Comparison between the Efficacy of 5% Imiquimod Cream and Intralesional Triamcinolone Acetonide in the Prevention of Recurrence of Excised Ear Keloid: A Prospective Randomized Study

Abstract

ackground: Ear keloid scars represents an abnormal, exaggerated healing response after skin injury. In addition to cosmetic concern, scars may cause pain, pruritus, or contractures. Nowadays, topical therapies have increased because they are easy to use, comfortable, and non-invasive. The 5% imiquimod cream has been reported as effective to prevent the recurrence of ear keloid after surgical excision. Objective: To evaluate the efficacy of 5% imiquimod cream in decreasing the recurrence rate of keloid after surgical excision, when compared with triamcinolone acetonide injection. Materials and Methods: Thirty patients, which included 6.67% male and 93.33% female, enrolled in a prospective-randomized study. Sixteen patients were informed to use triamcinolone injection (10 mg/mL) and 14 patients were informed to apply 5% imiquimod cream (nightly every other day) for 12 weeks after the ear keloid was excised and the stitches removed. Results: The 30 patients were examined of recurrence of ear keloids on their ears for 48 weeks after surgical excision. The overall mean of Vancouver Scar Scale at one year for evaluating the effectiveness of imiquimod to decrease recurrence rate when compared with triamcinolone acetonide injection showed at 6.50 and 4.25 respectively. The patient satisfaction was slightly higher in triamcinolone group. However, the two outcomes, the Vancouver Scar Scale (p=0.389) and the patient satisfaction (p=0.833), were not statistically significant. No serious local and systemic adverse event was detected in either groups of patients. Conclusion: Treatment of surgical excision ear keloids with triamcinolone acetonide injection might be a better selection as compared to imiquimod cream for effectiveness in term of lower recurrence rate and higher patient satisfaction. A limitation of the present study is the number of the patients. Keywords: Keloid, Imiquimod, Triamcinolone acetate, Recurrence of ear keloid