Table 1 Topical and intralesional corticosteroids
From: Keloid treatments: an evidence-based systematic review of recent advances
First author, year | Study design | Treatment | Duration | N | Outcome(s) | Follow-up time mean (range) | Adverse events | Comments |
|---|---|---|---|---|---|---|---|---|
Acosta, 2016 [18] | P | Intralesional (IL) triamcinolone acetonide (TAC) | Months 0 and 3 and monthly until optimal improvement (1–5 injections, median = 2) | 25 | Volume decreased an average 82.7% (p < 0.001) 4% recurrence | 30 months (18–53) | Central depression (12.5%), telangiectasia (20.8%), fat deposits | In children 6–14 yo; ultrasound monitored volume |
Aluko-Olokun, 2014 [19] | P | IL TAC | q2wks for maximum 6 months until flattening | 52 | Complete flattening in 88.46% of sessile vs 0% of pedunculated | 18 months | Not stated | Injection with metal dental syringe |
Aluko-Olokun, 2015 [20] | P | IL TAC dental syringe vs IL TAC hypodermic syringe | One injection | 88 | 9.1% flattened vs 2.3% (p < 0.05) | 25.2 mo (8–48) | Not stated | |
Aluko-Olokun, 2016 [21] | P | IL TAC | Once | 16 | Reduction in volume greatest within the first 2-week post injection | 6 weeks | Not stated | Investigated optimal frequency of administration |
Aluko-Olokun, 2018 [22] | P | Post-excision IL TAC vs pre and post-excision IL TAC | q2wks for 5 months | 18 | No recurrence in either group | 10 years | Not stated | Pedunculated earlobe keloids |
Bashir, 2015 [23] | RCT | Intraop IL TAC + excision vs intraop and post-excision IL TAC | Once or at months 1 and 2 postop | 70 | No difference in recurrence rate | 17.44 months (12–26) | Fewer complications w/single injection (8.5%) vs. postop IL TAC (23%): atrophy, telangiectasia, hypopigmentation, wound dehiscence | Helix keloids on female patients post-piercing |
Brown, 2020 [24] | P | Full-thickness skin graft + IL TAC | Once | 10 | No recurrences reported | 14 months | Not stated | Ear lobule keloids only |
Cai, 2020 [36] | P | IL TAC | Q1wk for 4 weeks | 51 | Dermal thickness decreased by 39.0% | None | 3 patients w/telangiectasia and 8 patients w/mild pruritus and pain | High-frequency ultrasound used for monitoring of keloids |
Chua, 2019 [25] | SB, RCT | IL TAC to wound closure after excision | Once | 150 | N/a Trial protocol ongoing | 12 months | Not stated | Pregnant women with keloid scars from a previous C-section |
Dos Santos, 2015 [26] | SB, RCT | Excision vs preop IL TAC + excision | q1wk for 3-week preop | 15 | No significant difference in reduction of keloid dimensions | 6 months | None | Earlobe keloids only |
Farkhad, 2012 [27] | P | Group 1: IL TAC Group 2: IL TAC + silicone gel or sheet Group 3: excision + IL TAC | Unclear | 44 | Group 1 “good” result Group 2 “good result” Group 3 2 of 3 with recurrence | 9–24 months | Not stated | No objective results, reported group 2 with best results |
Huu, 2019 [28] | P | IL TAC 7.5 mg/cm2 vs 15 mg/cm2 | Q4wks up to 6 times or clinical success | 65 | Lower dosage achieved “good” or “quite good” results in 90.7% of cases vs 68.7% of cases (p < 0.05) | None | 3% ulceration, 5.6% menstrual disorder, 3.0% hypertension vs. 18.6% ulceration, 6.4% acne, 25% menstrual disorder, and 3.1% hypertension | Keloid respond graded as “good,” “quite good,” and “poor” based on criteria of Henderson and El-Tonsy |
Kaushal, 2020 [29] | P | IL TAC vs IL radiofrequency (RF)+ IL TAC | Q3wks for 15 weeks | 60 | Equally efficacious and safe; RF and IL TAC fewer recurrences at 6 months | 18 weeks | TAC: 13.3% pain, 16.6% hypopigmentation RF + TAC: 16.6% pain + ulceration, 13.4% pain, 10% atrophy, and 10% hypopigmentation | |
Nor, 2017 [30] | RCT | Group 1: topical clobetasol propionate 0.05% cream under occlusion with silicone dressing Group 2: IL TAC 40 mg/ml | Group 1 daily for 3 months; G2 monthly for 3 months | 17 patients (34 scars) | No significant difference in keloid improvement between group | None | Significantly more adverse effects: erythema (41.2 vs. 17.6%), hypopigmentation (35.3 vs. 23.5%), telangiectasia (41.2 vs.17.6%), skin atrophy (23.5 vs. 5.9%) in group 2 vs. group 1 | |
Schwaiger, 2017 [31] | P | Cryotherapy + IL TAC | Q1mo for 4 months | 15 | 34.4% average decrease in volume, 41.3% average decrease in height | None | 8 patients telangiectasia, 4 hyperpigmentation, and 1 ulceration | 3D topographic imaging device and ultrasound monitored keloid volume and elevation |
Tan, 2019 [32] | Intraindividual controlled, P | First phase: TAC embedded dissolving microneedle arrays (MNA) 0.025 mg Second phase: 0.1 mg | Daily for 30 days | Phase 1: 27 Phase 2: 17 | Significant reduction volume, greater at higher dose, but increased to baseline 4 weeks after treatment | 4 weeks | Not stated | Primary outcome was keloid volume as assessed by 3D scanner |
Tey, 2017 [33] | P, SB, intraindividual controlled | TAC embedded dissolving hyaluronic acid MNA | 4 weeks, self-applied | 28 | Transient decrease in volume that increased near baseline at 8 weeks, improved itch and pain with MNA | 8 weeks | None | |
Tey, 2018 [34] | P, SB, intraindividual controlled | TAC embedded (0.015 mg/patch then 0.1 mg/patch) dissolving hyaluronic acid MNA | 4 weeks, self-applied | 27 for low dose then 17 high dose | Transient decrease in volume (7.7% low dose, 12.9% high dose) at completion, increased near baseline at 8-week f/u, improved itch and pain with MNA | 8 weeks | None | |
Tripoli, 2015 [35] | P | Radical excision + IL TAC intraop and once postop vs radical excision | 1-month postop | 18 | No recurrences with IL TAC, excision only with 6/9 recurrences | 2 years | None | External ear keloids only |