Observation Of The Curative Effect Of Locally Injecting Keloid With First-time Double Dosage Of Triamcinolone Acetonide

Keloid is a special type of scar, which has clinical manifestations of overgrowth, crossing the boundary of primary wounds, invading adjacent tissues, and showing tumor-like hyperplasia. It is often found among colored races, and can lead to dysfunction. The common sites of the disease are prothoraxes, maxilla margins, earlobes, upper arms, scapulars and etc.. Prothoraxes, especially the anterior part of sternums are the predilection sites of keloid. The disease is accompanied by pain and pruritus with a dissatisfactory cosmetic result, no degeneration, and very frequent recurrence after resection, which severely influence the normal lives of people.Triamcinolone acetonide is a kind of median-effect glucocorticoid with good efficacy. It is widely applied clinically, showing powerful and long lasting anti-inflammatory effects. Meanwhile, it increases collagenase activity, accelerates degradation of collagen, and inhibits the formation of scars, obtaining good effects in treating keloid.But the long-term injection of keloids will lead to the unnecessary side effects, such as menstrual cycle changes, pigmentation and so on. To avoid the side effects of hormone and reduce the frequency of disease recurrence, our ancestors have explored the shock therapy for nephrotic syndrome. So we try this way by injecting keloid with first-time double the dose of triamcinolone acetonide to avoid the side effects of the treatment and short patient treatment. PurposesComparative and analysis the treatment effect of injecting keloid with first-time double the dose of triamcinolone acetonide, explore its possible mechanism of action and provide certain theoretical basis for the future clinical treatment of keloids. MethodsSelect 80 keloid patients diagnosed at our hospital. Before the injection, randomly divide all the patients into two groups---the double dosage group and the normal dosage group. Cover the keloid surfaces of all the patients with transparent flexible area papers with square grids on top, and count the number of square grids. Grids which are bigger than half of the square grids can be counted as one unit area, and grids which are smaller than half of the square grids should be cast out. Measure the maximum height of the herniation surface with straight edge, and get the approximate volumes of keloids before the treatment with the formula: the number of square grids×0.25cm2×height. The dosage of first injection for the patients in double dosage group is the area of keloid times 5.0mg. The dosage of first injection for the patients in normal dosage group is the area of keloid times 2.5mg. After the first injection, dosages for patients in both groups in the following days are all the area of keloid times 2.5mg.Judging criteria: The primary area is marked as A, and the primary height is marked as B. After the treatment, the area is marked as Ax, and the height is marked as Bx.Cured: AxBx/AB<30%; Marked effect: 30%?AxBx/AB < 60%; Effective: 60%?AxBx/AB; Ineffective: unchanged.Statistical treatment: Analyze and process the obtained data with SPSS17.0 statistical software, and apply the two-category ?2 inspection of the independent two groups, the inspection level of which is ?=0.05. Results1. After the first injection, in the double dosage group, the cure rate was 35.0%, and it was 12.5% in the normal dosage group. ?2=5.591,p<0.05, the difference is statistically significant.2. After the second injection, in the double dosage group, the cure rate was 45.0%, and it was 22.5% in the normal dosage group. ?2=4.528,p<0.05, the difference is statistically significant.3. After the third injection, in the double dosage group, the cure rate was 57.5%, and it was 35.0% in the normal dosage group. ?2=4.072,p<0.05, the difference is statistically significant.4. After the fourth injection, in the double dosage group, the cure rate was 67.5%, and it was 45.0% in the normal dosage group. ?2=4.114,p<0.05, the difference is statistically significant.5. After 6 months of injection, in the double dosage group, the cure rate was 69.2%, and it was 45.0% in the normal dosage group. ?2=4.611,p<0.05, the difference is statistically significant. ConclusionsThe cure rate in the double dosage group(double dose at the first time) of triamcinolone acetonide was higher than that in the normal dosage group, and statisitically significant difference was obtained. It indicates that double dosage at the first injection of glucocorticoid is suitable for keloid treatment.