Keloid disorder: a clinical management update

Cryotherapy and intralesional injections of the chemotherapy drug vincristine can be effective treatments for keloids, according to a presentation at the lst International Keloid Symposium recently held in New York.

Dr. Tirgan“For over 100 years now, the biggest issue we have had in treating keloid disorder and trying to help patients with keloid lesions on their skin has been lack of scientific data and evidence-based medicine. Hence, every physician, no matter the location of his practice, uses whatever method he believes will help,” says Michael H. Tirgan, M.D., a medical oncologist in private practice in New York City. Dr. Tirgan founded the Keloid Research Foundation in 2011.

Treating keloids with a combination of surgery and radiation dates back to the early 1900s, according to Dr. Tirgan, whereas steroid injections have been the only medicine used in the past 50 years.

Dr. Tirgan and others are trying to change the paradigm for keloid therapy.

“Even as of 2016, we do not know the proper dosage of radiation therapy or steroids,” Dr. Tirgan tells Dermatology Times in a post-symposium interview. “We also constantly see patients who have been treated by a combination of surgery/radiation/injections, but with failed results, and with keloid lesions that are larger than (they were) prior to receiving surgery or a combination of surgery and radiation therapy.”

“We recognize that a lot of these patients with large keloids have had surgery in the past,” Dr. Tirgan says.

NEXT: Cryotherapy is promising

Cryotherapy is promising

Cryotherapy alone is one promising treatment modality. Dr. Tirgan is lead investigator of a retrospective study of 283 ear keloid patients he has treated over the past seven years with cryotherapy. Results have been excellent, according to Dr. Tirgan.

“It does not require surgery or radiation therapy and you can remove every keloid from the ear without exposing the patient to the risks of these competing therapies,” he says.

The standard protocol is between three to five sessions of cryotherapy, spaced six to eight weeks apart, until all keloid lesions have completely disappeared.

“The success rate in patients who are compliant with treatment is close to 100%, with very few recurrences,” reports Dr. Tirgan. He has submitted the study for publication.

For flat keloids that reside on the anterior chest, shoulders and posterior chest but do not respond to first-line steroid injections, intralesional injections of vincristine may be effective.

Dr. Tirgan has treated in excess of 200 keloid patients with vincristine over the past four years, with about a 60% response rate, half of which is durable.

The unpublished data of these patients indicate that roughly 10% achieve good results with a single injection, while the remainder require more than two injections, spaced two to three weeks apart, up to a total of six injections.

“However, we do not have a single drug that has been approved by the FDA for keloid disorder,” says Dr. Tirgan, with no green light on the horizon. “More than half of patients require some form of systemic treatment, either oral or intravenous, which we do not have available.”

Disclosure: Requested