Intralesional corticosteroid administration in the treatment of keloids: a survey among Dutch dermatologists and plastic surgeons

Figures & data

Figure 1. Small (15 × 10 mm) keloid on the left mandibula.

Figure 2. Multiple keloids on the chest.

Table 1. Demographic variables.

	Frequency (N), %
Medical specialty of training (N = 136)
Dermatology	73 (53.7)
Plastic surgery	46 (33.8)
Resident dermatology	13 (9.6)
Resident plastic surgery	4 (2.9)
Years of experience as medical specialist (N = 119)
0–5 years	42 (35.3)
6–10 years	19 (16.0)
11–20 years	32 (26.9)
>20 years	26 (21.8)
Practice setting (N = 136)
Academic hospital	24 (17.6)
Community hospital	56 (41.2)
Private practice	19 (14.0)
Combination^a	37 (27.2)
Keloid treatments per month (N = 128)
<3	77 (60.2)
3–10	44 (34.4)
10–20	6 (4.7)
>20	1 (0.8)

^a Combined practice in an academic hospital, community hospital and/or private practice. Details are presented in Supplementary material 3, Table 1.

Table 2. Type of corticosteroid and local anesthetics, dosing, treatment sessions, treatment interval.

	Frequency (N), %
Type of corticosteroid for needle injection (N = 136)
Triamcinolone	130 (95.6)
Betamethasone	2 (1.5)
I do not treat keloids with intralesional corticosteroid needle injection	1 (0.7)
Other^b	3 (2.9)
Local anesthesia (N = 128)
Local anesthesia is mixed and injected simultaneously with the corticosteroid	44 (34.4)
Local anesthesia is injected before treatment with the corticosteroid	3 (2.3)
Anesthetic cream is used before treatment with the corticosteroid	3 (2.3)
No	70 (54.7)
Combination^b	8 (6.3)
	Small keloid	Multiple keloids
Volume^a (N = 128)
Median value	0.5 mL (IQR 0.7)	3 mL (IQR 2.3)
Other^b	18 (14.1)	17 (13.3)
I would not treat this keloid with corticosteroid injection	0 (0)	8 (6.3)
Concentration^a (N = 128)
5 mg/mL	1 (0.8)	1 (0.8)
10 mg/mL	46 (35.9)	22 (17.2)
20 mg/mL	29 (22.7)	22 (17.2)
30 mg/mL	0 (0)	1 (0.8)
40 mg/mL	43 (33.6)	64 (50)
I would not treat this keloid with corticosteroid injection	0 (0)	8 (6.3)
Other^b	9 (7.0)	10 (7.8)
Treatment sessions (N = 128)
1–3	105 (82.0)	10 (7.8)
4–6	18 (14.1)	70 (54.7)
7–10	1 (0.8)	29 (22.7)
>10	0 (0)	9 (7.0)
I would not treat this keloid with corticosteroid injection	0 (0)	8 (6.3)
Other^b	4 (3.1)	2 (1.6)
Treatment interval (N = 128)
1 week	2 (1.6)
2 weeks	0 (0)
3 weeks	1 (0.8)
4 weeks	30 (23.4)
5 weeks	2 (1.6)
6 weeks	62 (48.4)
8 weeks	23 (18.0)
More than 8 weeks	5 (3.9)
Other^b	3 (2.3)

^a Dosing of the corticosteroid is calculated by multiplying the volume with the concentration that participants would use per case. For both the small keloid and multiple keloids, 20 responses were excluded for this calculation, as a result of missing or erroneous values of the volume and/or concentration.

^b Individual answers are specified in Supplementary material 3, Tables 2 and 3.

Table 3. Syringe size, needle size, and manual injection technique.

	Frequency (N), %
Syringe size (N = 128)
I always use the same syringe	68 (53.1)
0.5 mL	4 (5.9)
1 mL	28 (41.2)
2 mL	24 (35.3)
3 mL	5 (7.4)
5 mL	6 (8.8)
Other (0.45 mL)	1 (1.5)
The size of syringe depends on the keloid	44 (34.4)
I have no preference for a specific syringe	14 (10.9)
Other^a	2 (1.6)
Needle size (N = 128)
21 Gauge (Deep Green, 0.80 mm)	3 (2.3)
23 Gauge (Deep Blue, 0.60 mm)	3 (2.3)
24 Gauge (Med Purple, 0.55 mm)	1 (0.8)
25 Gauge (Orange, 0.50 mm)	54 (42.2)
26 Gauge (Brown, 0.45 mm)	1 (0.8)
27 Gauge (Medium Grey, 0.40 mm)	12 (9.4)
28 Gauge (Blue-green, 0.36 mm)	3 (2.3)
29 Gauge (Red, 0.33 mm)	1 (0.8)
30 Gauge (Yellow, 0.30 mm)	17 (13.3)
The size of needle depends on the keloid	16 (12.5)
I have no preference for a specific needle	7 (5.5)
Other^a	10 (7.8)
Factor(s) considered important for corticosteroid injection (N = 128)
Injection into one keloid at several sites, from several directions	67 (52.3)
Angle of the needle during injection	19 (14.8)
Almost parallel to skin	18 (94.7)
Approximately 45° angle against the skin surface	0 (0)
Approximately 60° angle against the skin surface	1 (5.3)
Speed of injection	26 (20.3)
Distribution	77 (60.2)
Observation of blanching directly after injection	104 (81.3)
Massage after injection	16 (12.5)
None of above	2 (1.6)
Other^a	5 (3.9)
Level of injection (N = 128)
Subepidermal	23 (18.0)
In the center of the keloid	60 (46.9)
Below the center of the keloid	8 (6.3)
Subepidermal + in the center of the keloid	16 (12.5)
In the center of the keloid + below the center of the keloid	8 (6.3)
Subepidermal + below the center of the keloid	4 (3.1)
I do not pay particular attention to the level of injection	4 (3.1)
Other^a	5 (3.9)
Factor(s) for preventing subcutaneous tissue loss (N = 128)
Level of injection	102 (79.7)
Dose adjustment (volume and/or concentration) of injection	88 (68.8)
Total number of treatment sessions	71 (55.5)
Distribution of medication	33 (25.8)
Type of medication	16 (12.5)
Needle size	8 (6.3)
Syringe size	2 (1.6)
I do not pay particular attention to preventing complications of subcutaneous tissue loss	2 (1.6)
Other^a	4 (3.1)

^a Individual answers are specified in Supplementary material 3, Tables 4 and 5.