An Observational Study On Superficial X-ray Combined With Intralesional Injection In The Treatment Of Multiple Keloids

Background and Purpose Keloid is a kind of pathological scar formed after the damage of skin barrier and the chronic inflammation of dermis.Clinical classification includes single keloid and multiple keloids(MK).The number of lesions in MK is not unique,and the pathogenesis has not been unified.MK secondary to skin infections,such as folliculitis and acne,a large amount of collagen could be deposited during its formation.It may cause a part of the epidermis,hair follicles and sebaceous glands to be embedded in the skin lesions,and the infectious lesions can exist for a long time.It’s difficult to treat effectively and control the recurrence rate.At present,there is no ideal intervention methods for MK.Therefore,it is necessary to actively explore new treatment to improve the efficacy and reduce adverse reactions.Studies have shown that triamcinolone acetonide can reduce inflammation and soften lesions.Hyaluronidase can accelerate drug absorption,reduce local tissue tension and relief the pain.Superficial X-ray can also play a therapeutic role by inhibiting newborn cells,reducing the sensitivity of peripheral nerves and inhibiting skin pathogenic microorganisms.In this study,superficial X-ray combined with intralesional injection triamcinolone acetonide and hyaluronidase were used to treat MK.Methods 144 cases of MK treated in the outpatient department of Southern Medical University Dermatology Hospital from March 2018 to October 2019 were selected according to the established criteria.65 cases in group A were treated with superficial X-ray radiotherapy combined with intralesional injection of triamcinolone acetonide and hyaluronidase;79 cases in group B were treated with simple local injection of triamcinolone acetonide and hyaluronidase.The patients were followed up for 18 months after treatment.The Vancouver Scar Scale(VSS)was evaluated and its effectiveness was evaluated.Two independent samples were statistically analyzed by t-test and chi-square test.Results In group A,51 cases were improved and 14 cases were significantly effective.The apparent efficiency rate was 21.54%.The main adverse reaction was transient pigmentation.In group B,74 cases were improved,2 cases were significantly effective and 3 cases were ineffective.The effective rate was 2.63%.The adverse reactions were mainly telangiectasia and skin atrophy.Among female patients,3 cases had abnormal menstrual cycle and 2 cases had hypertrichosis.There was no significant difference in VSS score between the two groups before treatment(t=-1.114,P=0.267),but significant difference in VSS score appeared after treatment(t=-3.836,P<0.001).There was notable difference between the two groups(x2=12.450,P<0.001).Conclusions Superficial X-ray combined with Intralesional injection triamcinolone acetonide and hyaluronidase,which has an ideal curative effect on MK,with lower incidence of adverse reactions and higher patient satisfaction.It is conducive to standardized development,as an intervention method with clinical application prospect.