Needle-free electronically-controlled jet injector treatment with bleomycin and lidocaine is effective and well-tolerated in patients with recalcitrant keloids

Vazula Zulfra Bekkers, Fatima Khan, Pim Aarts, Katarzyna Zdunczyk, Errol Prospero Prens, Albert Wolkerstorfer, Robert Rissmann, Martijn Bastiaan Adriaan van Doorn*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

1 Citation (Scopus)
14 Downloads (Pure)

Abstract

Objectives: 

The treatment of recalcitrant keloids is challenging. Although intralesional bleomycin using conventional needle injectors (CNI) is effective, it has important drawbacks, such as the need for repetitive and painful injections. Therefore, we aimed to evaluate the effectiveness, tolerability and patient satisfaction of intralesional bleomycin with lidocaine administered with a needle-free electronically-controlled pneumatic jet-injector (EPI) in recalcitrant keloids. 

Methods: 

This retrospective study included patients with recalcitrant keloids who had received three intralesional EPI-assisted treatments with bleomycin and lidocaine. Effectiveness was assessed using the Patient and Observer Scar Assessment Scale (POSAS) at baseline and four to six weeks after the third treatment. Additionally, treatment related pain scores numeric rating scale, adverse effects, patient satisfaction and Global Aesthetic Improvement Scale (GAIS) were assessed. 

Results: 

Fifteen patients with a total of >148 recalcitrant keloids were included. The median total POSAS physician- and patient-scores were respectively 40 and 41 at baseline, and reduced with respectively 7 and 6-points at follow-up (p < 0.001; p < 0.001). The median pain scores during EPI-assisted injections were significantly lower compared to CNI-assistant injections, (2.5 vs. 7.0, respectively (p < 0.001)). Adverse effects were mild. Overall, patients were “satisfied” or “very satisfied” with the treatments (14/15, 93.3%). The GAIS was “very improved” in one patient, “improved” in nine patients and “unaltered” in four patients. 

Conclusions: 

EPI-assisted treatment with bleomycin and lidocaine is an effective, well tolerated, patient-friendly alternative for CNI in patients with recalcitrant keloid scars. Randomized controlled trials are warranted to confirm our findings and improve the clinical management of recalcitrant keloids.

Original languageEnglish
Pages (from-to)45-53
Number of pages9
JournalLasers in Surgery and Medicine
Volume56
Issue number1
Early online date7 Nov 2023
DOIs
Publication statusPublished - Jan 2024

Bibliographical note

Publisher Copyright:
© 2023 The Authors. Lasers in Surgery and Medicine published by Wiley Periodicals LLC.

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