DS11 A double-blinded randomized control study to compare the effectiveness and safety of intralesional vitamin D3 with intralesional triamcinolone and its correlation with tissue expression of vitamin D receptors in patients with keloid

Abstract

Abstract Intralesional steroids are the first line of treatment for keloids, and intralesional vitamin D has shown promise in the management of keloids in a few small studies. The aim was to compare the efficacy and safety of intralesional vitamin D with intralesional triamcinolone and its correlation with tissue expression of vitamin D receptors (VDRs) in the treatment of keloids. Sixty patients were randomly divided into two groups in 1 : 1 ratio. Patients in group A received intralesional vitamin D (200 000 IU, dose 0.2 mL cm−2); those in group B received intralesional triamcinolone acetonide (20 mg mL−1, dose 0.1 mL cm−2). Four monthly injections were given, and the patients were followed-up for a further 24 weeks. The Vancouver Scar Scale (VSS) was used for keloid evaluation. Pre- and post-treatment biopsies of 20 patients from both groups were taken to assess the correlation between the expression of VDR receptor levels before and after treatment. The mean VSS scores of patients in both groups were statistically significantly reduced over the course of the follow-up (P < 0.001). Mean (SD) reduction in VSS at the end of treatment period was 5.17 (0.59) in patients in group A and 4.77 (0.77) in those in group B. The proportion of the patients showing > 50% reduction in VSS score was higher in patients in group B vs. those in group A (77% vs. 50%; P = 0.032). Rates of recurrence were comparable between the two groups (P = 0.51). Hypopigmentation (80% vs. 37%; P < 0.001) and atrophy (73% vs. 40%; P = 0.009) were more common in patients in group B than in those in group A. There was no significant difference in pre- and post-treatment values of tissue VDR expression in either group. Both triamcinolone and vitamin D are effective in the management of keloids. Although the reduction in VSS score was higher with corticosteroids than vitamin D, an intralesional injection of vitamin D had lower incidence of adverse effects such as atrophy and hypopigmentation.