Comparison of Combined Pulsed Dye Laser and Intralesional Triamcinolone versus Intralesional Triamcinolone alone in Treatment of Keloid

ackgroundKeloids are benign dermal fibroproliferative growths causing cosmetic disfigurement and physical disability. Various treatments exist, but no gold standard has been established.ObjectivesTo compare the effectiveness of pulsed dye laser combined with intralesional triamcinolone versus Intralesional triamcinolone alone in keloid treatment.Patients and MethodThis interventional, prospective study was conducted at Dermatology and Venereology center, Medical City Hospital, Baghdad, Iraq, from August 2021 to September 2022. Twenty-five patients participated. Ten patients had two keloid scars: one received pulsed dye laser with intralesional triamcinolone (Group A) and the other received only intralesional triamcinolone (Group B). The remaining fifteen patients had a single lesion divided into two halves: one half received pulsed dye laser with intralesional triamcinolone (Group A), and the other half received only intralesional triamcinolone (Group B).Laser parameters were (fluence 8 J/cm², spot size 7 mm, pulse duration 1.5 ms) or (fluence 5 J/cm², spot size 10 mm, pulse duration 0.45 ms). Triamcinolone acetonide concentration was 10-40 mg/ml. Each group received treatment at 0, 1, 2, and 3 months (four sessions). Follow-ups were conducted monthly for two months. Response was assessed using the Vancouver Scar Scale (VSS) and Patient Observer Scar Assessment Scale (POSAS).ResultsSignificant improvement in total VSS and POSAS scores was observed within each group between the first visit and the second follow-up visit (P=0.0001). There was a significant difference in mean total VSS at the second follow-up between Group A and Group B (P=0.005). The mean total observer score differed significantly between Group A and Group B at the second follow-up (P=0.031). However, there was no significant difference in the mean total patient score at the second follow-up between Group A and Group B (P=0.708).ConclusionIntralesional steroid is effective for keloid treatment, but its efficacy improves when combined with pulsed dye laser.