What is the role of intralesional corticosteroid injections for keloids before considering surgery?

Insalaco, Louis F.; Saxon, Sarah; Spiegel, Jeffrey H.

doi:10.1002/lary.25725

Cited by 5 publications

(7 citation statements)

References 5 publications

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“…Intralesional therapies have been developed to target these aberrant signaling and proliferation pathways. In keloids, ISI have been shown to inhibit TGF-β expression, promote fibroblast apoptosis, 28 flatten and soften scars, 29,30 and decrease recurrence rates after surgical excision. 31 It follows from the common pathogenesis underlying both keloids and airway stenosis that ISI would be similarly effective in both entities; our results support this conclusion.…”

Section: Discussionmentioning

confidence: 99%

Serial In-Office Intralesional Steroid Injections in Airway Stenosis

Bertelsen

Shoffel‐Havakuk

O’Dell

et al. 2018

JAMA Otolaryngol Head Neck Surg

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Section: Discussionmentioning

confidence: 99%

Serial In-Office Intralesional Steroid Injections in Airway Stenosis

Bertelsen

Shoffel‐Havakuk

O’Dell

et al. 2018

JAMA Otolaryngol Head Neck Surg

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“…It is pretty certain to reappear after excision, even though the incisions be carried far into the healthy skin” 6 . Today, despite various treatment options, keloid scarring continues to escape the normal process of wound healing and remains recalcitrant 7,8 …”

Section: Introductionmentioning

confidence: 99%

“…From a clinical perspective, keloids appear as elevated, firm, bosselated papules and ill‐defined plaques accompanied by variation in color, including erythematous, violaceous, or brown pigmentation 9 . In contrast to normal and hypertrophic scarring, keloids extend beyond the borders of original injury and fail to regress 8,9 . Given their composition of haphazardly branched and septal disorganized type I and III collagen bundles, keloids are often symptomatic with accompanying pain and pruritus 10 .…”

Section: Introductionmentioning

confidence: 99%

“…6 Today, despite various treatment options, keloid scarring continues to escape the normal process of wound healing and remains recalcitrant. 7,8 From a clinical perspective, keloids appear as elevated, firm, bosselated papules and ill-defined plaques accompanied by variation in color, including erythematous, violaceous, or brown pigmentation. 9 In contrast to normal and hypertrophic scarring, keloids extend beyond the borders of original injury and fail to regress.…”

Section: Introductionmentioning

confidence: 99%

“…9 In contrast to normal and hypertrophic scarring, keloids extend beyond the borders of original injury and fail to regress. 8,9 Given their composition of haphazardly branched and septal disorganized type I and III collagen bundles, keloids are often symptomatic with accompanying pain and pruritus. 10 Following disruption of skin integrity resulting from superficial and deep injuries, keloids can form within months to years later, 9 causing cosmetic deformation, functional impairment, psychological distress, and poor quality of life.…”

Section: Introductionmentioning

confidence: 99%

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Keloids: a review of therapeutic management

et al. 2020

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Keloid scar formation arises from a disorganized fibroproliferative collagen response that extends beyond the original wound margins because of excessive production of extracellular matrix (ECM). Despite treatment options for keloid scars including medical and surgical therapies, such as intralesional steroid injection and surgical excision, the recurrence rate remains high. Herein we consolidate recently published narrative reviews, systematic reviews, and meta‐analyses to provide an overview of updated treatment recommendations for keloidal scar formation. PubMed search engine was used to access the MEDLINE database to investigate updates regarding keloid incidence and treatment. More than 100 articles were reviewed. Keloid management remains a multimodal approach. There continues to be no gold standard of treatment that provides a consistently low recurrence rate; however, the increasing number of available treatments and synergistic combinations of these treatments (i.e., laser‐based devices in combination with intralesional steroids, or 5‐fluorouracil (5‐FU) in combination with steroid therapy) is showing favorable results. Future studies could target the efficacy of novel treatment modalities (i.e., autologous fat grafting or stem cell‐based therapies) for keloid management. This review article provides updated treatment guidelines for keloids and discusses insight into management to assist patient‐focused, evidence‐based clinical decision making.

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Treatment of ear keloids: algorithm for a multimodal therapy regimen

Thierauf¹,

Walther

Rotter³

et al. 2017

Eur Arch Otorhinolaryngol

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Keloids are benign cutaneous lesions, arising from proliferating fibroblasts. Keloids of the ear may occur after trauma, surgery or helix piercings and are difficult to treat, since they tend to form recurrences. Guidelines suggest multimodal therapy; however, recurrence rates remain high and distinct algorithms for the combination of different modalities are missing. To unravel the most effective combination of therapeutic options for keloids of the ear, 38 patients with the diagnosis of an ear keloid were included in our cohort. In a prospective subgroup (B) of this cohort (n = 17), patients either underwent surgery using the "fillet technique" (a meticulous peeling of the keloid skin) and intra-lesional injections of triamcinolone 10 mg/ml every 4-6 weeks for 6 months, or they were additionally treated with a non-customized pressure device which was recommended for at least 16/24 h per day over 6 months. To further compare our results, the remaining 21 patients of our cohort, who were treated at our clinic before, were retrospectively evaluated concerning their recurrence rates. The mean follow-up was 48 months. The mean count of adjuvant steroid injections was two in all patients, four in subgroup B. The recurrence rate was 30% (13/38) in all patients (subgroup B 0/17). Aesthetic results were good to excellent in all non-recurrent cases. No patient treated with fillet technique showed recurrence (p < 0.001). However, we could not confirm a significant effect but a trend of repeated steroid injections for preventing recurrences (p = 0.099). The application of pressure using our non-customized clip also showed a clear trend towards preventing recurrences in cross-table analysis (p = 0.057). Although several studies on different treatment regimens for keloids of the ear exist, the effectiveness of a multimodal treatment regimen needs to be elucidated. Overall, the best results in preventing recurrences were achieved by combining three different treatments. However, the fillet technique was the only modality preventing recurrences of keloids in uni- and multivariate analysis. The application of pressure with a non-customized clip and repeated steroid injections also showed a positive trend but failed level of significance. Based on our data and the literature we recommend, when feasible, the combination of more than one therapeutic regimen, since relapse risk went down from single to dual and triple therapy from 40% (8/20) to 14.3% (2/14) to 0% (0/4), respectively in our cohort. The use of "fillet technique" was especially beneficial.

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What is the role of intralesional corticosteroid injections for keloids before considering surgery?

Cited by 5 publications

References 5 publications

Serial In-Office Intralesional Steroid Injections in Airway Stenosis

Serial In-Office Intralesional Steroid Injections in Airway Stenosis

Keloids: a review of therapeutic management

Treatment of ear keloids: algorithm for a multimodal therapy regimen

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