Intralesional Triamcinolone Acetonide and Cryotherapy Reduces Keloid Size

A combination of intralesional triamcinolone acetonide (IL TAC) and cryotherapy was superior to IL TAC alone for decreasing the size of keloids, according to findings from a study published in the Journal of Cosmetic Dermatology.

Researchers prospectively compared outcomes in patients with keloids treated with IL TAC vs combination IL TAC and cryotherapy, including changes in pruritus, pain, and keloid size, at an American university center from 2019 through 2021.

Patients’ pruritus and pain scores were self-reported with use of a 10-point Likert scale. Keloid size changes were classified as “no change,” “up to 50% decrease,” “more than 50% decrease,” and “completely gone.” The outcomes were evaluated from the initial visit to the most recent visit.

A total of 109 patients with 178 keloids were included — 75 patients with 126 keloids received IL TAC only, and 34 patients with 52 keloids received IL TAC with cryotherapy. The participants were ages 13 to 79 years in both groups, with 44% ages 16 to 30 years in the IL TAC only group and 35.3% ages 16 to 30 years in the IL TAC and cryotherapy group. Overall, a majority of patients were Black (72.5%, n=79) and female (78.9%, n=86).

Participants who had cryotherapy received 1 or more injections of IL TAC 5%. The ear and chest were the most common locations of keloid lesions in the 2 groups.

Both treatment groups had a significant decrease in pruritus and pain scores after treatment (P < .0001). No statistically significant difference was observed between posttreatment pruritus or pain scores in the 2 groups (P =.3933 and P =.2123, respectively).

The majority of keloids that were treated with IL TAC and cryotherapy had a greater than 50% decrease in size or were completely flattened (71.1%, n=32). In patients who received IL TAC alone, most keloids did not have a change in size or up to a 50% decrease in size (57.0%, n=53). A statistically significant difference was found between the number of keloids that decreased in more than 50% in size in the IL TAC and cryotherapy treatment group compared with those in the IL TAC only treatment group (P =.0021).

Pubic keloids occurred in 3.97% of patients who received IL TAC and in 7.69% of those who received IL TAC with cryotherapy. “In pubic keloids, our results with combination therapy were remarkable,” researchers wrote. All patients who received IL TAC and cryotherapy had complete resolution of their pubic keloids, compared with 1 patient in the IL TAC only group who had a greater than 50% decrease in keloid size.

Study limitations include the lack of randomization into treatment arms and heterogeneities in the concentration of IL TAC treatment. Also, because the keloids that were treated with combination cryotherapy and IL TAC occurred in patients who were referred to the keloid clinic, those patients frequently had treatment-resistant keloids, which likely biased the findings against the combination treatment group.

“Overall, this study provides convincing evidence that treatment with the combination of IL TAC and cryotherapy is effective at reducing pain and itch and is superior to IL TAC alone in reducing the size of keloids, particularly in the pubic region, a treatment subgroup with difficult-to-treat keloids and high recurrence rates,” the study authors concluded.