Steroid Injection for Keloid: A Comprehensive Review

by Ella

Keloids are pathological scars characterized by excessive fibroblast proliferation and collagen deposition, resulting in raised, firm, and often pruritic lesions that extend beyond the boundaries of the original wound. While various treatment modalities exist for keloid management, intralesional steroid injection remains a cornerstone in the armamentarium of dermatologists and plastic surgeons. In this comprehensive article, we delve into the intricacies of steroid injection therapy for keloids, examining its efficacy, safety profile, mechanisms of action, optimal injection techniques, and factors influencing treatment outcomes.


Understanding Keloid Pathophysiology:

Keloids represent an aberrant wound healing response characterized by dysregulated fibroblast activity, prolonged inflammation, and excessive extracellular matrix deposition. Genetic predisposition, trauma, inflammation, and mechanical tension contribute to keloid formation, with African Americans, Asians, and individuals with a family history of keloids exhibiting a higher propensity for keloid development. Histologically, keloids demonstrate dense collagen bundles, increased vascularity, and inflammatory cell infiltration, distinguishing them from hypertrophic scars.


Rationale for Steroid Injection Therapy:

Intralesional corticosteroid injection is a widely accepted treatment modality for keloids owing to its anti-inflammatory, immunosuppressive, and antiproliferative effects. Triamcinolone acetonide (TAC), a long-acting corticosteroid, is the most commonly utilized agent for keloid injection due to its potent anti-inflammatory properties and favorable safety profile. TAC inhibits fibroblast proliferation, collagen synthesis, and pro-inflammatory cytokine production, thereby promoting scar softening, flattening, and symptom relief.


Efficacy of Steroid Injection Therapy:

Numerous clinical studies and meta-analyses have demonstrated the efficacy of intralesional steroid injection in reducing keloid volume, improving symptoms, and preventing recurrence. The optimal timing, frequency, and concentration of steroid injections vary based on keloid size, location, and individual patient factors. While some keloids may respond favorably to a single injection session, others may require multiple injections spaced several weeks apart to achieve optimal outcomes.


Safety Profile and Adverse Effects:

In general, intralesional steroid injection is considered safe and well-tolerated when performed by experienced healthcare providers. However, potential adverse effects, including skin atrophy, telangiectasia, hypopigmentation, and local pain, should be discussed with patients before initiating treatment. Strategies to minimize adverse effects include using lower steroid concentrations, avoiding injection into superficial vessels, and employing proper injection techniques, such as the Z-plasty or fan technique.

Optimal Injection Techniques:

The choice of injection technique plays a crucial role in the success of steroid therapy for keloids. Key considerations include needle gauge, injection depth, and distribution of the steroid solution within the keloid tissue. Techniques such as multiple puncture injection, cross-hatching, and intralesional pressure massage help ensure uniform steroid distribution and maximize tissue penetration, thereby enhancing treatment efficacy and reducing the risk of recurrence.

Factors Influencing Treatment Outcomes:

Several factors influence the response to intralesional steroid therapy for keloids, including keloid size, duration, location, skin tension, patient age, and genetic predisposition. Younger patients and individuals with smaller, recent keloids tend to exhibit better treatment responses compared to older patients with larger, longstanding lesions. Additionally, concomitant use of adjunctive therapies, such as silicone gel sheeting, pressure garments, and laser therapy, may enhance the efficacy of steroid injection and improve cosmetic outcomes.


What causes keloids?

Keloids can develop in response to various types of skin trauma, including surgical incisions, burns, acne scars, piercings, and even minor injuries. Certain individuals, particularly those with a genetic predisposition, are more prone to keloid formation.

Are keloids dangerous?

Keloids are typically harmless from a medical standpoint and do not pose any serious health risks. However, they can cause discomfort, itching, and cosmetic concerns, leading some individuals to seek treatment for aesthetic reasons or symptomatic relief.

What are corticosteroid injections for keloids?

Corticosteroid injections involve the direct administration of corticosteroid medication, such as triamcinolone acetonide, into the keloid scar. These injections help reduce inflammation, suppress collagen production, and soften the scar tissue, leading to flattening and improvement in symptoms.

Are corticosteroid injections effective for keloids?

Corticosteroid injections are considered one of the most effective non-surgical treatments for keloids. They can help reduce the size, thickness, and redness of keloid scars, as well as alleviate symptoms such as itching and tenderness.

Are corticosteroid injections painful?

Corticosteroid injections may cause some discomfort or pain at the injection site, but this is usually mild and short-lived. Healthcare providers often use local anesthesia or numbing creams to minimize discomfort during the procedure.

How many corticosteroid injections are needed for keloids?

The number of corticosteroid injections required depends on the individual keloid’s size, location, and response to treatment. In many cases, a series of injections spaced several weeks apart may be necessary to achieve optimal results.

Are there any side effects of corticosteroid injections for keloids?

While corticosteroid injections are generally safe and well-tolerated, they can occasionally cause side effects such as skin atrophy, hypopigmentation, telangiectasia (visible blood vessels), and local pain or irritation. Your healthcare provider will discuss potential risks and benefits before initiating treatment.

Can corticosteroid injections prevent keloid recurrence?

Corticosteroid injections can help reduce keloid recurrence rates when used as part of a comprehensive treatment plan that may include surgical excision, pressure therapy, and post-treatment scar management strategies. However, keloids may still recur in some cases despite treatment.


Intralesional steroid injection remains a cornerstone in the management of keloid scarring, offering a safe, effective, and minimally invasive treatment option for patients with keloid lesions. By harnessing the anti-inflammatory and antiproliferative properties of corticosteroids, healthcare providers can achieve scar softening, flattening, and symptom relief while minimizing the risk of recurrence and adverse effects. Through comprehensive evaluation, tailored treatment planning, and judicious injection techniques, clinicians can optimize treatment outcomes and improve the quality of life of individuals affected by keloid scarring.


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