Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Department of Immunopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Wound Repair Regen. 2024 Sep-Oct;32(5):696-703. doi: 10.1111/wrr.13209. Epub 2024 Sep 11.
Intralesional steroids commonly used for keloid treatment have adverse effects like cutaneous atrophy and telangiectasias. Safer and more effective therapies are needed. Preliminary studies suggest intralesional vitamin D as a potential alternative treatment. The aim of this study was to compare efficacy and safety of intralesional vitamin D with triamcinolone for keloids, and correlate tissue expression of vitamin D receptors (VDRs) with treatment outcomes. Sixty patients were randomly assigned to two groups: Group A (intralesional vitamin D) and Group B (intralesional triamcinolone). Four injections were given at 4-week intervals, with an 8-week follow-up. Biopsies were taken pre- and post-treatment to examine VDR expression levels and treatment response correlation. The primary outcome of interest was the proportion of patients achieving a 50% reduction in Vancouver Scar Scale (VSS). Secondary outcomes included incidence of adverse effects, and changes in VDR expression before and after treatment. Baseline VSS scores were 9.73 ± 1.01 (vitamin D group) and 10.13 ± 1.07 (triamcinolone group). After treatment, mean VSS decreased to 5.17 ± 0.59 (vitamin D group, p < 0.001) and 4.77 ± 0.77 (triamcinolone group, p < 0.001), with significantly better response in latter (p = 0.03). More than 50% reduction in VSS score was higher in the triamcinolone group (76.7% vs. 50%, p = 0.032). No recurrences were noted during the 8-week follow-up. Hypopigmentation (80% vs. 36.7%, p < 0.001) and atrophy (73.3% vs. 40%, p = 0.009) were more common in the triamcinolone group. No significant difference in pre- and post-treatment VDR receptor expression was observed in either group. Both triamcinolone acetonide and vitamin D were effective for keloids. Triamcinolone was more efficacious, whereas vitamin D was safer, suggesting it as a viable alternative for keloid management.
局部类固醇常用于瘢痕疙瘩治疗，但其具有皮肤萎缩和毛细血管扩张等不良反应。因此，需要更安全、更有效的治疗方法。初步研究表明，局部维生素 D 可能是一种潜在的替代治疗方法。本研究旨在比较局部维生素 D 与曲安奈德治疗瘢痕疙瘩的疗效和安全性，并将维生素 D 受体 (VDR) 的组织表达与治疗结果相关联。
将 60 名患者随机分为两组：A 组（局部维生素 D）和 B 组（局部曲安奈德）。每 4 周注射一次，8 周后随访。治疗前后取活检，检测 VDR 表达水平与治疗反应的相关性。主要观察指标为温哥华瘢痕量表 (VSS) 评分降低 50%的患者比例。次要观察指标包括不良反应发生率及治疗前后 VDR 表达的变化。
基线时 VSS 评分分别为维生素 D 组 9.73±1.01，曲安奈德组 10.13±1.07。治疗后，维生素 D 组平均 VSS 降至 5.17±0.59（p<0.001），曲安奈德组降至 4.77±0.77（p<0.001），后者的反应明显更好（p=0.03）。VSS 评分降低 50%以上的患者比例在曲安奈德组更高（76.7%比 50%，p=0.032）。在 8 周随访期间，未观察到复发。曲安奈德组色素减退（80%比 36.7%，p<0.001）和萎缩（73.3%比 40%，p=0.009）更为常见。两组治疗前后 VDR 受体表达均无显著差异。
曲安奈德和维生素 D 对瘢痕疙瘩均有效。曲安奈德更有效，而维生素 D 更安全，表明维生素 D 可能是瘢痕疙瘩治疗的一种可行替代方法。
