Needle‐free electronically‐controlled jet injector treatment with bleomycin and lidocaine is effective and well‐tolerated in patients with recalcitrant keloids

Abstract

ObjectivesThe treatment of recalcitrant keloids is challenging. Although intralesional bleomycin using conventional needle injectors (CNI) is effective, it has important drawbacks, such as the need for repetitive and painful injections. Therefore, we aimed to evaluate the effectiveness, tolerability and patient satisfaction of intralesional bleomycin with lidocaine administered with a needle‐free electronically‐controlled pneumatic jet‐injector (EPI) in recalcitrant keloids.MethodsThis retrospective study included patients with recalcitrant keloids who had received three intralesional EPI‐assisted treatments with bleomycin and lidocaine. Effectiveness was assessed using the Patient and Observer Scar Assessment Scale (POSAS) at baseline and four to six weeks after the third treatment. Additionally, treatment related pain scores numeric rating scale, adverse effects, patient satisfaction and Global Aesthetic Improvement Scale (GAIS) were assessed.ResultsFifteen patients with a total of >148 recalcitrant keloids were included. The median total POSAS physician‐ and patient‐scores were respectively 40 and 41 at baseline, and reduced with respectively 7 and 6‐points at follow‐up ( p < 0.001; p < 0.001). The median pain scores during EPI‐assisted injections were significantly lower compared to CNI‐assistant injections, (2.5 vs. 7.0, respectively ( p < 0.001)). Adverse effects were mild. Overall, patients were “satisfied” or “very satisfied” with the treatments (14/15, 93.3%). The GAIS was “very improved” in one patient, “improved” in nine patients and “unaltered” in four patients.ConclusionsEPI‐assisted treatment with bleomycin and lidocaine is an effective, well tolerated, patient‐friendly alternative for CNI in patients with recalcitrant keloid scars. Randomized controlled trials are warranted to confirm our findings and improve the clinical management of recalcitrant keloids.

Introduction to the 2024 special dermatology plastic surgery issue

“…Using a patientfriendly alternative to needle injection, Bekkers et al treat 15 patients with >148 recalcitrant keloids with bleomycin and lidocaine delivered intralesionally by electronic pneumatic injection, reporting significantly less pain compared to regular needle injection in addition to clinical improvement. 3 Murray et al present a case series of various scar types treated with a new 2910 nm ablative fractional laser. Sharing their experience with the device, authors report little to no treatment discomfort, minimal side effects and healing time-potentially offering a tool for treating larger skin areas, darker skin types and pediatric populations.…”