Intralesional corticosteroid administration in the treatment of keloids: a survey among Dutch dermatologists and plastic surgeons

Intralesional corticosteroid administration (ICA) is a first-line therapy in keloid treatment. However, its clinical results are still highly variable and often suboptimal. Treatment results may strongly be influenced by various ways of ICA. To explore the prevailing practice of ICA in keloid treatment among dermatologists and plastic surgeons in the Netherlands. The survey was constructed based on a scoping review on ICA in keloid treatment. Members of the Dutch Society for Plastic surgery and the Dutch Society for Dermatology and Venereology were asked to participate. One hundred and thirty-six responses were obtained. One hundred and thirty (95.6%) participants used triamcinolone acetonide. The majority (54.7%) did not use local anesthesia for pain reduction. Reported corticosteroid dosing that one would inject in one specific keloid differed by a factor of 40. Treatment intervals varied from 1 week to more than 8 weeks. The keloid center was most often injected (46.9%), followed by subepidermal (18.0%). A wide variety in ICA for keloids is noted among dermatologists and plastic surgeons, even in a limited geographic region and when evidence points toward an optimal way of treatment. Future studies and better implementation of existing evidence may reduce variation in ICA and optimize its treatment results.

皮损内糖皮质激素注射疗法（Intralesional Corticosteroid Administration, ICA）是瘢痕疙瘩治疗的一线疗法。然而其临床疗效仍存在显著异质性，且往往未达最优水平。治疗效果可能受该疗法的不同操作方式显著影响。本研究旨在探究荷兰皮肤科医师与整形外科医师在瘢痕疙瘩治疗中采用该疗法的主流临床实践模式。本调研基于一项针对瘢痕疙瘩治疗中该疗法的范围综述（scoping review）构建。研究邀请荷兰整形外科学会与荷兰皮肤性病学学会的会员参与，最终共回收有效问卷136份。其中130名（占比95.6%）参与者使用曲安奈德（triamcinolone acetonide）。多数（54.7%）受访者未采用局部麻醉以缓解注射疼痛。针对单个瘢痕疙瘩的报告糖皮质激素注射剂量差异可达40倍，治疗间隔时长从1周至8周以上不等。最常选择的注射部位为瘢痕疙瘩中心（46.9%），其次为表皮下区域（18.0%）。即便在地理范围有限的区域内，且已有研究证据提示存在最优治疗方案的情况下，荷兰皮肤科医师与整形外科医师在该疗法的操作上仍存在显著差异。未来可通过开展更多研究，并更好地落实现有循证证据，以缩小该疗法的操作差异，优化其治疗效果。