Krishna P Sravya, Gopal K V T, Ananditha K, Reddy V Sai Teja, Rao T Narayana
Department of Dermatology, Maharajah's Institute of Medical Sciences, Nellimarla, Vizianagaram, Andhra Pradesh, India.
Indian Dermatol Online J. 2025 Apr 15;16(3):407-413. doi: 10.4103/idoj.idoj_789_24. eCollection 2025 May-Jun.
Despite the availability of various treatment modalities, the treatment of keloids is often incomplete, with a high recurrence rate. The present study was undertaken to assess the efficacy and safety of cryotherapy combined with intralesional steroid injections (Cy + ILS), intralesional combined bleomycin and steroids (ILB + S), and fractional carbon dioxide laser (Fr CO) in keloid management.
Ninety cases with keloids were enrolled and randomly divided into three groups of 30 patients each. The baseline severity of keloids was graded using the Vancouver scar scale (VSS) and high-frequency ultrasonography (HFUS). Group A, B, and C patients were treated with Cy + ILS, ILB + S, and Fr CO, respectively for four sittings at 4-week intervals. Improvement in VSS score was calculated after 4, 8, 12, and 16 weeks, and with HFUS after 16 weeks. At each visit, adverse effects, if any, were noted. Statistical analysis was done using Chi-square test and ANOVA.
At the end of 16 weeks, the reductions in VSS in Cy + ILS, ILB + S, and Fr CO groups were 5.12 (60.09%), 5.84 (69.30%), and 3.06 (38.3%), respectively ( = 0.00). The difference in mean VSS reduction after 16 weeks between ILB + S and Cy + ILS was not significant ( = 0.28), whereas ILB + S and Cy + ILS were more efficacious than Fr CO ( = 0.01 and = 0.02, respectively). The incidence of adverse effects was comparable between ILB + S and Fr CO ( = 0.11) but higher with Cy + ILS ( = 0.04).
Small sample size, non-blinded design, and short follow-up period.
ILB + S may be considered as the first-line treatment option for keloids in view of its satisfactory efficacy, and excellent safety profile.
尽管有多种治疗方式可供选择，但瘢痕疙瘩的治疗往往并不彻底，复发率很高。本研究旨在评估冷冻疗法联合病灶内注射类固醇（Cy + ILS）、病灶内联合注射博来霉素和类固醇（ILB + S）以及分次二氧化碳激光（Fr CO）治疗瘢痕疙瘩的疗效和安全性。
纳入90例瘢痕疙瘩患者，随机分为三组，每组30例。采用温哥华瘢痕量表（VSS）和高频超声（HFUS）对瘢痕疙瘩的基线严重程度进行分级。A组、B组和C组患者分别接受Cy + ILS、ILB + S和Fr CO治疗，共进行4次治疗，间隔4周。在第4、8、12和16周计算VSS评分的改善情况，并在16周后用HFUS评估。每次就诊时，记录有无不良反应。采用卡方检验和方差分析进行统计分析。
16周结束时, Cy + ILS组、ILB + S组和Fr CO组的VSS降低值分别为5.12（60.09%）、5.84（69.30%）和3.06（38.3%）（P = 0.00）。ILB + S组和Cy + ILS组16周后平均VSS降低值的差异不显著（P = 0.28），而ILB + S组和Cy + ILS组比Fr CO组更有效（分别为P = 0.01和P = 0.02）。ILB + S组和Fr CO组的不良反应发生率相当（P = 0.11），但Cy + ILS组更高（P = 0.04）。
样本量小、非盲法设计和随访期短。
鉴于ILB + S疗效满意且安全性良好，可考虑作为瘢痕疙瘩的一线治疗选择。
