Comparative efficacy of intralesional therapies for keloid scars: a network meta-analysis.
Camila Sanchez Cruz, Angelo Magallanes Bajana, William Matheus de Araujo et al.
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In 30 seconds
This network meta-analysis compared the efficacy and safety of intralesional treatments for keloid scars, drawing on randomized, non-randomized, and crossover trials. Across 51 studies involving 3234 participants and 23 interventions, 5-fluorouracil (5-FU) plus corticoids improved keloid reduction versus corticoids alone (RR = 1.59; 95% CI: 1.31-1.92; p < 0.01). Adding YAG laser to 5-FU and corticoids showed a larger effect (RR = 2.73; 95% CI: 1.36-5.48; p < 0.01). No significant differences in recurrence were identified across interventions.
Key findings
- 5-FU plus corticoids improved keloid reduction versus corticoids alone (RR = 1.59; 95% CI: 1.31-1.92; p < 0.01).
- 5-FU plus corticoids plus YAG laser showed greater reduction versus corticoids alone (RR = 2.73; 95% CI: 1.36-5.48; p < 0.01).
- BTX-A and verapamil were associated with lower adverse-effect risk than corticoids (RR = 0.29; 95% CI: 0.09-0.95; p = 0.04; and RR = 0.35; 95% CI: 0.14-0.84; p = 0.01, respectively).
- No significant differences in recurrence were found across interventions.
Why it matters
Keloids can cause pain, pruritus, and emotional distress, and this analysis compares a broad range of intralesional options. Its findings suggest that combination approaches may reduce keloid size more effectively than corticoids alone, while some alternatives may have fewer adverse effects. The lack of clear recurrence differences means comparative long-term control remains uncertain.
What to keep in mind
The analysis included randomized, non-randomized, and crossover trials, and the authors call for standardized methods and longer-term follow-up; recurrence evidence was insufficient to distinguish interventions.