Intra-lesional Steroids
Injecting steroids directly inside the keloid tissue, known as an intra-lesional injection, is a commonly used method of treating small keloids. This treatment however is only partially effective. Triamcinolone acetonide is the most commonly steroid that is used for this purpose.
Steroid injections are not as effective as we would like them to be and can also be harmful in some situations.
Dr. Tirgan has researched and published on the efficacy of this method of treatment. The treatment was found to be effective only in one third of cases, but most importantly was found to lead to worsening of keloids in 17.3% of patients. Click here to download this publication.
He has also published a comprehensive reviews and treatment guidelines for usage of steroids that you can download.
Like all other human illnesses, when it gets to steroid usage in keloid disorder, there are keloid lesions that are Steroid Sensitive, and there are also lesions that Steroid Resistant.
In treating Steroid Sensitive Keloids, the lowest doses of steroids will induce a response, with no need to use high concentration of the steroid. On the other hand, in Steroid Resistant Keloids, even the highest doses of steroids will NOT induce a response, however, it will for sure contribute to adverse effects. There is a linear relationship between the dose of steroids and the resultant side effects.
Repeated steroid injections, especially with high doses will often cause skin atrophy (loss of normal skin tissue) and discoloration and loss of normal skin pigments. The image below is an example of skin atrophy in the chest area from repeated steroid injections. Please note that this linear keloid has not responded to the treatment and is therefore steroid resistant.
Skin Atrophy from Steroid injection
Another issue with the usage of intra-lesional steroids is the size, length and thickness of the needle used to inject the keloid lesions. Some physicians falsely believe that a large and thick needle should be used to inject large keloid lesions. This belief comes from the fact that injecting into an old and dense keloid lesion is a rather difficult task.
In injecting keloids, the smaller and thinner the needle is, the less damage it causes to the keloid tissue. Dr. Tirgan only uses the smallest and thinnest needles, those that are used to inject insulin under the skin. With this method, Dr. Tirgan is able to inject any keloid.
The very dense and thick keloids are hard to inject, will never respond to steroid injections, and should not even be treated in this manner. Very large and dense keloid lesions are best treated with cryotherapy, will result in the reduction of the mass of these keloids.
Last but not the least is the expertise of the physician who injects keloid lesions. An unfortunate fact these days is that the task of injecting keloid lesions, in busy dermatology practices, is often delegated to non-physicians. As such, a non-physician is put in charge of deciding:
- the dose and
- the volume of steroid that is used, and
- the size of the needle and
- choosing where and what to inject.
This approach of treating keloid lesions is obviously less than satisfactory. Below is a video that demonstrates how Dr. Tirgan injects steroids.