Chong, Nicholas Franklin Tow Mun
(2020)
Keloid: multicentre study on the outcome of multimodality management.
Masters thesis, Universiti Sains Malaysia.
Abstract
Introduction: Keloids are benign hyperproliferative growths of dermal
fibroblasts characterized by the excessive deposition of extracellular matrix
components, especially collagen, fibronectin, elastin, proteoglycans, and growth
factors such as TGF-β. They remain difficult to improve despite a plethora of
advocated treatment strategies frequently observed in daily clinical routine.
Hence, multimodality treatment is often recommended for optimum control of
the disease. This study aims to assess the outcome of intralesional
triamcinolone acetonide (TAC) injections with concurrent scar massage in
management of keloid scarring in our setting, in order to optimise its
management in the local population.
Methods:This is a prospective observational study conducted in the
Reconstructive Sciences Unit, Hospital UniversitiSains Malaysia (Hospital USM)
and the Department of Plastic & Reconstructive Surgery, Hospital Kuala
Lumpur (HKL). This study involves the collection of POSAS scores from
patients with keloid scars while they undergo treatment with intralesional TAC
injections with concurrent scar massage.The POSAS scores is used to analyse
the treatment outcome of keloid scars in the Malaysian population.
Results:The one-way repeated measures ANOVA was applied to assess the
outcome of treatment. All patient and observer components of the POSAS
showed improvements in keloid scars between the initial and conclusion visit.
Patient components: pain (39.04%), itch (36.45%), thickness (30.40%), stiffness
(23.62%), irregularity (20.50%), colour (10.18%) (NS), overall (20.50%) and
total (26.74%). Observer components: vascularity (44.19%), relief (36.94%),
thickness (34.67%), surface area (34.55%), pliability (34.22%), pigmentation
(16.58), overall (34.63%) and total (33.93%). The overall and total patient
scores showed significant improvements by mean differences of 1.43 (p=0.016)
and 9.50(p<0.001)respectively, while the overall and total observer scores
showed significant improvements by mean differences of 2.00 (p<0.001) and
9.30 (p<0.001) respectively.
Conclusion:The treatment of keloid scars with intralesional TAC injections and
concurrent scar massage is found to be effective in the Malaysian population.
These improvements were demonstrated through the use of the POSAS.
Cosmetic concerns appear to predominate the help-seeking behaviour of
patients, with a persistence of these characteristics at the end of the study.
Clinical assessment, however reveal contour deformity to be tenacious, rather
than colour inconsistency. Nevertheless, in totality, the combination of
intralesional TAC with scar massage is a cost effective yet clinically potent
regime effective in improving keloid scars in the local setting.
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