Long-Term Results of Intralesional Triamcinolone Acetonide Injections in Keloid Treatment

Hietanen, Kristiina; Välisuo, Petri

doi:10.4172/2167-0870.1000278

Cited by 3 publications

(7 citation statements)

References 35 publications

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“…It reduces scar dimensions and symptoms such as pain and itching, and it prevents recurrence. 7 , 10 , 13 – 22 The action mechanism is multiple: reducing collagen and Glycosaminoglycans (GAGs) synthesis, inhibiting fibroblast growth, enhancing fibroblast degeneration, and having anti-inflammatory effects. 22 …”

Section: Discussionmentioning

confidence: 99%

“…IntraLesional Injection of Triamcinolone Acetonide (that we called ILITA treatment), alone or in combination with other therapy, is one of the first-line treatment modalities. 7 , 9 , 13 – 20 The efficacy of triamcinolone acetonide in keloids treatment has been demonstrated in various clinical trials since 1960, with efficacy rate from 50 to 100%, and recurrence rate of 50% in five years. 18 – 21 …”

Section: Introductionmentioning

confidence: 99%

“…ILITA therapy may induce adverse effects such as telangiectasias, atrophy, hypo/hyper-pigmentation, ulcers, necrosis, and Cushing's syndrome. 13 – 20 …”

Section: Introductionmentioning

confidence: 99%

“…7,18,19,21 ILITA therapy may induce adverse effects such as telangiectasias, atrophy, hypo/hyperpigmentation, ulcers, necrosis, and Cushing's syndrome. [13][14][15][16][17][18][19][20] The efficacy of treatment may be evaluated with subjective scales. In literature we identified 10 different scales: Vancouver Scar Scale (VSS), Dermatology Life Quality Index (DLQI), Manchester Scar Scale (MSS), Patient and Observer Scar Assessment Scale (PSAS/OSAS), Bock Quality of Life questionnaire (Bock QoL), Stony Brook Scar Evaluation Scale (SBSES), Patient-Reported Impact of Scars Measure (PRISM), Patient Scar Assessment Questionnaire (PSAQ), University of North Carolina "4P" Scar Scale (UNC4P) (Table 1).…”

Section: Introductionmentioning

confidence: 99%

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The objective evaluation of triamcinolone acetonide efficacy in keloids management using Antera3D® imaging system

Lembo

Cecchino

Parisi

et al. 2022

Scars, Burns & Healing

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Background Keloids are pathological scars characterized by nodular fibrous tissue that extends beyond the border of initial damage. These lesions do not spontaneously regress and can cause cosmetic disfigurements and functional disabilities. IntraLesional Injection of Triamcinolone Acetonide (ILITA), alone or in combination with other therapy, is one of the first-line treatment modalities. In this study the authors evaluated the objective efficacy of ILITA treatment in keloids management using this new imaging system. Materials and Methods 37 patients with 45 keloid scars were treated with intralesional injection of triamcinolone acetonide (TAC) 20 mg/ml at an interval of three weeks. Antera3D® camera took the images and dates of the treated area in each patient, before the treatment (T0) and at three weeks after the last injection (T1). The system processed the levels of color, elevations, melanin and hemoglobin expression. All the scars were also evaluated, at the same times, by validated Vancouver Scar Scale (VSS). Comparison of the variables was performed using a Wilcoxon signed-rank test with a p < 0.05. Results At T0, mean VSS score was 8.67 ± 1.35 which reduced to 3.62 ± 1.72 at final follow up. Antera3D® scores were statistically significant differences in color (8.14 ± 2.41 vs 9.54 ± 1.81), protrusion (381.3 ± 15.6 vs 198.6 ± 21.3), melanin (0.53 ± 0.02 vs 0.62 ± 0.2) and hemoglobin (1.26 ± 0.41 vs 2.21 ± 0.41) expression levels after the treatment. Conclusions In our clinical trial, the data results demonstrated that ILITA seems to be effective in reducing keloid dimensions and symptoms such as itching and pain, even if the treatment has local minimal adverse effects such as pain, telangiectasias and atrophy. Lay Summary Keloids are pathological scars characterized by nodular fibrous tissue that extends beyond the border of initial damage. Large keloids can cause cosmetic disfigurements and functional disabilities that affect quality of life. In literature, several treatment approaches have been described but, to date, no single method is considered superior. The International Advisory Panel on Scar Management recommended the use of intralesional steroid injections for keloids treatment. The efficacy of treatment may be evaluated with subjective scale; as no one can guarantee an objective evaluation. To eliminate the observer and/or patient factors, and to obtain a reliable, consistent, feasible, valid and objective evaluation a skin analysis camera system called Antera3D® (Miravex, Dublin, Ireland) can be used. In this study the authors evaluated the objective efficacy of triamcinolone acetonide treatment in keloids management using this imaging system. In this series, for Antera3D® scores there were statistically significant differences in color, protrusion, melanin and hemoglobin expression levels before and after treatment. The device directly shows the treatment changes, measured objectively and accurately, without bias of traditional evaluation scoring scale. Antera3D® system guarantees an objective evaluation of effectiveness of scar treatment enabling clinicians to modulate the therapy according to the scores registered.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…ILITA therapy may induce adverse effects such as telangiectasias, atrophy, hypo/hyper-pigmentation, ulcers, necrosis, and Cushing's syndrome. 13 – 20 …”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The objective evaluation of triamcinolone acetonide efficacy in keloids management using Antera3D® imaging system

Lembo

Cecchino

Parisi

et al. 2022

Scars, Burns & Healing

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show abstract

“…Triamcinolone acetate (TAC) has been the mostly used substance by far, with proven efficacy in many patients . However, it is commonly known that a certain number of keloids do not respond to corticosteroid injection therapies and are often labeled as resistant to cortisone . Thus, other treatment options such as 5‐fluorouracil (5‐FU), bleomycin, and verapamil have been introduced in keloid treatment.…”

Section: Introductionmentioning

confidence: 99%

Histopathology and immunohistochemical analysis of 5‐fluorouracil and triamcinolone treated keloids in double‐blinded randomized controlled trial

Hietanen

Järvinen

Tolonen

et al. 2020

Wound Repair Regeneration

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Keloids are a major complication related to surgical wound healing and very challenging condition to treat. Many treatment options are available, but the efficacy of the treatment is poor in most of cases and some keloids do not respond to the treatment at all. We compared the efficacy of intralesional 5-fluorouracil (5-FU) and triamcinolone (TAC) injections in a double-blind randomized controlled trial (RCT). Forty-three patients with 50 keloid scars were treated with either intralesional TAC or 5-FUinjections over 6 months. We wanted to find out whether biological features (cell density, cell proliferation rate, vascular density, myofibroblast numbers, steroid hormone receptor expression) in keloids could be used to predict the response to therapy and define the biological changes that take place in patients receiving a response. As there was no statistically significant difference in the remission rate between TAC and 5-FU treatments, all patients were combined and analyzed as responders and nonresponders. Although responders have slightly more myofibroblasts than the nonresponders in their keloids in the pretreatment biopsy samples, we could not identify a single predictive factor that could identify those patients that respond to drug injections. The good clinical response to therapy is associated with the simultaneous reduction of myofibroblasts in the keloid. This study demonstrates that myofibroblasts are reduced in number in those keloids that were responsive to therapy, and that both 5-FU and TAC injections are useful for keloid treatment.

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Treatment of keloid scars with intralesional triamcinolone and 5-fluorouracil injections – a randomized controlled trial

Hietanen

Järvinen

Huhtala

et al. 2019

Journal of Plastic, Reconstructive & Aesthetic Surgery

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Keloids have high recurrence rates. Current first-line therapy is triamcinolone (TAC) injection, but it has been suggested that approximately 50% of keloids are steroid resistant. We compared the efficacy of intralesional 5-fluorouracil (5-FU) and triamcinalone injections in a double-blind randomized controlled trial. Forty-three patients with 50 keloid scars were treated with either intralesional TAC or 5-FU-injections over 6 months. There was no statistically significant difference in the remission rate at 6 months between the 5-FU and TAC groups (46% vs 60%, respectively). Local adverse effects were higher in the TAC group compared to the 5-FU group. Occurrence of skin atrophy in TAC group was 44% and in the 5-FU group 8% (p < 0.05). Also the occurrence of telangiectasia in the TAC group was 50% and in the 5-FU 21% (p < 0.05). Vascularity of the keloids, assessed by spectral imaging and immunohistochemical staining for blood vessels, after treatment decreased in the TAC group, but not in the 5-FU group (p < 0.05). Fibroblast proliferation evaluated by Ki-67 staining significantly decreased in the TAC group (p < 0.05) but increased in the 5-FU group (p < 0.05). TAC and 5-FU injections did not differ in their clinical effectivity in this randomized study, but 5-FU injections lead to increased proliferation rate and did not affect vascular density

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Long-Term Results of Intralesional Triamcinolone Acetonide Injections in Keloid Treatment

Cited by 3 publications

References 35 publications

The objective evaluation of triamcinolone acetonide efficacy in keloids management using Antera3D® imaging system

The objective evaluation of triamcinolone acetonide efficacy in keloids management using Antera3D® imaging system

Histopathology and immunohistochemical analysis of 5‐fluorouracil and triamcinolone treated keloids in double‐blinded randomized controlled trial

Treatment of keloid scars with intralesional triamcinolone and 5-fluorouracil injections – a randomized controlled trial

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