A Sequential Treatment of Keloids

BACKGROUNDDense and multiple keloids present significant therapeutic challenges due to their stubborn nature and high recurrence rates. Although various treatment options exist, optimizing current approaches and integrating them into a rational, systematic regimen for keloid management remains a difficult clinical problem.

AIMSThis study aims to establish an effective multimodal sequential treatment protocol for patients with dense, multiple keloids.

METHODSA total of 87 patients with 285 keloid lesions were enrolled from September 2023 to April 2024. All cases underwent a sequential treatment: Stage I involved drug-assisted multiple-hole punch excision followed by adjuvant superficial radiotherapy; Stage II consisted of periodic intralesional injections of betamethasone and 5-fluorouracil. Clinical outcomes, recurrence, and adverse events were evaluated at 12-month follow-up. The POSAS and VSS scores were recorded at each time point.

RESULTSAt 12 months post-treatment, marked improvement was achieved in 78 patients (89.66%), with improvement in 7 (8.04%) and ineffective results in 2 (2.30%). The POSAS and VSS scores were recorded before treatment and at follow-up points at 30, 60, 90, 180, and 360 days. All patients developed varying degrees of local hyperpigmentation within 2 months after Stage I of multi-hole punch excision. In 80.75% of cases, the hyperpigmentation resolved within 3 months following Stage I, with the longest duration of resolution being 12 months. During Stage I, four cases of localized ulcers and five instances of acute radiation dermatitis appeared. All adverse reactions were effectively alleviated. No other adverse reactions occurred.

CONCLUSIONThis sequential treatment protocol offers a practical, minimally invasive, and effective option for patients with multiple, dense keloids.

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