KECORT Study: An International E-delphi Study On The Treatment Of Keloids Using Intralesional Corticosteroids In Clinical Practice
Qi Yin (MD), Albert Wolkerstorfer (MD, PhD),
BACKGROUND
Keloid management, specifically intralesional corticosteroid administration (ICA) as a first-line treatment, faces significant variability in global clinical practice. This hinders comparability of treatment results, underscoring the need for universal treatment guidelines to standardize ICA and enhance consistency for clinical practice.
OBJECTIVE
To reach consensus on the different aspects of ICA using hypodermic needles in keloids among an international group of dermatologists and plastic surgeons specialized in keloid treatment.
MATERIALS AND METHODS
The keloid expert panel of twelve dermatologists and eleven plastic surgeons rated 35 statements. Two e-Delphi rounds were held, both with a response rate of 100%. Fifteen (65%) keloid experts participated in the final consensus meetings. Consensus was defined as ≥75% of the participants choosing ‘agree’ or ‘strongly agree’ on a seven-point Likert scale.
RESULTS
Consensus was reached on 25 statements concerning treatment goals, indication for ICA, triamcinolone acetonide (TAC) 40 mg/mL as the preferred corticosteroid, at a maximum of 80 mg per month to avoid systemic adverse effects, and at suggested intervals of four weeks. Consensus was also reached on minimizing pain during
ICA, the general use of 1 mL syringes and 25 or 27 Gauge needles, blanching as endpoint of successful infiltration, caution of not injecting subcutaneously, and the option of creating multiple passes in very firm keloids prior to infiltration allowing better deposition of the corticosteroid within the needle tracts. Consensus could not
be reached on TAC dosing per specific area or volume of keloid, adequate methods of prior local anesthesia, and location of injection in the keloid.
CONCLUSION
This e-Delphi study provides important clinical recommendations on essential aspects of ICA in keloids. By implementing these recommendations, uniformity of ICA in keloid treatment will increase and treatment results will become more comparable. Additionally, better treatment results may be achieved.
METRICS
Qi Yin1 (MD), Albert Wolkerstorfer1 (MD, PhD), Oren Lapid2-4 (MD, PhD), Khatera Qayumi1 (MD), Murad Alam (MD, MSCI, MBA)5 , Firas Al-Niaimi6 (MD, PhD), Ofir Artzi7, 8 (MD, PhD), Martijn B.A. van Doorn9, 10 (MD, PhD), Ioannis Goutos11 (MD, PhD), Merete Haedersdal12 (MD, PhD), Chao-Kai Hsu13 (MD, PhD), Woraphong Manuskiatti14 (MD, PhD), Stan Monstrey15 (MD, PhD), Thomas A. Mustoe16 (MD, PhD), Rei Ogawa17 (MD, PhD), David Ozog18 (MD, PhD), Tae Hwan Park19 (MD, PhD), Julian Pötschke20 (MD, PhD), Anthony Rossi21 (MD, PhD), Swee T. Tan22, 23 (MD, PhD), Luc Téot24 (MD, PhD), Fiona M. Wood25 (MD, PhD), Nanze Yu26 (MD, PhD), Susan Gibbs27, 28 (PhD), Frank B. Niessen2 (MD, PhD), Dr. Paul P.M. van Zuijlen2-4, 29 (MD, PhD)
- Department of Dermatology, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
- Pediatric Surgical Centre, Emma Children’s Hospital. Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Movement Sciences (AMS) Institute, Amsterdam UMC, Amsterdam, The
Netherlands - Departments of Dermatology, Otolaryngology, Surgery, and Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL.
- Taktouk clinic, London, UK Aalborg University Hospital, Aalborg, Denmark.
- Division of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Dermatology, Erasmus Medical Center, Rotterdam, the Netherlands
- Centre for Human Drug Research, Leiden, the Netherlands
- The London Scar Clinic, 152 Harley Street, London W1G 7LH
- Department of Dermatology, Copenhagen University Hospital – Bispebjerg, Copenhagen, Denmark
- Department of Dermatology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
- Woraphong Manuskiatti: Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
- Department of Plastic Surgery, Ghent University Hospital, Gent, Belgium.
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois USA
- Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School, Tokyo, Japan
- Department of Dermatology Henry Ford Health, Detroit MI, USA Michigan State University School of Medicine Department of Medicine, East Lansing MI, USA
- Department of Plastic and Reconstructive Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Republic of Korea
- Department of Plastic and Handsurgery, Burn Center, Klinikum St. Georg gGmbH, Leipzig, Germany
- Memorial Sloan Kettering Cancer Center, 530 East 74th Street, Office 9104, New York, NY 10021
- Gillies McIndoe Research Institute, Wellington, New Zealand
- Wellington Regional Plastic, Maxillofacial and Burns Unit, Hutt Hosptal, Wellington, New Zealand
- Department of Plastic Surgery Wound Healing Burns, Hôpital La Colombière, Montpellier University Hospital, Montpellier, France
- Burns Service of Western Australia, Fiona Stanley Hospital, Perth Childrens Hospital, University of Western Australia.
- Department of Plastic and Aesthetic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College
- Department of Molecular Cell Biology and Immunology, Amsterdam institute for Infection and Immunity (AII), Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
- Department of Oral Cell Biology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit, Amsterdam, The Netherlands
- Burn Center and Department of Plastic, Reconstructive and Hand Surgery, Red Cross Hospital, Beverwijk, The Netherlands
Running Title
KECORT study: an international e-Delphi study on the treatment of KEloids using intralesional CORTicosteroids in clinical practice