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Bleomycin Injection Combined with Punch Excision and X-ray Radiotherapy for Treating Medium to Large Keloids: A

Xurong Liu1, Zhengzheng Fu2, Wen Zheng3

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|January 21, 2026
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Bleomycin combined with punch excision and superficial X-ray therapy (SXRT) offers superior keloid treatment outcomes compared to triamcinolone. This combination therapy demonstrates higher efficacy, patient satisfaction, and fewer adverse events for keloid management.

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Area of Science:

  • Dermatology
  • Wound Healing
  • Oncology (for bleomycin use)

Background:

  • Keloids are inflammatory skin disorders resulting from abnormal wound healing.
  • Pruritus and pain are common symptoms, posing therapeutic challenges due to high recurrence and resistance.
  • Current guidelines suggest combination therapies, but standardized protocols are lacking.

Purpose of the Study:

  • To compare the efficacy and safety of bleomycin versus triamcinolone when combined with punch excision and superficial X-ray therapy (SXRT).
  • To evaluate outcomes for medium-to-large keloids treated with these combined modalities.

Main Methods:

  • A retrospective analysis of 69 patients with 137 keloid lesions was performed.
  • Patients received punch excision with intraoperative intralesional bleomycin or triamcinolone, followed by 4 sessions of postoperative SXRT.
  • Outcomes including Vancouver Scar Scale (VSS) scores, recurrence rates, patient satisfaction, and adverse events were assessed at 12 months.

Main Results:

  • Both treatment groups showed significant VSS improvement (P < 0.05).
  • The bleomycin group demonstrated greater VSS reduction (68% vs 58.82%), higher response rates (82.5% vs 60.0%), and increased patient satisfaction.
  • The bleomycin group experienced fewer adverse events and lower recurrence rates (1.16% vs 3.92%) compared to the triamcinolone group.

Conclusions:

  • Bleomycin-Punch Excision-SXRT (B-P-X) therapy is an effective novel treatment for medium-to-large keloids.
  • This combined modality shows excellent clinical efficacy, low recurrence rates, and minimal adverse effects.
  • B-P-X therapy represents a promising advancement in keloid treatment.