Efficacy of Intralesional Bevacizumab Versus Intralesional Triamcinolone Acetonide Injection in the Treatment of Keloids: A Randomized Clinical Trial

BACKGROUND: Keloids are an abnormal fibroproliferative disorder that often causes pruritus, pain, and hyperpigmentation, thereby significantly impacting quality of life. Vascular endothelial growth factor (VEGF) is upregulated in scars and, therefore, can be a potential target for their treatment. OBJECTIVES: Our aim was to evaluate the efficacy and safety of intralesional triamcinolone acetonide (TAC) versus intralesional bevacizumab injection in the treatment of post-traumatic keloids. METHODS: This randomized clinical trial was conducted on 28 adult patients with post-traumatic keloids. Patients were randomized into two groups; one group received intralesional triamcinolone acetonide, and the other received intralesional bevacizumab. Injections were done monthly. Patients received a total of three sessions. Therapeutic efficacy was defined in terms of the modified Vancouver Scar Scale (mVSS), erythema index by spectrophotometry, histopathological evaluation, and biochemical assessment of VEGF, collagen type I, and collagen type III levels. RESULTS: A statistically significant difference in mVSS was observed between the triamcinolone acetonide and bevacizumab groups, favoring the TAC group. The TAC group showed a significant decrease in VEGF level and an increase in collagen type III after treatment. The bevacizumab group showed significant improvement in the spacing between collagen fibers after treatment. The patient satisfaction score and the physician global assessment revealed superior outcomes regarding intralesional triamcinolone acetonide. CONCLUSION: Despite the superior results observed with triamcinolone, bevacizumab warrants further investigation to determine whether it can be used for early and vascular keloids or as an adjuvant to optimize results. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT07014280.