The clinical efficacy of single-hole punch excision combined with intralesional steroid injection for nodular keloid treatment: a self-controlled trial

Abstract

There are many methods to treat keloid, including various excision operations, laser, injection and radiotherapy. However, few studies have explored the effectiveness of single-hole punch excision in keloid treatment. This study aimed to investigate the efficacy and safety of lateral punch excision combined with intralesional steroid injection for keloid treatment through self-control trial. In this self-controlled trial, 50 patients meet the diagnosis of nodular keloid, and try to choose left-right symmetrical control, one skin lesion in the control group (50 skin lesionsin total) and the other in the observation group (50 skin lesions in total).The keloids in the treatment group were initially treated with punch excision combined with intralesional steroid injection, followed by injection treatment alone. Keloids in the control group received intralesional steroid injection alone. The Vancouver Scar Scale (VSS) of the keloid before and after the punch excision was evaluated; the keloid scores at different time points and the number of injection treatments required in both groups were compared, and adverse reactions were observed. The effective rate of the observation group was 86.0%, which was significantly higher than that of the control group (66.0%), and the recurrence rate of 22% was lower than that of the control group (χ² = 4.141,63417), all of which were statistically significant (all P < 0.05). At the end of treatment, the VSS and total injection times in the observation group were significantly lower than those in the control group (t = 5.900,3.361), with statistical significance (P < 0.01). The combination of single-hole punch excision and intralesional steroid injection is an effective method to treat multiple nodular keloids, shortening the treatment course of tralesional steroid injection without obvious adverse reactions.

Keywords: Intralesional injection; Nodular keloid; Punch excision; Recurrence; Single-hole; Steroid; Symmetry.

Figure 1

The typical presentation of symmetric multiple nodular scarring.

Figure 2

The method of punch excision: the needle was inserted from the side of the keloid by electric circular rotation (the inner diameter of the needle hole was 1.0 mm, and the outer diameter was 1.1 mm), and all the scar tissues were transferred from different directions in one hole as far as possible until only the superficial skin tissue formed a dermal vascular network flap.

Figure 3

(A) Before treatment: the left side is drilling combined with hormone therapy, and the right side is hormone therapy (B) After 1 year of treatment: the left side is drilling combined with hormone therapy, and the right side is hormone therapy.