Eveline Bijlard1, Reinier Timman2, Gerda M Verduijn3, Frank B Niessen4, Steven E R Hovius5, Marc A M Mureau6. 1. Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, Postbus 2040, 3000 CA, Rotterdam, The Netherlands. Electronic address: e.bijlard@erasmusmc.nl. 2. Department of Psychiatry, Unit of Medical Psychology and Psychotherapy, Erasmus MC, University Medical Centre Rotterdam, Postbus 2040, 3000 CA, Rotterdam, The Netherlands. 3. Department of Radiation Oncology, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, Postbus 2040, 3000 CA, Rotterdam, The Netherlands. 4. Department of Plastic and Reconstructive Surgery, VU University Medical Centre, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands. 5. Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, Postbus 2040, 3000 CA, Rotterdam, The Netherlands; Hand and Wrist Surgery, Xpert Clinic, Jan Leentvaarlaan 14-24, 3065 DC Rotterdam, The Netherlands. 6. Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, Postbus 2040, 3000 CA, Rotterdam, The Netherlands.
Abstract
BACKGROUND: Keloids are a burden for patients due to physical, aesthetic and social consequences. Treatment remains a challenge due to therapy resistance and high recurrence rates. The main goals of treatment are to improve scar appearance and symptoms and patients' quality of life (QoL). METHODS: Two multicentre, randomised controlled open trials that compared 1) intralesional cryotherapy with excision and corticosteroid injections for primary keloids, and 2) intralesional cryotherapy with excision and brachytherapy for therapy resistant keloids. Primary outcome was scar appearance assessed with the Patient and Observer Scar Assessment Scale. Secondary outcomes were patient reported QoL (Skindex-29, SF-36, EQ-5D-5L), recurrence rates and scar volume reduction. For analysis, a linear mixed model was used. Power analysis indicated 33 patients in each group were needed. RESULTS: The trial was prematurely terminated after inclusion of 26 patients due to unexpectedly inferior outcomes after intralesional cryotherapy. For primary keloids no convincing difference between treatments was found, but surgery improved scar appearance while cryotherapy did not. For resistant keloids, excision followed by brachytherapy improved scar appearance (POSAS) and scar symptoms (itch and pain) significantly (p < 0.001, p < 0.001 and p = 0.006 respectively) while cryotherapy did not. Neither of the treatments caused indisputable improvements in QoL. CONCLUSIONS:Intralesional cryotherapy is inferior to keloid excision followed by brachytherapy for resistant keloids. In primary keloids, intralesional cryotherapy reduced keloid volume and, therefore, may be used in these patients and specific cases. Primary keloid group size was too small to draw valid conclusions, further research on the efficacy of intralesional cryotherapy for primary keloids is warranted.
RCT Entities:
BACKGROUND: Keloids are a burden for patients due to physical, aesthetic and social consequences. Treatment remains a challenge due to therapy resistance and high recurrence rates. The main goals of treatment are to improve scar appearance and symptoms and patients' quality of life (QoL). METHODS: Two multicentre, randomised controlled open trials that compared 1) intralesional cryotherapy with excision and corticosteroid injections for primary keloids, and 2) intralesional cryotherapy with excision and brachytherapy for therapy resistant keloids. Primary outcome was scar appearance assessed with the Patient and Observer Scar Assessment Scale. Secondary outcomes were patient reported QoL (Skindex-29, SF-36, EQ-5D-5L), recurrence rates and scar volume reduction. For analysis, a linear mixed model was used. Power analysis indicated 33 patients in each group were needed. RESULTS: The trial was prematurely terminated after inclusion of 26 patients due to unexpectedly inferior outcomes after intralesional cryotherapy. For primary keloids no convincing difference between treatments was found, but surgery improved scar appearance while cryotherapy did not. For resistant keloids, excision followed by brachytherapy improved scar appearance (POSAS) and scar symptoms (itch and pain) significantly (p < 0.001, p < 0.001 and p = 0.006 respectively) while cryotherapy did not. Neither of the treatments caused indisputable improvements in QoL. CONCLUSIONS: Intralesional cryotherapy is inferior to keloid excision followed by brachytherapy for resistant keloids. In primary keloids, intralesional cryotherapy reduced keloid volume and, therefore, may be used in these patients and specific cases. Primary keloid group size was too small to draw valid conclusions, further research on the efficacy of intralesional cryotherapy for primary keloids is warranted.
Authors: Jaclyn B Anderson; Aaron Foglio; Alex B Harrant; Christene A Huang; C Scott Hultman; David W Mathes; Tae W Chong Journal: Plast Reconstr Surg Glob Open Date: 2021-03-22
Authors: Jiaheng Xie; Liang Chen; Yuan Cao; Dan Wu; Wenwen Xiong; Kai Zhang; Jingping Shi; Ming Wang Journal: Front Immunol Date: 2021-12-22 Impact factor: 7.561