Evaluation of Intralesional Bleomycin and Triamcinolone Acetonide in the Treatment of Keloids: A Prospective, Randomized, Open-Label, Comparative Study.

In 30 seconds

This prospective, randomized, open-label comparative study evaluated intralesional bleomycin versus triamcinolone acetonide in 136 patients with clinically diagnosed keloids. Both treatments were associated with clinical improvement after four sessions, but bleomycin produced a greater mean percentage reduction in Vancouver Scar Scale score (72.02% vs. 58.10%; p < 0.00001). More patients receiving bleomycin achieved at least 75% improvement, while surface-area reduction was comparable. Adverse effects differed between groups: pain and hyperpigmentation were more frequent with bleomycin, and skin atrophy and telangiectasia with triamcinolone.

Key findings

• Mean Vancouver Scar Scale reduction was 72.02% with bleomycin versus 58.10% with triamcinolone (p < 0.00001).
• At least 75% improvement occurred in 36.8% (n = 25/68) with bleomycin and 14.7% (n = 10/68) with triamcinolone (p = 0.0027).
• Mean scar height was reduced to 0.8 versus 1.9 mm with bleomycin and triamcinolone, respectively (p = 0.003); surface-area reduction was comparable (p = 0.850).
• Pain (n = 50, 74%) and hyperpigmentation (n = 18, 26%) were more frequent with bleomycin; skin atrophy (n = 16, 24%) and telangiectasia (n = 15, 22%) were more frequent with triamcinolone.

Why it matters

The comparison suggests that intralesional treatments for keloids may differ both in scar-severity response and in adverse-effect profile. These results help frame treatment discussions around the measured benefits and harms, while the short follow-up and need for further study mean that durability and recurrence remain uncertain.

What to keep in mind

The study was open-label, follow-up was limited to 2 months after the final session, and the authors call for larger, multicenter, blinded studies to assess longer-term outcomes, including recurrence.