Bleomycin and lidocaine delivered via needle-free EPI viable treatment of recalcitrant keloids

According to a recent study published in Lasers in Surgery and Medicine, EPI-assisted (electronically-controlled pneumatic jet-injector) treatment with bleomycin and lidocaine is an effective, well-tolerated alternative to conventional needle injectors (CNI) in recalcitrant keloid scars cases. Based on the study findings, this option is viable and well-operated in such cases.

The treatment of keloids can be challenging. Intralesional bleomycin using CNI is effective but is associated with disadvantages. It requires repetitive and painful injections. This study evaluated the effectiveness, tolerability, and patient satisfaction of intralesional bleomycin with lidocaine administered using EPI in recalcitrant keloids.

This retrospective study involved patients who received three intralesional EPI-assisted treatments with bleomycin and lidocaine. Patient and Observer Scar Assessment Scale (POSAS) at baseline and four to six weeks after the third treatment evaluated the effectiveness. Pain scores, adverse effects, patient satisfaction, and the Global Aesthetic Improvement Scale (GAIS) were also assessed.

Key findings from the research are:

· Fifteen included patients had >148 recalcitrant keloids.

· At baseline, the median total POSAS physician- and patient scores were 40 and 41, respectively. It was reduced by 7 and 6 points at follow-up.

· The median pain scores during EPI-assisted injections were lower than CNI-assistant injections, with 2.5 vs. 7.0, respectively.

· There were mild adverse effects.

· Patients were "satisfied" or "very satisfied" with the treatments.

· In one case, GAIS was "very improved", "improved" in nine patients and "unaltered" in four patients.

· Hyperpigmentation at the site of injection was a common adverse effect.

Concluding further, they said that EPI-assisted treatment with bleomycin and lidocaine is an effective, well-tolerated, patient-friendly alternative for CNI in patients with recalcitrant keloid scars. Further investigations are warranted to add more confirmation and improvement.

In our clinic, for safety reasons, patients are treated with a bleomycin and lidocaine solution of 1 USPE/mL, with a maximum dose of 3 mL, they said.

A real-world setting and a patient-oriented approach were the major strengths of this study.

Study limitations include lack of a control group, short duration of follow-up, limited sample size of 15 patients.

Reference:

Bekkers, V. Z. et al. Needle‐free electronically‐controlled jet injector treatment with bleomycin and lidocaine is effective and well‐tolerated in patients with recalcitrant keloids. Lasers in Surgery and Medicine. https://doi.org/10.1002/lsm.23737