TMSS Medical College Journal

Background: Keloids are an aberration of normal healing process. Majority of the cases are symptomatic and indolent to treat. Though there is no ideal monotherapy, intralesional injection of triamcinolone acetonide is one of the first line treatment. Triamcinolone has a variable sensitivity, chance of complication and recurrence. As an emerging novel treatment, intralesional application of bleomycin shown promise in several studies. Materials and Methods: Single blind comparative study done at Sheikh Hasina National Institute of Burn and Plastic Surgery, Dhaka, Bangladesh from February, 2019 to August, 2020. Purposive sampling of 50 adult patients with keloid were enrolled, later by lottery with sealed envelope were done, to allocate into two groups A and B. They were given intralesional injection of triamcinolone acetonide and bleomycin every four weeks respectively. Both groups were assessed before and followed up every two months for a total of six months after completion of three dose of intralesional infiltration. Outcomes were compared against each other as per Vancouver scar scale score, numeric rating scale score for pain and itching. Results: Majority of the subjects (23) belonged to 18-24 years age group. In group A (triamcinolone acetonide), mean Vancouver scar scale score remission rate was 34.46% and In group B (bleomycin), it was 49.6% over 6 months follow up. Remission rate of pain in group B was 92%, while in group A it was 42%. Remission rate of itching in group B was 77.7% and in group A it was 34.2%. Conclusion: Intralesional injection of bleomycin is better for the treatment of keloid than triamcinolone acetonide.

Keloid is a benign fibro-proliferative disorder which results from an up-regulation of collagen synthesis, deposition and accumulation. It is a cicatricle lesion that extends beyond the limits of the trauma, with invasion of adjacent healthy tissue. There is significant impairment of quality of life for patients, with physical, motor, aesthetic and psychosocial sequel. There are multiple treatment methods for keloids. Despite several reported strategies, no standard treatment protocol exists. Intralesional injection of corticosteroid triamcinolone acetonide (TAC) is one of the first line treatment modalities for keloid treatment.! It could promote vasoconstriction in the keloid scar and control local inflammation by reducing expression of TGF β receptors. Though triamcinolone acetonide (TAC) has been the first line agent for treatment, its response rates vary with higher recurrence rates.’ Despite good tolerance, a significant fraction of keloids are steroid resistant. Recent studies shown hope in treatment of steroid resistant as well as steroid sensitive cases with intralesional injection of bleomycin.