A Prospective Study of Patients Presenting With Pre-sternal Keloids

Area of Science:

• Dermatology
• Pathology
• Wound Healing

Background:

• Keloids are pathological scars, frequently occurring on the anterior chest due to factors like acne, folliculitis, and skin tension.
• Anterior chest keloids are influenced by cyclical tension from upper limb and respiratory movements, prolonging inflammation and promoting growth.
• Pre-sternal keloids represent a distinct clinical entity with unique pathogenic and presentation characteristics.

Purpose of the Study:

• To evaluate the efficacy of intralesional injections of triamcinolone acetonide and hyaluronidase for symptomatic pre-sternal keloids.
• To assess treatment outcomes in patients who decline surgical intervention for anterior chest keloids.

Main Methods:

• A prospective study involving 47 patients with symptomatic pre-sternal keloids.
• Patients received three monthly sessions of intralesional injections combining triamcinolone acetonide and hyaluronidase.
• Exclusion criteria included prior thoracic surgery; outcomes were assessed post-treatment.

Main Results:

• Significant improvement in patient symptoms, including reduced pruritus and pain scores.
• Observed reduction in keloid lesion size, particularly in height.
• Positive changes noted in Vancouver Scar Scale (VSS) scores for vascularity and pliability.

Conclusions:

• Pre-sternal keloids are a distinct clinico-pathological entity requiring specific management considerations.
• Intralesional triamcinolone acetonide and hyaluronidase combination therapy is an effective non-surgical treatment for pre-sternal keloids.
• While effective, recurrences are possible, necessitating further treatment considerations.