Amsterdam UMC, Department of Dermatology, Amsterdam, The Netherlands.
Amsterdam UMC, Department of Plastic, Reconstructive and Hand Surgery, Amsterdam, The Netherlands.
Dermatology. 2023;239(3):462-477. doi: 10.1159/000529220. Epub 2023 Jan 19.
Intralesional corticosteroid administration (ICA) is a first-line treatment for keloids. However, its clinical results are still highly variable and often suboptimal. Treatment results may strongly be influenced by various operator-dependent factors. The aim of this study was to map the details of ICA in keloids described in randomized controlled trials (RCTs), hence presenting the scientific practice of a first-line treatment for keloids in the best available evidence.
A systematic search was performed on PubMed, Ovid MEDLINE, Ovid EMBASE, and CENTRAL. Eligible studies were RCTs including patients with keloids treated with intralesional corticosteroids. Treatment and study design-related data were charted on a predefined form. Thirty-eight RCTs were included for data extraction. Triamcinolone acetonide was used in 37 (97.4%) studies. Dosing per cm2 could only be compared among ten (26%) studies and varied from 1 to 20 mg. The maximum dose per session varied from 20 to 80 mg. Local anesthetics were administered in seven (20%) RCTs. Treatment intervals varied from weekly to monthly, with 4 weeks most frequently (50%) used. Needle size was reported in eleven (29%) studies and varied from 26 to 30-gauge. Syringe size was specified in four (11%) studies, being 1 mL. The injection level was described in eleven (29%) studies. Blanching as endpoint was reported in ten (26%) studies. Outcome measures varied widely, from height, surface area, or volume, to Vancouver Scar Scale, Patient and Observer Scar Assessment Scale, pain and itch scores, patient satisfaction, and different efficacy rates. Only six studies had a follow-up of ≥6 months. Recurrence was identified in two studies with 18 weeks and 1 year of follow-up. Adverse events were reported in 23 (61%) studies.
皮质内类固醇注射（ICA）是瘢痕疙瘩的一线治疗方法。然而，其临床效果仍然高度可变，且往往不理想。治疗结果可能受到各种操作者相关因素的强烈影响。本研究旨在绘制随机对照试验（RCT）中描述的 ICA 细节，从而呈现瘢痕疙瘩一线治疗的最佳现有证据中的科学实践。
在 PubMed、Ovid MEDLINE、Ovid EMBASE 和 CENTRAL 上进行了系统检索。纳入的研究为接受皮质内类固醇治疗的瘢痕疙瘩患者的 RCT。在预定义表格上记录治疗和研究设计相关数据。纳入 38 项 RCT 进行数据提取。37 项（97.4%）研究使用曲安奈德。每平方厘米的剂量只能在 10 项（26%）研究中进行比较，剂量范围为 1 至 20mg。每次治疗的最大剂量范围为 20 至 80mg。7 项（20%）RCT 中使用了局部麻醉剂。治疗间隔从每周到每月不等，最常用的是 4 周（50%）。11 项（29%）研究报告了针头大小，范围为 26 至 30 号。4 项（11%）研究中指定了注射器大小，为 1mL。11 项（29%）研究中描述了注射水平。10 项（26%）研究报告了以变白作为终点。结果测量指标差异很大，从高度、表面积或体积到温哥华瘢痕量表、患者和观察者瘢痕评估量表、疼痛和瘙痒评分、患者满意度和不同的疗效率不等。只有 6 项研究的随访时间≥6 个月。2 项研究在 18 周和 1 年的随访中发现了复发。23 项（61%）研究报告了不良事件。
