Therapeutic evaluation of various modalities in keloid

Abstract

Keloid is deregulated fibroproliferative growth in response to tissue injury. Keloids are known for their stubborn nature and present as therapeutic challenges in practice. Aim of our study is to evaluate various treatment modalities for search of treatment which stand out with maximum efficacy and least side effect. 120 patients with presternal keloid (female and male, aged 18-60 years) were recruited to receive one of the five treatment methods which were(1) Cryotherapy,(2) Cryotherapy and intralesional Triamcinolone acetonide,(3) Cryotherapy and intralesional 5- Fluorouracil(4) Cryotherapy and combination of Intralesional Triamcinolone acetonide with 5- Fluorouracil(5) Cryotherapy and Intralesional Triamcinolone acetonide combined with Silicone gel sheet application in each group respectively. Evaluation done by the Patient and Observer Scar Assessment Scale (POSAS) score at every 3 week till 6 months. Patients with significant improvement (> 50% reduction in POSAS) were 42%, 75%, 75%, 85%, and 90% in each 5 group respectively. Side effects like Hypopigmentation and Skin atrophy were significantly much frequent in group 2 while skin ulceration and pain were common with group 3. Group 1 showed maximum recurrence of lesion while no recurrence was seen in group-2 and 5 even after 3 month of post treatment. Among nonsurgical treatment modalities, Cryotherapy along with intralesional medication like triamcinolone acetonide and 5 fluorouracil and adjuvant therapy like silicone gel sheet are promising, inexpensive and an effective OPD based treatment that provide good alternative for keloid treatment in comparison to surgical procedures.