Needle-free electronically-controlled jet injector treatment with bleomycin and lidocaine is effective and well-tolerated in patients with recalcitrant keloids
Vazula Zulfra Bekkers MD, Fatima Khan BSc, Pim Aarts MD, Katarzyna Zdunczyk MSc, Errol Prospero Prens MD, PhD, Albert Wolkerstorfer MD, PhD, Robert Rissmann PhD, Martijn Bastiaan Adriaan van Doorn MD, PhD
{"title":"Needle-free electronically-controlled jet injector treatment with bleomycin and lidocaine is effective and well-tolerated in patients with recalcitrant keloids","authors":"Vazula Zulfra Bekkers MD, Fatima Khan BSc, Pim Aarts MD, Katarzyna Zdunczyk MSc, Errol Prospero Prens MD, PhD, Albert Wolkerstorfer MD, PhD, Robert Rissmann PhD, Martijn Bastiaan Adriaan van Doorn MD, PhD","doi":"10.1002/lsm.23737","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Objectives</h3>\n \n <p>The treatment of recalcitrant keloids is challenging. Although intralesional bleomycin using conventional needle injectors (CNI) is effective, it has important drawbacks, such as the need for repetitive and painful injections. Therefore, we aimed to evaluate the effectiveness, tolerability and patient satisfaction of intralesional bleomycin with lidocaine administered with a needle-free electronically-controlled pneumatic jet-injector (EPI) in recalcitrant keloids.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>This retrospective study included patients with recalcitrant keloids who had received three intralesional EPI-assisted treatments with bleomycin and lidocaine. Effectiveness was assessed using the Patient and Observer Scar Assessment Scale (POSAS) at baseline and four to six weeks after the third treatment. Additionally, treatment related pain scores numeric rating scale, adverse effects, patient satisfaction and Global Aesthetic Improvement Scale (GAIS) were assessed.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Fifteen patients with a total of >148 recalcitrant keloids were included. The median total POSAS physician- and patient-scores were respectively 40 and 41 at baseline, and reduced with respectively 7 and 6-points at follow-up ( <i>p</i> < 0.001; <i>p</i> < 0.001). The median pain scores during EPI-assisted injections were significantly lower compared to CNI-assistant injections, (2.5 vs. 7.0, respectively ( <i>p</i> < 0.001)). Adverse effects were mild. Overall, patients were “satisfied” or “very satisfied” with the treatments (14/15, 93.3%). The GAIS was “very improved” in one patient, “improved” in nine patients and “unaltered” in four patients.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>EPI-assisted treatment with bleomycin and lidocaine is an effective, well tolerated, patient-friendly alternative for CNI in patients with recalcitrant keloid scars. Randomized controlled trials are warranted to confirm our findings and improve the clinical management of recalcitrant keloids.</p>\n </section>\n </div>","PeriodicalId":17961,"journal":{"name":"Lasers in Surgery and Medicine","volume":null,"pages":null},"PeriodicalIF":2.2000,"publicationDate":"2023-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lsm.23737","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Lasers in Surgery and Medicine","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/lsm.23737","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"DERMATOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Objectives
The treatment of recalcitrant keloids is challenging. Although intralesional bleomycin using conventional needle injectors (CNI) is effective, it has important drawbacks, such as the need for repetitive and painful injections. Therefore, we aimed to evaluate the effectiveness, tolerability and patient satisfaction of intralesional bleomycin with lidocaine administered with a needle-free electronically-controlled pneumatic jet-injector (EPI) in recalcitrant keloids.
Methods
This retrospective study included patients with recalcitrant keloids who had received three intralesional EPI-assisted treatments with bleomycin and lidocaine. Effectiveness was assessed using the Patient and Observer Scar Assessment Scale (POSAS) at baseline and four to six weeks after the third treatment. Additionally, treatment related pain scores numeric rating scale, adverse effects, patient satisfaction and Global Aesthetic Improvement Scale (GAIS) were assessed.
Results
Fifteen patients with a total of >148 recalcitrant keloids were included. The median total POSAS physician- and patient-scores were respectively 40 and 41 at baseline, and reduced with respectively 7 and 6-points at follow-up ( p < 0.001; p < 0.001). The median pain scores during EPI-assisted injections were significantly lower compared to CNI-assistant injections, (2.5 vs. 7.0, respectively ( p < 0.001)). Adverse effects were mild. Overall, patients were “satisfied” or “very satisfied” with the treatments (14/15, 93.3%). The GAIS was “very improved” in one patient, “improved” in nine patients and “unaltered” in four patients.
Conclusions
EPI-assisted treatment with bleomycin and lidocaine is an effective, well tolerated, patient-friendly alternative for CNI in patients with recalcitrant keloid scars. Randomized controlled trials are warranted to confirm our findings and improve the clinical management of recalcitrant keloids.
目的:顽固性瘢痕疙瘩的治疗具有挑战性。尽管使用传统针头注射器(CNI)的病灶内博来霉素是有效的,但它也有重要的缺点,例如需要重复和痛苦的注射。因此,我们旨在评估病变内博来霉素与利多卡因在无针电控气动喷射注射器(EPI)治疗顽固性瘢痕疙瘩中的有效性、耐受性和患者满意度。方法:本回顾性研究纳入了接受过博莱霉素和利多卡因三次病灶内EPI辅助治疗的顽固性瘢痕疙瘩患者。在基线和第三次治疗后4-6周,使用患者和观察者疤痕评估量表(POSAS)评估疗效。此外,还评估了与治疗相关的疼痛评分数字评定量表、不良反应、患者满意度和整体美学改善量表(GAIS)。结果:纳入了15名患者,总计>148个顽固性瘢痕疙瘩。POSAS医师和患者的中位总分在基线时分别为40分和41分,在随访时分别降低了7分和6分( p 结论:EPI辅助博来霉素和利多卡因治疗顽固性瘢痕疙瘩是一种有效、耐受性好、患者友好的CNI替代方案。随机对照试验有助于证实我们的发现,并改善顽固性瘢痕疙瘩的临床管理。
期刊介绍:
Lasers in Surgery and Medicine publishes the highest quality research and clinical manuscripts in areas relating to the use of lasers in medicine and biology. The journal publishes basic and clinical studies on the therapeutic and diagnostic use of lasers in all the surgical and medical specialties. Contributions regarding clinical trials, new therapeutic techniques or instrumentation, laser biophysics and bioengineering, photobiology and photochemistry, outcomes research, cost-effectiveness, and other aspects of biomedicine are welcome. Using a process of rigorous yet rapid review of submitted manuscripts, findings of high scientific and medical interest are published with a minimum delay.