Intralesional Injection Of Keloids And Hypertrophic Scars - Robbins ...

scars is well documented. I have added the Wydase to
the steroid solution because it appears to cause greater
diffusion of the solution. I also believe that it lessens
the stinging pain which often results after injection of
the steroid. Cornbleet 5 stated that infiltration of the scar
with Hyaluronidase produces softening even of old,
hard keloids and some diminishing in size.
Method of Treatment
The technique is simple and is performed as an
office procedure. Several patients are usually done
simultaneously to prevent wastage of the solution. Only
the plastic cuff on the end of the instrument needs
sterilization between patients. No type of anesthesia is
required. The scar to be injected is sponged off with a
mild antiseptic solution. With each injection by the
Dermo-Jet, a pale white wheal measuring
approximately 1 to 1.5 cm. in diameter is attained. The
injections are spaced so that the wheals from each
injection more or less touch each other and fuse. The
entire scar is injected at one sitting. In the smaller scars
only 1 or 2 injections may be needed. As many as 25 to
30 injections have been done for some of the larger
scars. The instrument is placed vertically over the scar
so that the removable and easily sterilized plastic cuff
on the end touches the scar (fig. 2). Rarely, when there
is a small area to inject, the plastic cuff may obscure the
lesion. Then it is wise to remove it and keep the nozzle
of the instrument approximately ½ cm. above the scar.
After the first treatment is completed, the
patient is advised to return again in 2 weeks, at which
time a second injection is done if necessary. After the
second injection series, the patient is advised to come
back in a month. Many patients do not require more
than 2 series of injections. However, the larger keloids
may require several doses. One had a total of 10 series
of injections spaced about 1 month apart.
For the initial injection it is best to acquaint the
patients with the machine and allow them to hear the
“snap” of the machine before giving the injection.
Many of the younger patients are frightened by the appearance
of the machine and the snapping sound. This
sometimes makes them hypersensitive to the small
amount of pain caused by the injection. By and large,
these patients are much more cooperative for
subsequent injections.
Table I
Location No. of Patients
Left shoulder 6
Arms 6
Anterior chest wall 4
Face 3
Abdomen 3
Thigh 1
Foot 1
Hand 1
Mastoid 1
Neck 1
Back 1
Total 28
Clinical Material
Since November 1965, 28 Caucasian patients
with keloid or hypertrophic scars have received a
combined total of 64 injection series of this mixture of
triamcinolone acetonide and Wydase.
The ages of 22 patients ranged between 6 and
29 years, and the other 6 patients were between 33 and
70 years of age. The average age was 22 years. Seven
were men and 21 were women.
Of the 22 patients in the younger age group, 14
had scars which were considered to be true keloids. All
the scars treated in the older age group were
hypertrophic scars. The locations of the scars are shown
in table 1.
The causes of the scars varied. Of the 14
keloids, 6 were the result of vaccinations, 3 resulted
after surgical excision of benign lesions, I from a burn,
2 from infection due to acne and 2 from injury. Of the
14 hypertrophic scars, 8 resulted from operative incisions,
3 from injuries, 2 from burns and 1 from
dermabrasion on the face. At the time of the initial
treatment of these patients, the lesions had been present
from 2 months to 10 years with an average of 3 years.
A total of 64 series of injections ranging from
1 to 10 were given to the 28 patients. Nine are still
under treatment. A total of 49 series were given to the
completed 19 cases, making an average of 2.6. Of the
28 patients treated, 14 had no symptoms referable to the
scars, and they were primarily interested in improving
the appearance of the scars. In the remaining 14, the
most common symptoms were chronic itching and pain.
Of these 14, 10 were interested in relief of symptoms
and improvement of the appearance of the scars. The
remaining 4 were interested only in relief of symptoms