1
|
Yin Q, Wolkerstorfer A, Lapid O, Qayumi K, Alam M, Al-Niaimi F, Artzi O, van Doorn MBA, Goutos I, Haedersdal M, Hsu CK, Manuskiatti W, Monstrey S, Mustoe TA, Ogawa R, Ozog D, Park TH, Pötschke J, Rossi A, Tan ST, Téot L, Wood FM, Yu N, Gibbs S, Niessen FB, van Zuijlen PPM. KECORT Study: An International e-Delphi Study on the Treatment of KEloids Using Intralesional CORTicosteroids in Clinical Practice. Am J Clin Dermatol 2024:10.1007/s40257-024-00888-7. [PMID: 39298112 DOI: 10.1007/s40257-024-00888-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2024] [Indexed: 09/21/2024]
Abstract
BACKGROUND Intralesional corticosteroid administration (ICA) is a first-line keloid treatment. However, it faces significant variability in current clinical and scientific practice, which hinders comparability of treatment results. OBJECTIVES The aim of the study was to reach consensus on different aspects of ICA using hypodermic needles in keloids among an international group of dermatologists and plastic surgeons specialized in keloid treatment to provide consensus-based clinical treatment recommendations for all physicians treating keloids. METHODS The keloid expert panel of 12 dermatologists and 11 plastic surgeons rated 30 statements. Two online e-Delphi rounds were held, both with a response rate of 100%. Fifteen (65%) keloid experts participated in the final consensus meetings. Consensus was defined as ≥ 75% of the participants choosing agree or strongly agree on a 7-point Likert scale. RESULTS Consensus was reached on treatment goals, indication for ICA, triamcinolone acetonide (TAC) 40 mg/mL as the preferred corticosteroid administered at a maximum of 80 mg per month and at intervals of 4 weeks, minimizing pain during ICA, the use of 1 mL syringes and 25 or 27 Gauge needles, blanching as endpoint of successful infiltration, caution of not injecting subcutaneously, and the option of making multiple passes in very firm keloids prior to infiltration. Consensus could not be reached on TAC dosing, methods of prior local anesthesia, and location of injection. CONCLUSIONS This e-Delphi study provides important clinical treatment recommendations on essential aspects of ICA in keloids. By implementing these recommendations, uniformity of ICA in keloid treatment will increase and better treatment results may be achieved.
Collapse
Affiliation(s)
- Qi Yin
- Department of Dermatology, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, 1100 DD, Amsterdam, The Netherlands.
| | - Albert Wolkerstorfer
- Department of Dermatology, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, 1100 DD, Amsterdam, The Netherlands
| | - Oren Lapid
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
- Pediatric Surgical Centre, Emma Children's Hospital, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Movement Sciences (AMS) Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Khatera Qayumi
- Department of Dermatology, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, 1100 DD, Amsterdam, The Netherlands
| | - Murad Alam
- Departments of Dermatology, Otolaryngology, Surgery, and Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Firas Al-Niaimi
- Taktouk Clinic, London, UK
- Aalborg University Hospital, Aalborg, Denmark
| | - Ofir Artzi
- Division of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Martijn B A van Doorn
- Department of Dermatology, Erasmus Medical Center, Rotterdam, The Netherlands
- Centre for Human Drug Research, Leiden, The Netherlands
| | - Ioannis Goutos
- The London Scar Clinic, 152 Harley Street, London, W1G 7LH, UK
| | - Merete Haedersdal
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg, Copenhagen, Denmark
| | - Chao-Kai Hsu
- Department of Dermatology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Woraphong Manuskiatti
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Stan Monstrey
- Department of Plastic Surgery, Ghent University Hospital, Gent, Belgium
| | - Thomas A Mustoe
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Rei Ogawa
- Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School, Tokyo, Japan
| | - David Ozog
- Department of Dermatology, Henry Ford Health, Detroit, MI, USA
- Department of Medicine, Michigan State University School of Medicine, East Lansing, MI, USA
| | - Tae Hwan Park
- Department of Plastic and Reconstructive Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Republic of Korea
| | - Julian Pötschke
- Department of Plastic and Handsurgery, Burn Center, Klinikum St. Georg gGmbH, Leipzig, Germany
| | - Anthony Rossi
- Memorial Sloan Kettering Cancer Center, 530 East 74th Street, Office 9104, New York, NY, 10021, USA
| | - Swee T Tan
- Gillies McIndoe Research Institute, Wellington, New Zealand
- Wellington Regional Plastic, Maxillofacial and Burns Unit, Hutt Hospital, Wellington, New Zealand
| | - Luc Téot
- Department of Plastic Surgery, Montpellier University Hospital, Montpellier, France
| | - Fiona M Wood
- Burns Service of Western Australia, Fiona Stanley Hospital, Perth Childrens Hospital, University of Western Australia, Crawley, Australia
| | - Nanze Yu
- Department of Plastic and Aesthetic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Susan Gibbs
- Department of Molecular Cell Biology and Immunology, Amsterdam Institute for Infection and Immunity (AII), Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
- Department of Oral Cell Biology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit, Amsterdam, The Netherlands
| | - Frank B Niessen
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Paul P M van Zuijlen
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
- Pediatric Surgical Centre, Emma Children's Hospital, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Movement Sciences (AMS) Institute, Amsterdam UMC, Amsterdam, The Netherlands
- Burn Center and Department of Plastic, Reconstructive and Hand Surgery, Red Cross Hospital, Beverwijk, The Netherlands
| |
Collapse
|