Post caesarean section keloids: effectiveness of surgical excision and intralesional triamcinolone acetonide injections for prevention of subsequent recurrence.
Abstract
Background: Intralesional triamcinolone acetonide (ITA) injection has been used for the treatment of keloids for many decades, but its efficacy in the treatment of caesarean section keloids has not been assessed. This pilot study investigated the efficacy of surgical excision and ITA in the treatment of keloids after caesarean section.
Methods: In this pilot study, 28 patients met the criteria for having a keloid at the site of their previous caesarean section. The keloid lesion was excised at the time of a subsequent caesarean section in the operating theatre. Following excision, 1 mL of triamcinolone acetonide (40 mg/mL) was injected into the upper and lower edges of the wound before its closure. After the intervention, follow-up data were recorded in the patients’ notes and medical notes, which were used for this retrospective study. We used the Kyoto scar scale questionnaire to assess the outcomes based on the information available from all patients from 2006 to 2014.
Results: Before the treatment, 89% of the patients had poor grades and 11% had fair grades on the Kyoto scar scale, including assessment of symptoms and signs. After receiving the ITA injection, 36% had excellent grades and 21% had good grades, with significant remission in their keloid lesions after one-year follow-up (p < 0.001). The remaining 43% had fair-poor grades. There was a significant reduction in redness, hardness, elevation, pruritus, pain, and swelling after receiving the treatment (p < 0.001). No side effects were reported, and most patients (86%) reported a high level of satisfaction with the treatment: 86% reported that the treatment was worthwhile and 93% said they would recommend the treatment.
Conclusion: Surgical excision followed by ITA is an effective and satisfactory treatment for caesarean section keloids.