Efficacy and safety of glucocorticoid-based therapies in the management of keloids: a systematic review and meta-analysis of clinical outcomes
Abstract
Background: Hypertrophic scars and keloids are fibroproliferative conditions that are resistant to treatment and recur often. The effectiveness and safety of glucocorticoid-based treatments and their combinations in the treatment of keloid disease were objectively assessed in this systematic review and meta-analysis.
Methods: 42 randomized and comparative clinical studies were considered. Intralesional, topical, or aided glucocorticoid delivery were eligible treatments.
Results: The use of corticosteroids alone in intervention methods (SMD = 1.28; 95% CI: 1.05-1.51; p 2 = 43%). The use of 5-FU-based treatments yielded the same results (SMD = 1.15; 95% CI: 0.97-1.34; p p p 2 = 47%). Techniques with and without delivery, such as steroids + 5-FU, laser-assisted delivery, microneedling, or cryotherapy-assisted corticosteroid delivery, provided consistently better results. The GRADE evaluation indicated that the certainty of evidence was poor for microneedle and cryotherapy-aided techniques, medium for recurrence rate, cosmetic results, and negative consequences, and excellent for scar volume decrease, pain, and pruritus relief. The adverse outcomes, primarily telangiectasia and moderate atrophy, were temporary and self-resolving.
Conclusion: The best and safest treatment for keloid management is intralesional TAC, based upon the data at hand. The mainstay of clinically proven scar therapy is still multimodal, glucocorticoid-centered regimens that show consistent therapeutic…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid.
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