Intralesional Triamcinolone More Effective for Keloids, but Vitamin D3 Offers Safer Alternative: Study
India: In a double-blinded randomized controlled trial, researchers have investigated the safety and effectiveness of intralesional vitamin D3 versus intralesional triamcinolone for treating keloids, a common dermatological condition characterized by raised scars. The study, published in Wound Repair and Regeneration, also explored the correlation between tissue expression of vitamin D receptors and treatment outcomes.
The researchers discovered that triamcinolone acetonide and vitamin D effectively treat keloids. While triamcinolone demonstrated greater efficacy, vitamin D proved a safer option, positioning it as a promising alternative for keloid management.
Keloids often result from excessive collagen formation during wound healing, leading to disfiguring scars that can cause both physical and emotional distress. Current standard treatment typically involves intralesional injections of corticosteroids, with triamcinolone acetonide being the most widely used option. While effective, concerns about potential side effects, such as skin atrophy and pigmentation changes, have spurred interest in alternative therapies. Considering this, a need arises for safer and more effective treatments.
Against the above background, Tarun Narang, Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India, and colleagues aimed to compare the efficacy and safety of intralesional vitamin D with triamcinolone for treating keloids, while also examining the correlation between tissue expression of vitamin D receptors (VDRs) and treatment outcomes.
For this purpose, the researchers randomly assigned sixty patients into two groups: Group A received intralesional vitamin D, while Group B was treated with intralesional triamcinolone. Each participant received four injections at four-week intervals, followed by an eight-week follow-up. Biopsies were collected before and after treatment to assess VDR expression levels and their correlation with treatment outcomes.
The primary outcome measured was the percentage of patients achieving at least a 50% reduction in the Vancouver Scar Scale (VSS). Secondary outcomes included the incidence of adverse effects and changes in VDR expression before and after treatment.
The study led to the following findings:
- Baseline VSS scores were recorded as 9.73 ± 1.01 for the vitamin D group and 10.13 ± 1.07 for the triamcinolone group.
- Post-treatment, the mean VSS decreased to 5.17 ± 0.59 for the vitamin D group and 4.77 ± 0.77 for the triamcinolone group, with the triamcinolone group showing a significantly better response.
- A greater proportion of patients in the triamcinolone group achieved more than a 50% reduction in VSS scores (76.7% versus 50%).
- There were no recurrences during the eight-week follow-up. However, adverse effects were more prevalent in the triamcinolone group, with hypopigmentation occurring in 80% compared to 36.7% in the vitamin D group and atrophy in 73.3% versus 40%.
- In either group, there were no significant differences in VDR receptor expression before and after treatment.
"The findings showed that intralesional triamcinolone was more effective in treating keloids but was associated with a higher incidence of side effects. In contrast, vitamin D3 emerged as a safer alternative for keloid management, offering a promising option for patients concerned about the adverse effects of corticosteroids," the researchers concluded.
Reference:
Goyal, A., Mehta, H., Narang, T., Vinay, K., Chhabra, S., Kaushik, H., Kaur, M., Sachdeva, N., & Dogra, S. (2024). A double-blinded randomised control study to compare the effectiveness and safety of intralesional vitamin D3 with intralesional triamcinolone and its correlation with tissue expression of vitamin D receptors in patients with keloid. Wound Repair and Regeneration, 32(5), 696-703. https://doi.org/10.1111/wrr.13209
