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Corticosteroid Injection Alone or Combined with Surgical Excision of Keloids versus Other Therapies Including Ionising Radiotherapy: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

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Department of Burn and Plastic Surgery, West China Hospital of Sichuan University, Chengdu 610041, China
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Department of Dermatology and Copenhagen Wound Healing Center, Bispebjerg Hospital, University of Copenhagen, 2400 Copenhagen, Denmark
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Burn Injury Research Unit, The University of Western Australia, Perth 6009, Australia
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Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, 2400 Copenhagen, Denmark
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Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
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Plastic Surgery, Royal Perth Hospital, Perth 6009, Australia
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Department of Nephrology, West China Hospital of Sichuan University, Chengdu 610041, China
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Paediatric Department, The People’s Hospital of Sichuan Province, Chengdu 610041, China
*
Author to whom correspondence should be addressed.
Academic Editors: Naiem Moiemen and Peter M. Vogt
Eur. Burn J. 2021, 2(2), 41-54; https://doi.org/10.3390/ebj2020004
Received: 13 March 2021 / Revised: 29 April 2021 / Accepted: 7 May 2021 / Published: 14 May 2021
Keloid scars are difficult to manage and remain a therapeutic challenge. Corticosteroid therapy alone or ionising radiation (radiotherapy) alone or combined with surgery are first-line treatments, but the scientific justification for these treatments is unclear. The aim of this systematic review and meta-analysis of randomised controlled trials (RCTs) is to assess the effects of intralesional corticosteroid injection in treating keloids or preventing their recurrence after surgical removal. Searches for RCTs were conducted through the MEDLINE, EMBASE, EBSCO and Cochrane databases from January 1974 to September 2017. Two authors independently reviewed study eligibility, extracted data, analysed the results, and assessed methodological quality. Sixteen RCTs that included more than 814 patients were scrutinised. The quality of evidence for most outcomes was moderate to high. In 10 RCTs, corticosteroid intralesional injections were compared with 5-fluorouracil, etanercept, cryosurgery, botulinum toxin, topical corticosteroid under a silicone dressing, and radiotherapy. Corticosteroid intralesional injections were more effective than radiotherapy (RR 3.3, 95% CI: 1.4–8.1) but equipotent with the other interventions. In conjunction with keloid excision, corticosteroid treatment was compared with radiotherapy, interferon α-2b and verapamil. In two RCTs, there were fewer keloid recurrences (RR 0.43, 95% CI: 0.21–0.89) demonstrated with adjuvant radiotherapy than with corticosteroid injections. More high-quality, large-scale RCTs are required to establish the effectiveness of corticosteroids and other therapies in keloid management. View Full-Text
Keywords: fibrosing disorders; wound healing; surgery fibrosing disorders; wound healing; surgery
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MDPI and ACS Style

Wang, R.; Danielsen, P.L.; Ågren, M.S.; Duke, J.; Wood, F.; Zeng, X.-X.; Mao, Y.; Cen, Y. Corticosteroid Injection Alone or Combined with Surgical Excision of Keloids versus Other Therapies Including Ionising Radiotherapy: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. Eur. Burn J. 2021, 2, 41-54. https://0-doi-org.brum.beds.ac.uk/10.3390/ebj2020004

AMA Style

Wang R, Danielsen PL, Ågren MS, Duke J, Wood F, Zeng X-X, Mao Y, Cen Y. Corticosteroid Injection Alone or Combined with Surgical Excision of Keloids versus Other Therapies Including Ionising Radiotherapy: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. European Burn Journal. 2021; 2(2):41-54. https://0-doi-org.brum.beds.ac.uk/10.3390/ebj2020004

Chicago/Turabian Style

Wang, Ru, Patricia L. Danielsen, Magnus S. Ågren, Janine Duke, Fiona Wood, Xiao-Xi Zeng, Yu Mao, and Ying Cen. 2021. "Corticosteroid Injection Alone or Combined with Surgical Excision of Keloids versus Other Therapies Including Ionising Radiotherapy: A Systematic Review and Meta-Analysis of Randomised Controlled Trials" European Burn Journal 2, no. 2: 41-54. https://0-doi-org.brum.beds.ac.uk/10.3390/ebj2020004

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