A prospective study of pattern of keloid and number of intralesional triamcinolone acetonide injections in a community based dermatology clinic in Lagos, Nigeria
Keywords:Keloid, Triamcinolone acetonide, Number of times, Pattern, Dermatology, Nigeria
Background: Keloid a benign tumor of the skin is said to be common in Africans, Hispanics and Asians. Triamcinolone acetonide is a known treatment for keloid and patients come to the clinic asking how many times they need to come in for treatment. The number of times patients need to be injected is not clearly documented. The aim of this study was to document the socio-demographic factors, symptoms, clinical characteristics and determine how many times patients need to be injected with triamcinolone acetonide.
Methods: This was a prospective descriptive study over a one year period in the outpatient Dermatology clinic of the General Hospital Lagos. Eighty six (86) patients were studied. Patients were clinically evaluated for keloid, a structured questionnaire for socio-demographic variables was administered to the patients. Patients were treated mainly with intralesional triamcinolone (40 mg/ml) every six weeks. Data was analyzed using the Epi-info 7.
Results: There were 47 men and 39 women. The mean age of the patients was 33.18±13.37 years. Keloid was found to occur mainly in people aged 20-29 years (45.88%). The commonest anatomical location was the head and neck (45.88%) with multiple keloids in 44.70%. Patients were injected on the average 4 times irrespective of the length of keloid.
Conclusions: Keloids are common, occur mostly in the third decade of life and require 3-5 injections of triamcinolone acetonide.
Chike-Obi C, Cole PD, Brissett AE. Keloids: Pathogenesis, Clinical Features, and Management. Seminars in Plastic Surg. 2009;23:178-84.
Hunasgi S, Koneru A, Vanishree M, Shamala R. Keloid: A Case Report and Review of Pathophysiology and Differences Between Keloid and Hypertrophic scars. J Oral Maxillofac Pathol. 2013;17:116-20.
Juckett G, Hartman-adams H. Management of Keloids and Hypertrophic Scars. Am Fam Physician. 2009;80:253-60.
Henshaw EB, Olasode OA. Skin Diseases in Nigeria: the Calabar Experience. Int J Dermatol. 2015;54:319-26.
Dlova NC, Mankahla A, Madala N, Grobler A, Tsoka-Gwegweni J, Hift RJ. The Spectrum of Skin Diseases in a Black Population in Durban, KwaZulu-Natal, South Africa Int. J. Dermatol. 2015;54:279-85.
Akinboro AO, Mejiuni AD, Akinlade MO, Audu BM, Ayodele OE. Spectrum of Skin Diseases Presented at LAUTECH Teaching Hospital, Osogbo, Southwest Nigeria. Int J Dermatol. 2015;54:443-50.
Brown JJ, Bayat A. Genetic Susceptibility to Raised Dermal Scarring. Br J Dermatol. 2009;161:8-18.
Fijałkowska M, Kasielska A, Antoszewski B, Variety of Complications after Auricle Piercing. Int J Dermatol. 2014;53:952-5.
Ogawa R, Okai K, Tokumura F, Mori K, Ohmori Y, Huang C, et al. The Relationship between Skin Stretching/contraction and Pathologic Scarring:The Important Role of Mechanical Forces in Keloid Generation. Int J Tissue Repair Regen. 2012;20:149-57.
Bock O, Schmid-Ott G, Malewski P, Mrowietz U. Quality of life of Patients with Keloid and Hypertrophic Scarring. Arch Dermatol Res. 2006;297:433-8.
Bijlard E, Kouwenberg CAE, Timman R, Hovius SER, Busschbach JJV, Mureau MAM. Burden of Keloid Disease: A Cross-sectional Health-related Quality of Life Assessment. Acta Derm Venereol. 2017;97:225-9.
Lee HJ, Jang YJ. Recent Understandings of Biology, Prophylaxis and Treatment Strategies for Hypertrophic Scars and Keloids. Int J Mol Sci. 2018;19(3):E711.
Bijlard E, Steltenpool S, Niessen FB. Intralesional 5-Fluorouracil in Keloid Treatment: A Systematic Review. Acta Derm Venereol. 2015;95:778-82.
O’Boyle CP, Shayan-Arani H, Hamada MW. Intralesional Cryotherapy for Hypertrophic Scars and keloids: a Review. Scars Burns Healing. 2017;3:1-9.
Zhang Z, Cheng L, Wang R, Cen Y, Li. Z. Effects and Safety of Triamcinolone Acetonide-Controlled Common Therapy in Keloid Treatment: a Bayesian Network Meta-analysis. Therap Clin Risk Management. 2018;14:973-80.
Kombate K, Pitche P, Tchangaï-Walla K. Keloids in Dermatology Outpatients in Lome, Togo. Int J Dermatol. 2005;44(s1):51-2.
Reinholz M, Poetschke J, Schwaiger H, Epple A, Ruzicka T, Gauglitz GG. The Dermatology Life Quality Index as a Means to Assess Life Quality in Patients with Different Scar Types. J Eur Acad Dermatol Venereol. 2015;29:2112-9.
Olaitan PB. Keloids: Assessment of Effects and Psychosocial- impacts on Subjects in a Black African population. Indian J Dermatol Venereol Leprol. 2009;75:368-72.
Furtado F, Hochman B, Ferrara SF, Dini GM, Camelo-Nunes J, Juliano Y, et al. What Factors Affect the Quality of Life of Patients with Keloids? Rev Assoc Med Bras. 2009;55:700-4.
Ud-Din S, Bayat A. Strategic Management of Keloid Disease in Ethnic Skin:a Structured Approach Supported by the Emerging literature. Brit J Dermatol. 2013;169(s3):71-81.
Boutli-Kasapidou F, Tsakiri A, Anagnostou E, Mourellou O. Hypertrophic and Keloidal Scars:an Approach to Polytherapy. Int. J. Dermatol. 2005;44:324-7.
Bijlard E, Timman R, Verduijn GM, Niessen FB, van Neck JW, Busschbach JJV, et al. Intralesional Cryotherapy Versus Excision and Corticosteroids or Brachytherapy for keloid Treatment: Study Protocol for a Randomised Controlled trial. Trials. 2013;14:439.
Srivastava S, Patil A, Prakash C, Kumari H. Comparison of Intralesional Triamcinolone Acetonide, 5-Fluorouracil, and their Combination in Treatment of Keloids. World J Plast Surg. 2018;7:212-9.
Coppola MM, Salzillo R, Segreto F, Persichetti P. Triamcinolone Acetonide Intralesional Injection for the Treatment of Keloid Scars: Patient Selection and Perspectives. Clin Cosm Invest Dermatol. 2018;11:387-96.