Comparative study of the 80% trichloroacetic acid multiple puncture technique versus botulinum toxin type A in the treatment of keloid scars

Abstract

Background Keloid is one of the most challenging clinical problems encountered in wound healing. Although there are numerous treatment modalities, none of them have shown excellent therapeutic results. Aim The aim of the study was to evaluate the efficacies of 80% trichloroacetic acid (TCA) and botulinum toxin type A in the treatment of patients with keloid scars. Methods Thirty keloid patients were divided into two groups (each consisting of 15 patients). In group A, keloid scars were punctured using a punch instrument previously dipped in 80% TCA, whereas in group B keloid scars were injected intralesionally with botulinum toxin type A (2.5 U/cm 3 ;). All patients underwent three to five therapeutic sessions 1 month apart, and follow-up for 1 year. The therapeutic response was determined according to the scores on the Vancouver scar scale and a self-assessment scale for pain and pruritus. Results In group A, the mean scores on the Vancouver scar scale before and after treatment were 9.73±1.33 and 4.94±2.44, respectively, with a total improvement of 49%. In group B, the mean scores on the Vancouver scar scale before and after treatment were 9.05±1.34 and 4.68±2.67, respectively, with a total improvement of 48%. Comparison between mean values obtained on the Vancouver scar scale in groups A and B after treatment showed a statistically nonsignificant difference. Group B showed better improvement as per the self-assessment score. Most common side effects were reported in group A and were in the form of hyperpigmentation (33.3%), hypopigmentation (6.7%), and mixed pigmentation (6.7%). Relapses occurred in 26.7% of patients in group A, whereas no relapses occurred in group B. Conclusions The 80% TCA multiple puncture technique is better than botulinum toxin type A in the treatment against keloids.