Clinical Observation Of Botulinum Toxin A In The Treatment Of Keloid

Objective:Keloid is an abnormal hyperplastic disease of the connective tissue of the skin fibers,which mainly affects patients in African or Asian descent.It often leads to organ dysfunction or even disfigurement,a condition that can lead devastating psychological or social consequences.So far there is no ideal treatment.Triamcinolone acetonide acetate(glucocorticoid drugs)is the first-line drug for the prevention and treatment of keloid.Botulinum toxin A for injection has been widely used in the treatment of various diseases in recent years,especially in plastic surgery.Existing studies have shown that it can inhibit keloid production by reducing wound tension and inhibiting the growth of some fibroblasts.This study investigated the efficacy and adverse reactions of closed injection of botulinum toxin type A and triamcinolone acetonide alone on 48 keloid subjects in the First affiliated hospital of dalian medical university.To analyze and evaluate the clinical effect of botulinum toxin A in the treatment of keloid,and further guide the clinical treatment.Methods:A total of 48 keloid patients admitted to the plastic and cosmetic department of the First affiliated hospital of dalian medical university from March 2017 to March2018 were selected.By simple randomization,24 patients were randomly divided into the experimental group(group A),the botulinum toxin type A treatment group and the control group(group B),the triamcinolone acetonide treatment group.The experimental group was treated with 5U/cm2 injection of type A botulinum toxin scar,which was injected once A week and repeated four times.The control group was also injected with5mg/cm 2 by intrauterine keloid injection once a week and repeated four times.The patients were followed up for six months after treatment.Parameters before and after each treatment were recorded,including objective indicators(keloid diameter,thickness,color,tissue changes under color doppler),subjective indicators(pain degree,patient satisfaction),adverse reactions of patients in the two groups and clinical photos before and after each treatment.Pain was assessed using the(Visualanalogyscale,VAS)[1-2]for the severity of itch,which was measured by x2 test and t test for each treatment.In terms of adverse reactions,weekly evaluation was conducted during the treatment,and monthly follow-up was conducted after the completion of the complete treatment cycle,lasting for 6 months.Results : In terms of treatment,measurements were made one week after each treatment.Keloid volume was significantly reduced in both groups compared with the baseline,and there was no significant difference in keloid length and diameter and lesion thickness between the two groups(p > 0.05).Keloids were significantly softened in all patients compared with baseline,and there was no significant difference in other objective indicators.Color doppler imaging showed that after four treatments,the thickness of skin lesions in both groups was significantly reduced,and the echo inside the scar skin lesions before treatment was relatively uniform with clear boundaries with the surrounding area.After treatment,the echo gradually increased,and the echo was uneven,close to the normal level of surrounding skin,and the muscle fibers under the skin lesion in the botox group tended to be aligned.All patients degree of subjective symptoms are referred to the difficulties for the first week after treatment significantly reduce,in a month after the treatment about the difficulties the degree of visual contrast score(Visualanalogyscale,VAS)value decreased,the experimental group decreased from(8.08±1.08)points is reduced to(2.35±1.66)points,the control group by(7.89±1.09)points to(5.23±1.65),the difference between the experimental group than the control group decreased more significantly,groups with statistical significance(P <0.05).The results showed that the improvement of the experimental group was more significant,and the pain and itching symptoms of the patients were significantly relieved.The botulinum toxin A treatment group was superior to the triamcinolone acetonide treatment group in the degree of pain and itching.In terms of satisfaction,after four treatments,the score of the experimental group(3.6±1.2)was significantly higher than that of the control group(2.7±0.3),and the satisfaction of the experimental group was significantly higher than that of the control group.In terms of adverse reactions,both groups were well tolerated and reported mild pain or discomfort during and hours after injection.During the follow-up,4 patients in the control group had delayed menstruation and increased menstruation,and 3 patients had obvious skin atrophy and telangiectasia.No adverse reactions were observed in the botulinum toxin group.Conclution : In conclusion,this experiment demonstrated the efficacy and safety of closed injection of botulinum toxin type A in the treatment of keloid.Subjective indicators: after the treatment of botulinum toxin type A,compared with the treatment of triamcinolone,the degree of pain and itching of the patients was significantly reduced,and the degree of satisfaction was higher,with statistical differences.Objective indicators:(keloid diameter,thickness,color)the im provement was similar to the glucocorticoid injection in the lesion,with no statistical difference.Adverse reactions:patients treated with botulinum A had better tolerance and fewer adverse reactions.