Comparative study of various treatment modalities for patients with Keloid.

Madhavi, S (2011) Comparative study of various treatment modalities for patients with Keloid. Masters thesis, Madras Medical College, Chennai.

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Abstract

INTRODUCTION : Collagen synthesis and collagen degradation take place in a strictly controlled state of equilibrium. Loss of this equilibrium, results in abnormal tissue repair. Excessive collagen synthesis and / or degradation may lead to one of the most challenging sequels in the clinical practice. Keloid scars are one of the most challenging problems for physicians and surgeons. These scars have been treated in many ways with varying success. In our study, we are comparing 5 different treatment modalities in the management of keloid. AIM OF THE STUDY : The aim of the study was 1. To study the efficacy of various modalities of treatment and to compare them with one another. 2. To study the adverse effects of the various modalities used. 3. To study the correlation between treatment response and the duration, size, number of lesions. The different modalities of treatment used in this study were 1. Intralesional Triamcinolone (40mg/ml) ; 2. Intralesional 5-Flourouracil (50mg/ml) ; 3. Intralesional Verapamil(2.5mg/ml) ; 4. Combination of Intralesional Triamcinolone (40mg/ml)and Intralesional 5- Fluorouracil (50mg/ml) ; 5. Combination of Cryotherapy, Intralesional Triamcinolone and Silicone gel sheets. CONCLUSION : 1. In our study the prevalence of keloids was found to be equal among both sexes. 2. The majority of keloids were seen in the 20 to 40 years age group in our study. 3. The maximum number (68%) of patients had spontaneous onset of keloids in our study. The other common risk factors observed were trauma, Acne vulgaris, herpes zoster, surgery, and tattoo in the descending order of frequency. 4. The most common site of occurrence of keloid in our study was observed to be the chest (50%). The other sites of involvement were shoulder, forearm, arm, back, abdomen, thigh, neck, hand and leg. 5. A positive family history was observed in 8% of the patients in our study. 6. The response to treatment varied between the study groups, for the three parameters assessed. The patients treated with a combination of Cryotherapy, Intralesional Triamcinolone acetonide and silicone gel sheets showed the best and the earliest response, among all the 5 study groups (Pigmentation – 20%, Pliability and Height – 80%). 7. 73.33% of the patients treated with Intralesional triamcinolone acetonide had shown complete response with respect to pliability and height. 13.34% of the patients had shown complete response to pigmentation in this group. 8. Complete response was seen in 66.67% of the patients treated with a combination of Intralesional Triamcinolone Acetonide and 5 – Flourouracil with respect to pliability and height. 13.34% of the patients showed complete response to pigmentation in this study group. 9. In the group treated with Intralesional Verapamil, 53.34% of the patients had shown complete response in pliability and height. 6.67% of the patients showed complete response to pigmentation in this group. 10.The patients treated with Intralesional 5- Fluorouracil had shown the least response among all the 5 study groups. (Pigmentation – 0%, Pliability and Height – 26.67%). 11.Itching was significantly reduced (p<0.001) in all the five modalities of treatment. 12.The side effects were severe in the group treated with 5- Fluorouracil alone and least in the group treated with Verapamil. 13.The number of keloids (single and multiple) in a patient does not significantly alter the treatment response in any of the study groups (p > 0.05). 14.There is no significant association between the size of the keloids and the response to therapy in any of the study groups (p> 0.05). 15.No significant association is observed between the duration of keloids (≤ 1year and > 1 year) and the treatment response (p>0.05). Each group in our study is comprised of 15 patients only. This remains the limitation of our study. Therefore studies in larger groups are needed to identify the influence of such factors on the treatment response.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Keloid ; treatment modalities ; Comparative study.
Subjects: MEDICAL > Dermatology Venereology Leprosy.
Depositing User: Subramani R
Date Deposited: 05 Jul 2017 06:08
Last Modified: 05 Jul 2017 09:17
URI: http://repository-tnmgrmu.ac.in/id/eprint/996

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