Comparison between Triamcinolone With or Without Hyaluronidase in the Management of Keloids
Saai Ram ThejasAbstract
Background:
Keloids are challenging fibroproliferative disorders with high recurrence rates despite multiple therapeutic modalities. Intralesional triamcinolone acetonide (TAC) remains the cornerstone of nonsurgical therapy, but its efficacy is limited by incomplete responses and side effects. Hyaluronidase, by enhancing drug dispersion and tissue penetration, has been proposed as an adjunct to improve outcomes.
Materials and Methods:
This prospective comparative study was conducted on 80 patients with keloids, randomly assigned into two groups. Group A received intralesional TAC (40 mg/ml), while Group B received TAC combined with hyaluronidase (1500 IU). Injections were administered every 3 weeks for six sessions. Outcomes were assessed using the Vancouver Scar Scale (VSS) parameters, vascularity, pigmentation, pliability, and height, along with patient-reported symptoms and adverse effects.
Results:
Both groups demonstrated significant posttreatment improvements in VSS scores. Group A showed a mean reduction from 11.1 to 5.0, while Group B improved from 11.2 to 3.5. Combination therapy resulted in significantly greater reductions in pliability, height, and vascularity compared to TAC alone (
Discussion:
The addition of hyaluronidase to TAC enhances clinical outcomes, likely by facilitating corticosteroid dispersion into fibrotic tissue and vascular compartments. This translated into superior improvement across all VSS domains and improved tolerability.
Conclusion:
Intralesional TAC combined with hyaluronidase is more effective and safer than TAC monotherapy, offering superior short-term outcomes in the management of keloids.