Identification of steroid sensitive responders versus non-responders in the treatment of keloid disease.

Intralesional corticosteroid injection is a well-recognised treatment modality for keloid disease (KD). Approximately 50% of KD cases are considered non-responders (or steroid resistant) with no consensus or indicators in detecting steroid-sensitive cases. In view of the undesirable side effects, uncertainty in timing and regularity of steroid treatment, we planned to identify responders and non-responders to target treatment more effectively. A scar injection proforma was developed capturing a detailed history focusing on symptoms and signs (redness, appearance, contour, texture, distortion and severity) associated with KD. The cause, site, number of keloid scars and scar recurrence were recorded as the lesions were injected on a monthly basis. A detailed description of response to steroid injection was documented and photographs were taken. Demographic data were collected on 65 patients (11 to 74 years with mean age 34.7 years, 60% were females, 50% were Caucasian). 77% (n = 50) were classified as steroid responders and showed improvement in symptoms and signs within 3 months. There was a statistically significant correlation between patients with higher contour scores of KD prior to treatment (p = 0.013) and frequency of injections (p = 0.003). Thus, the odds of being a responder were greater for patients with more than one injection and with higher contour scores. This preliminary case series has provided early evidence in enabling identification of steroid responders versus non-responders within a 3-month period. Selection of KD non-responders to steroid treatment can avoid potentially painful injection, its subsequent side effects and unnecessary continuation of redundant therapy and follow-up.