Emerging treatments
Botulinum toxin
The rationale for botulinum toxin administration for keloid scarring rests on the alleviation of tension on the skin via chemo-immobilisation of the underlying musculature, as well as direct effect on fibroblast gene expression and cell cycle modulation.[84] Evidence suggests botulinum toxin is equivalent to triamcinolone in producing short-term improvements in scar volume, height, and vascularity; a number of studies have also found that injection of botulinum toxin alone or in combination with corticosteroids may be particularly helpful in alleviating symptoms of pain and itch.[84]
Platelet rich plasma (PRP)
Autologous platelet concentrates are increasingly popular adjuncts to a variety of aesthetic and reconstructive interventions. The principle rests on delivering a high concentration of growth factors found in platelets to target tissues with a view to optimising wound healing/remodelling outcomes.[85] Preliminary studies have achieved encouraging results, but there are few high-quality studies to support the use of PRP for treatment of keloids.[86][87][88] One randomised trial of 40 patients reported significant improvements in keloid height, pigmentation, pliability, and overall Vancouver scar scale score in patients who received intralesional triamcinolone plus one injection of PRP, compared with those who received triamcinolone alone.[89]
Percutaneous collagen induction (PCI)
PCI or needling techniques rely on creating minute non-confluent perforations to the skin via the application of a manual or energy-coupled device. This causes a wound healing response with the preferential stimulation of transforming growth factor beta-3, which is critical for the remodelling of collagen in scars.[90][91] One comparative study employed needling as an adjunct for the management of keloid scarring with beneficial results.[92] Further research with long-term follow-up is needed.[93]
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