New KECORT Study Offers Guidelines for Consistent Keloid Treatment Using Intralesional Corticosteroids

This e-Delphi study offers significant clinical treatment recommendations regarding key aspects of intralesional corticosteroid administration (ICA) in keloids. The researchers note that implementing these guidelines is expected to enhance consistency in keloid treatment and improve overall outcomes. The findings were published online in the American Journal of Clinical Dermatology. 

Keloids are raised scars that result from an overproduction of collagen during the healing process. They can cause discomfort and distress for patients, making effective treatment crucial. ICA is the primary treatment for keloids. However, there is considerable variability in its application across clinical and scientific practices, making it difficult to compare treatment outcomes effectively.

To address this issue, Qi Yin, Department of Dermatology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands, and colleagues sought to reach a consensus on key aspects of intralesional corticosteroid administration using hypodermic needles for keloid treatment. They convened a global panel of dermatologists and plastic surgeons who specialize in this field, to develop consensus-based clinical recommendations for all physicians involved in managing keloids.

For this purpose, a panel of 12 dermatologists and 11 plastic surgeons specializing in keloids rated 30 statements over two online e-Delphi rounds, achieving a 100% response rate in both sessions. A total of 15 keloid experts took part in the final consensus meetings. Consensus was established when at least 75% of participants selected "agree" or "strongly agree" on a 7-point Likert scale.

The following were the key findings:

• Consensus was achieved on several key treatment aspects, including treatment goals, the indication for intralesional corticosteroid administration, and the preference for triamcinolone acetonide (TAC) at a concentration of 40 mg/mL, with a maximum dosage of 80 mg per month administered at 4-week intervals.
• Strategies to minimize pain during the procedure, the use of 1 mL syringes with 25 or 27-gauge needles, and blanching as an endpoint for successful infiltration were agreed upon. Participants also noted the importance of avoiding subcutaneous injections and the possibility of making multiple passes in very firm keloids before infiltration.
• Consensus was not reached on TAC dosing, methods of prior local anesthesia, or the specific location of injection.

To conclude, this e-Delphi consensus study offers evidence-based clinical treatment recommendations for intralesional corticosteroid administration in keloids, targeting all physicians involved in keloid management. Key aspects covered include treatment goals, indications for ICA, choice of corticosteroid, dosing guidelines, treatment intervals, syringe and needle specifications, local anesthesia use, and manual injection techniques.

"Implementing these recommendations is expected to enhance consistency in ICA practices for keloid treatment, making outcomes more comparable and potentially improving overall treatment results," the researchers concluded.

Reference:

Yin, Q., Wolkerstorfer, A., Lapid, O. et al. KECORT Study: An International e-Delphi Study on the Treatment of KEloids Using Intralesional CORTicosteroids in Clinical Practice. Am J Clin Dermatol (2024). https://doi.org/10.1007/s40257-024-00888-7