# Efficacy and safety of glucocorticoid-based therapies in the management of keloids: a systematic review and meta-analysis of clinical outcomes

## TL;DR

This study reviews and compares the effectiveness and safety of glucocorticoid-based treatments for managing keloids, finding that intralesional TAC is the best and safest option.

## Contribution

The study provides a systematic review and meta-analysis of glucocorticoid-based therapies for keloids, highlighting the most effective and safe treatment.

## Key findings

- Intralesional TAC is identified as the best and safest treatment for keloid management.
- Multimodal, glucocorticoid-centered regimens show consistent therapeutic outcomes.
- Adverse effects like telangiectasia and atrophy are temporary and self-resolving.

## Abstract

Hypertrophic scars and keloids are fibroproliferative conditions that are resistant to treatment and recur often. The effectiveness and safety of glucocorticoid-based treatments and their combinations in the treatment of keloid disease were objectively assessed in this systematic review and meta-analysis.

42 randomized and comparative clinical studies were considered. Intralesional, topical, or aided glucocorticoid delivery were eligible treatments.

The use of corticosteroids alone in intervention methods (SMD = 1.28; 95% CI: 1.05–1.51; p < 0.05; I2 = 43%). The use of 5-FU-based treatments yielded the same results (SMD = 1.15; 95% CI: 0.97–1.34; p < 0.05) with very low level of inconsistency. The laser treatment approach significantly improved the scar condition (SMD = 0.99; 95% CI: 0.81–1.16; p < 0.05). CCD interventions had been significant changes and improvements (SMD = 1.07; 95% CI: 0.97–1.18; p < 0.05; I2 = 47%). Techniques with and without delivery, such as steroids + 5-FU, laser-assisted delivery, microneedling, or cryotherapy-assisted corticosteroid delivery, provided consistently better results. The GRADE evaluation indicated that the certainty of evidence was poor for microneedle and cryotherapy-aided techniques, medium for recurrence rate, cosmetic results, and negative consequences, and excellent for scar volume decrease, pain, and pruritus relief. The adverse outcomes, primarily telangiectasia and moderate atrophy, were temporary and self-resolving.

The best and safest treatment for keloid management is intralesional TAC, based upon the data at hand. The mainstay of clinically proven scar therapy is still multimodal, glucocorticoid-centered regimens that show consistent therapeutic outcomes.