Clinical and Histopathological Effects of Current Keloid Treatments

From a therapeutic point of view, keloids represent a clinical challenge. The high recurrence rate of the disease is one of the many obstacles involved. Keloids are induced by even the most minor skin trauma, and their etiopathogenesis is still only partially understood despite exhaustive studies. Keloid disease mostly affects people in their early adulthood. A number of different treatment strategies are currently available, which can be very confusing for the treating physician. There is also a lack of proper scientific data. To date, there seems to be a consensus that the first line of keloid treatment is triamcinolone (TAC) injections, when feasible. However, recent evidence and clinical findings suggest that up to half of keloid patients are resistant to this treatment. Also, a relatively high number of side effects, like skin atrophy and telangiectasias, have been reported after TAC treatments. Hence, the use of alternative treatment modalities, such as 5-flurouracil (5-FU), have been reported for keloids. In addition, the role of surgical excision with post-operative radiotherapy has increased in keloid treatment.

Keloid patients, who attended Tampere University Hospital in 1996-2018, were studied retrospectively and prospectively. At first, 43 patients with 50 keloids were enrolled to a randomized controlled trial comparing the efficacy and biological effects of TAC and 5-FU injections. Then, the collected biopsies were analyzed obtained from these 43 patients and assessed the histological effects of these injection on keloid tissue in vivo. Finally in the results of the keloids treated with surgery and radiotherapy in Tampere University hospital were assessed retrospectively.

According this study, local adverse effects (telangiectasis, skinatrophy) seem to be more permanent than what has been presented previously. No significant difference was found between the efficacy of TAC and 5-FU in the treatment of keloids, and both of these drugs can be used safely. However, according to this study, it seems that TAC injections result in greater local side effects, including skin atrophy and telangiectasia, than 5-FU. According a histological and immunohistological analysis, myofibroblasts play a crucial role in keloid formation, especially in keloids which respond to these (TAC, 5-FU) therapies. Finally, it seems that the most effective method of keloid treatment is surgery and adjuvant radiotherapy, which may be considered as the first line therapy in adult patients.