dutch dermatologists and plastic surgeons

Yin, Qi; Niessen, Frank B.; Gibbs, S.; Lapid, Oren; Louter, J M I; Zuijlen, Paul P. M. van; Wolkerstorfer, Albert

doi:10.1080/09546634.2022.2159308

Cited by 6 publications

(6 citation statements)

References 26 publications

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“…The treatment intervals go from weekly to monthly, with 4 weeks being the most common. The syringe and needle size also changes; 9 the plane of injection is not specified, or it is vaguely described. Triamcinolone is used 97% of the time, but the volume and concentration are highly variable, with maximum doses of 80 mg per session.…”

Section: Discussionmentioning

confidence: 99%

Dexamethasone Mesotherapy: An Alternative for Keloid Treatment in Hispanic Skin

Carvajal,

Carvajal

2024

Plastic and Reconstructive Surgery - Global Open

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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.

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Section: Discussionmentioning

confidence: 99%

Dexamethasone Mesotherapy: An Alternative for Keloid Treatment in Hispanic Skin

Carvajal,

Carvajal

2024

Plastic and Reconstructive Surgery - Global Open

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“…Moreover, corticosteroid injections can produce side effects such as fat atrophy and telangiectasia. 15 The fractional Er:YAG laser emits at a wavelength of 2940 nm, which is closely approximate to the absorption peak of collagen at 3030 nm, thus the 2940 nm wavelength can be absorbed by both water (2940 nm) and collagen (3030 nm). 16 The principle of treating scars with this technology involves, on one hand, creating columnar micro-ablation zones in the superficial skin to reduce scar volume and promote skin remodeling, and on the other hand, stimulating the remodeling of collagen.…”

Section: Discussionmentioning

confidence: 99%

Betamethasone transdermal administration combined with fractional Er:YAG lasers or microplasma radiofrequency technology improved hypertrophic scars: A retrospective study

Liu,

Li,

Zhang

et al. 2024

J of Cosmetic Dermatology

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ObjectiveThis retrospective study aims to compare the efficacy rates in treating hypertrophic scars among four distinct groups of patients who either underwent fractional Erbium: yttrium‐aluminum‐garnet (Er:YAG) laser or microplasma radiofrequency technology as standalone treatments or in combination with compound betamethasone transdermal administration.MethodThe study retrospectively examined 208 patients treated at our institution from April 2011 to December 2022 for hypertrophic scars, receiving no less than three treatments (with an interval of 8 weeks between each). The patients were categorized into four groups: the F group (treated with fractional Er:YAG laser), the F + B group (treated with fractional Er:YAG laser combined with compound betamethasone transdermal administration), the P group (treated with microplasma radiofrequency technology), and the P + B group (treated with microplasma radiofrequency technology combined with compound betamethasone transdermal administration). The therapeutic effects were evaluated based on the changes in the Vancouver Scar Scale (VSS) scores before and after treatment in these groups.ResultsThere was no statistically significant difference in the VSS scores among the four groups before treatment. After undergoing three sessions of the aforementioned four types of treatment, all groups showed a decrease in VSS scores, with average posttreatment VSS scores for the F group scored 5.15 ± 2.084, F + B group scored 3.7 ± 1.781, P group scored 4.41 ± 1.933, and P + B group scored 3.16 ± 1.775, respectively. With an increasing number of treatments, the total effective rate gradually increased in all four groups, and the combination treatment using compound betamethasone transdermal administration proved more effective than the standalone treatment.ConclusionAll four treatments yielded favorable outcomes, with the combined therapy involving compound betamethasone transdermal administration proving more effective than the standalone treatments, meriting further clinical attention.

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“…They can be challenging to treat. Intralesional corticosteroid administration (ICA) by needle injection is traditionally considered a first-line treatment for keloids, with triamcinolone acetonide (TAC) being used most frequently [ 3 , 4 ]. Nevertheless, clinical results of this treatment are highly variable and often suboptimal [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

“…Conventional needle injection using hypodermic needles has been used predominantly for ICA in the past few decades. Yet, a wide variation in this injection technique exists in current clinical practice [ 4 ]. Alternatively, different types of jet injectors can be used for ICA.…”

Section: Introductionmentioning

confidence: 99%

The biodistribution of triamcinolone acetonide injections in severe keloids: an exploratory three-dimensional fluorescent cryomicrotome study

Yin,

Bekkers,

Roelofs

et al. 2024

Arch Dermatol Res

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Intralesional corticosteroid injections are a first-line treatment for keloids; yet clinical treatment results are highly variable and often suboptimal. Variation in triamcinolone acetonide (TAC) biodistribution may be an important reason for the variable effects of TAC treatment in keloids. In this exploratory study we investigated the biodistribution of TAC in keloids and normal skin using different drug delivery techniques. Fluorescent-labeled TAC suspension was administered into keloids and normal skin with a hypodermic needle and an electronic pneumatic jet injector. TAC biodistribution was represented by the fluorescent TAC volume and 3D biodistribution shape of TAC, using a 3D-Fluorescence-Imaging Cryomicrotome System. Twenty-one keloid and nine normal skin samples were analyzed. With needle injections, the mean fluorescent TAC volumes were 990 µl ± 479 in keloids and 872 µl ± 227 in normal skin. With the jet injector, the mean fluorescent TAC volumes were 401 µl ± 252 in keloids and 249 µl ± 67 in normal skin. 3D biodistribution shapes of TAC were highly variable in keloids and normal skin. In conclusion, TAC biodistribution in keloids is highly variable for both needle and jet injection. This may partly explain the variable treatment effects of intralesional TAC in keloids. Future research is needed to confirm this preliminary finding and to optimize drug delivery in keloids.

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Intralesional corticosteroid administration in the treatment of keloids: a survey among Dutch dermatologists and plastic surgeons

Cited by 6 publications

References 26 publications

Dexamethasone Mesotherapy: An Alternative for Keloid Treatment in Hispanic Skin

Dexamethasone Mesotherapy: An Alternative for Keloid Treatment in Hispanic Skin

Betamethasone transdermal administration combined with fractional Er:YAG lasers or microplasma radiofrequency technology improved hypertrophic scars: A retrospective study

The biodistribution of triamcinolone acetonide injections in severe keloids: an exploratory three-dimensional fluorescent cryomicrotome study

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