A COMPARATIVE STUDY OF EFFECTIVENESS OF CRYOTHERAPY WITH INTRALESIONAL TRIAMCINOLONE VS FRACTIONAL CO2 LASER WITH TOPICAL BETAMETHASONE FOR THE TREATMENT OF KELOIDS

Abstract

Keloids occur as a hyperproliferative response of dermal connective tissue to trauma. Their management remains a challenge for practitioners as there is still no single universally accepted treatment, leading to recurrences which are frustrating for patients and clinicians alike. Unlike monotherapy, combination therapies have proved to produce better response rates. Hence, it becomes essential to compare the upcoming combination therapies to determine a modality with highest efficacy, least recurrence and produces good aesthetic results. OBJECTIVES 1) To compare the therapeutic effectiveness of cryotherapy with Intralesional Corticosteroid and Fractional CO2 laser followed by Topical Corticosteroids in the treatment of keloids. 2) To assess the efficacy of Fractional CO2 laser with Topical Steroid in the treatment of keloids. 3) To assess the efficacy of Cryotherapy with Intralesional Corticosteroid in the treatment of keloids. MATERIALS AND METHODS A comparative study conducted in Department of Dermatology, Venereology and Leprosy in R.L.J Hospital and Research Centre attached to Sri Devaraj Urs Medical College from December 2019 and May 2021. 170 patients were randomly allocated in two different regimens of 85 each to receive a combination of cryotherapy with intralesional triamcinolone xv acetonide (40mg/ml) injection and laser ablation of keloid followed by topical corticosteroid application, twice a day, until the next treatment session. Patients were given 4 treatment sessions each and were evaluated after each treatment session to look for improvement. For quantitative variables, mean and standard deviation were used, whereas for categorical variables, frequency and proportion were used. Appropriate tests were used to perform inferential statistics. Statistical significance was defined as a P value of less than 0.05. RESULTS There was remarkable difference in the treatment outcome of both the group, with group 2 showing more improvement (p value < 0.001) and markedly fewer side effects (p value < 0.001) like atrophy, pigmentation abnormality, etc. as compared to group 2 patients. Patients in group 2 had less pain as compared to patients in group 1, making them more compliant to treatment. Majority (31.8%) of patients belonged to 31-40 years of age group. The most common reason for treatment was for cosmetic concerns, seen in 70.6% of the patients. CONCLUSION Both combination regimens showed excellent responses with minimum recurrence rates, indicating high efficacy in management of keloids. Regimen I, however, was associated with more troublesome and persistent adverse effects signifying regimen II to be safer for the treatment of these exuberant scars.