A comparative study of intralesional injection of triamcinolone acetonide alone versus combined cryotherapy and triamcinolone acetonide

Background: A keloid is dysregulated firoproliferative scar tissue in response to skin injuries, which extends beyond the wound margin. Since it has a poor response to treatment, variable therapies are used. Current therapies of keloid include intralesional corticosteroid injection, cryotherapy and various laser therapies, silicone gel sheets (pressure therapy), interferon-α-2b, 5floruracilorbleomycine administration. In this scenario, the present study was designed to evaluate the effect of combined intralesional triamcinolone acetonide injection with cryotherapy vs. Intra lesional triamcinolone alone in the treatment of keloids. Objective: This study was aimed to evaluate the efficacy of combined intralesional triamcinolone acetonide injection with cryotherapy vs. Intra lesional triamcinolone alone in the treatment of keloids. Settings: After approval of the study protocol from the ethical committee of the institute, a total one hundred patients attending at Department of Dermatology Venereology and Leprosy, Narayan Medical College, Bihar, India between August 2009 to July 2014 having keloids were included in the study. Study Design: Hospital based comparative study . The 100 keloid patients were randomly divided into two groups, Group -A:Intralesional injection of 40/ml undiluted Trimacinolone acetonide was given alone. Group B: Cryotherapy followed by intralesional injection of triamcinolone acetonide. Results: The maximum no. of patients was in the age group between 11-30 yrs (64%), the average age was 29.2 yrs, 64% cases were male and 36% were female with a male to female ratio 1.8:1. Cosmetic problems form the main symptom in both the groups with 100%. The response after completion of treatment showed excellent result in group B with 48% of lesions flattened . The recurrence after completion of treatment during follow up in group B patients was found to be 12 % of lesions whereas recurrence is 76% of lesions in group A patients. Conclusion: The present study conclude that the combination of cryotherapy followed by intralesional injection of triamcinolone acetonide (40mg/ml) required lesser number of procedures (3-5) for excellent (76-100%) flattening of the lesions, reduction of complain of pain /tenderness (100%), pruritus (90%), restricted mobility (70%) and cosmetic problems (84%).