Intralesional Triamcinolone Alone Vs. Combined Platelet-Rich Plasma for Keloid Treatment

By Imtiaz Khan Afridi, Shah Fiaz, Aiman Wazir, Salma Noreen

Affiliations

1. Department of Dermatology, Hayatabad Medical Complex, Peshawar, Pakistan

doi: 10.29271/jcpsp.2025.07.922

ABSTRACT
Objective: To compare the efficacy of intralesional triamcinolone acetonide alone versus its combination with platelet-rich plasma (PRP) in the treatment of keloids.
Study Design: Quasi-experimental study.
Place and Duration of the Study: Department of Dermatology, MTI-Hayatabad Medical Complex, Peshawar, Pakistan, from March to September 2022.
Methodology: Sixty patients with refractory keloids were enrolled and randomly assigned to two equal groups. Group A received intralesional triamcinolone acetonide (20 mg/mL) injections every three weeks for a total of four sessions. Group B received the same regimen of triamcinolone, supplemented with autologous PRP injections administered one week after each corticosteroid session. PRP was prepared using a two-step centrifugation technique and activated with calcium chloride before intralesional injection. Treatment response was assessed using the Vancouver scar scale (VSS) at 12 weeks. Data were analysed using SPSS version 23.0, with a p-value ≤0.05 considered statistically significant.
Results: Significant clinical improvement (≥50% VSS reduction) was observed in 86.7% of patients in Group B compared to 33.3% in Group A (p <0.001).
Conclusion: Combining intralesional triamcinolone acetonide with PRP is significantly more effective than corticosteroid monotherapy in the treatment of keloids.

Key Words: Keloids, Intralesional triamcinolone acetonide, Platelet-rich plasma, Scar therapy.

INTRODUCTION

Keloids are benign fibroproliferative overgrowths that develop in genetically predisposed individuals following skin injury, extending beyond the original wound margins with minimal spontaneous regression.¹ They disproportionately affect individuals with darker skin tones, particularly those of the African, Hispanic, and Asian descent.^2,3 They frequently appear in high-tension areas such as the chest, shoulders, and earlobes.⁴

Beyond cosmetic concerns, keloids significantly impact the quality of life, causing pain, itching, and restricted mobility.⁵ Despite various treatments—including intralesional corticosteroids, surgical excision, cryotherapy, and laser therapy— high recurrence rates pose a challenge.^1,5,6

 

Intralesional triamcinolone acetonide (TA) remains the standard treatment, known for its anti-inflammatory and anti-proliferative effects, suppressing fibroblasts and degrading excess collagen. A study by Hewedy et al. demonstrated that the combination of intralesional triamcinolone acetonide with platelet-rich plasma (PRP) significantly improved keloid treatment outcomes, with a reduction in mean Vancouver scar scale (VSS) scores from 7.3 ± 1.99 to 0.85 ± 0.98.² In comparison, the group treated with triamcinolone acetonide alone showed a less marked improvement, with scores decreasing from 6.95 ± 2.4 to 1.95 ± 1.84.^2,4-6

PRP has emerged as a promising adjunct therapy, rich in growth factors such as platelet-derived growth factor (PDGF), transforming growth factor-beta (TGF-β), and vascular endothelial growth factor (VEGF), which modulate inflammation, enhance collagen remodelling, and promote tissue regeneration.^7-9 Though PRP has shown potential in wound healing and scar remodelling, its role in keloid treatment remains underexplored. The authors intended to provide evidence-based recommendations for optimising keloid management in dermatological practice.

This study aimed to compare the efficacy of TA alone versus TA combined with PRP in keloid treatment.

METHODOLOGY

This study was conducted at the Dermatology Unit, MTI- Hayatabad Medical Complex, Peshawar, Pakistan, from March to September 2022. A quasi-experimental design was selected due to non-randomised group allocation while maintaining controlled intervention conditions.

A total of 60 patients with clinically diagnosed keloids were enrolled and divided equally into two groups: Group A received intralesional triamcinolone acetonide (TA) alone, while Group B received TA in combination with PRP. The sample size was calculated based on the findings of Hewedy et al.,² with 80% statistical power, a 5% significance level, and an anticipated drop-out rate of 15%.

Inclusion criteria required patients aged ≥18 years with keloids measuring ≥1 cm in diameter, persistent for at least 6 months despite prior treatment. To ensure anatomical consistency, only keloids located on the chest, shoulders, or earlobes were included. Exclusion criteria were pregnancy, lactation, haemoglobin levels <10 g/dL, active skin infections, autoimmune disorders, or ongoing treatment with anticoagulants or chemotherapeutic agents.

To minimise selection bias, participants were recruited through a non-probability consecutive sampling method from the out- patient dermatology clinic. A single experienced dermatolo- gist conducted the eligibility screening and standardisation of diagnostic criteria.

Ethical approval was obtained from the institutional review board, and written informed consent was secured from all participants. The total treatment duration was 12 weeks. Group A received intralesional injections of triamcinolone acetonide (20 mg/mL) every three weeks for a total of four sessions.

In Group B, PRP was administered as an adjunct to the same TA regimen. PRP was prepared using a standardised two-step centrifugation method. Approximately 20 mL of autologous venous blood was collected in acid-citrate dextrose (ACD-A) tubes. The first centrifugation was performed at 1500 rpm for 10 minutes to separate red blood cells. The plasma layer was then subjected to a sffecond centrifugation at 3000 rpm for 10 minutes to concentrate the platelets. The resulting PRP (2–3 mL) was activated with 10% calcium chloride (w/v) immediately before use and injected intralesionally using a 30-gauge insulin syringe. PRP injections were administered one week after each TA session.

Treatment efficacy was evaluated using the VSS, which assesses pigmentation, vascularity, pliability, and height. A reduction of ≥50% in the total VSS score at 12 weeks was considered  a  successful  outcome.

Data were analysed using SPSS version 23.0. Independent samples t-test was applied for continuous variables, and the Chi-square test was used for categorical data. A p-value ≤0.05 was considered statistically significant.

RESULTS

A total of 60 patients were enrolled and equally divided between Group A (triamcinolone alone) and Group B (triamcinolone with PRP). Baseline demographic and clinical characteristics, including age, keloid duration, and pre-treatment VSS scores, were comparable between the groups (p >0.05), indicating effective group matching prior to intervention (Table I).

Table  I:  Descriptive  statistics  of  study  between  groups  (n  =  60).

Groups	Mean	Std. deviation
Group A (n = 30)
Age (years)	27.37	5.968
Duration of keloid (days)	4.33	1.788
VSS score	2.27	2.033
Group B (n = 30)
Age (years)	28.40	9.239
Duration of keloid (days)	4.50	1.737
VSS score	0.37	0.890

Figure  1:  Graphical  presentation  of  efficacy  and  clinical  outcomes.

Figure  2:  Comparison  of  VSS  scores  pre-  and  post-treatment.

Following treatment, both groups showed improvement in VSS scores; however, the reduction was significantly greater in Group B (mean post-treatment VSS: 0.37 ± 0.89) compared to Group A (2.27 ± 2.03), with a mean difference of 1.90 (95% CI: 1.22 to 2.58; p <0.001). The effect size (Cohen’s d = 1.21) indicated a large treatment effect in favour of combination therapy (Figure 1).

Clinical improvement, defined as ≥50% reduction in VSS score, was observed in 26 (86.7%) patients in Group B versus 10 (33.3%) patients in Group A (p <0.001; risk difference: 53.4%; 95% CI: 30.5% to 76.3%). Furthermore, Group B demonstrated superior outcomes in scar pigmentation, vascularity, and pliability, each showing statistically significant improvement (p <0.001 for all comparisons).

Figure 2 illustrates the comparative effectiveness and consistency of treatment outcomes between the groups. No serious adverse events were reported during the study period.

DISCUSSION

This study demonstrates that intralesional TA combined with PRP is significantly more effective than TA alone in keloid treatment. Group A, receiving TA alone, showed 33.3% efficacy, while Group B, treated with TA and PRP, exhibited a significantly higher 86.7% efficacy (p <0.001). These findings suggest that PRP enhances TA’s therapeutic effects by improving scar pigmentation, vascularity, pliability, and overall clinical outcomes. Kim et al. reported similar results, indicating PRP’s role in collagen remodelling, inflammation suppression, and fibroblast activity regulation.¹⁰

Several studies have highlighted PRP’s impact on scar remodel- ling. Zhang et al. found significant improvements in scar pig- mentation and vascularity, consistent with this study’s findings of 86.7% pigmentation normalisation in Group B versus 33.3% in Group A.¹¹ Similarly, Zhang et al. demonstrated enhanced vascularity and pliability, supporting the observation that PRP-treated patients experienced superior scar remodelling.¹²

Although PRP has shown promising results, its role in keloid recurrence remains unclear.

Kim et al. suggested PRP may reduce recurrence, but the present study’s 12-week follow-up prevents long-term assessment.¹³ Faghih et al. found PRP-corticosteroid therapy led to greater scar pliability, but longer follow-ups are needed to confirm its sustained effects.¹⁴

PRP’s effectiveness is attributed to growth factors such as platelet-derived growth factor (PDGF), transforming growth factor-beta (TGF-β), and vascular endothelial growth factor (VEGF), which regulate inflammation, fibroblast activity, and extracellular matrix deposition. Wang et al. demonstrated that PRP inhibits fibroblast proliferation, supporting its role in improving scar pliability and vascularity.¹⁵

Long-term studies have shown mixed results.¹⁶ Lee et al. reported sustained scar improvement and lower recurrence rates over 12 months, while the present study’s shorter follow-up prevents similar conclusions.¹⁷ Alharbi et al. found that PRP improves scar elasticity and patient satisfaction, though multiple PRP sessions may be necessary for long-term benefits.¹⁸ Further research should explore whether repeated PRP applications enhance long-term outcomes.

Despite promising results, this study has limitations. The small sample size (n = 60) may not fully reflect treatment variability, emphasising the need for larger, multicentre trials. The short follow-up period (12 weeks) prevents assessment of long-term recurrence, requiring extended follow-ups. The single-centre design limits generalisability, necessitating broader studies.

Although various treatment modalities exist for keloids, includ-ing intralesional corticosteroids, cryotherapy, laser therapy, and surgical excision, high recurrence rates and inconsistent outc-omes remain major challenges. While PRP has shown promise in enhancing wound healing and tissue regeneration, its application in keloid treatment is still underexplored, especially in combination with established therapies such as TA.^19,20 There is a clear gap in the literature regarding high-quality clinical data evaluating the synergistic effect of PRP with corticosteroids for keloid management, particularly within the South Asian population. This study contributes to the existing body of knowledge by providing comparative data on the efficacy of intralesional triamcinolone alone versus its combination with PRP, demonstrating significantly better clinical outcomes in the combination group. These findings support the growing interest in biologically based combination therapies and offer practical insights for improving non-surgical treatment strategies for keloids in dermatological practice.

CONCLUSION

This study shows that combining intralesional TA with PRP offers a more effective treatment for keloids than triamcinolone alone. The combination therapy resulted in better improvements in scar characteristics, making it a promising option for keloid management.

COMPETING  INTEREST:
The  authors  declared  no  conflict  of  interest.

AUTHORS’  CONTRIBUTION:
IKA: Data collection, introduction, discussion write-up, literature search, and reference setting.
SF: Conception, study design, critical evaluation, and statistical analysis.
AW, SN: Material and methods section, discussion section, and interpretation of the data.
All authors approved the final version of the manuscript to be published.

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