Comparison of efficacy and recurrence of intralesional Verapamil and Triamcinolone injection for postoperative ear keloid treatment: A randomized controlled trial

Abstract

               Keloids are abnormal scars caused by an excessive repair process without interruption and extend beyond the original boundary. There is no single effective treatment modality and surgical removal has a recurrence rate of 45 to 100%. Multimodality therapy combining steroid injections with surgery decreases recurrence. Verapamil is now included as an alternative treatment for keloids in European guidelines due to its ability to improve keloids appearance by reducing and modifying the scar, with low adverse effects. This clinical trial investigated the efficacy of two treatment methods for ear keloid excision. Fifty-two patients who met the inclusion criteria underwent ear keloid excision. They were then divided into two groups: 26 patients received an intralesional triamcinolone injection (group T), and the other 26 patients received an intralesional verapamil injection (group V). The injections were administered immediately after surgical excision and repeated 4 weeks later. Patients were regularly followed up every 8 weeks for one year. The results revealed that the recurrence of ear keloid scars was observed in 4 patients (15.4%) in group T and 6 patients (23.1%) in group V at 44 weeks after surgery. Both groups showed significant improvements in the Vancouver Scar Scale (VSS) scores. Group T experienced quicker resolution of skin redness or vascularity, pliability, and total VSS scores while pigmentation in group V demonstrated a faster response. Significantly more complications were recorded in group T compared to group V such as telangiectasia and dermal atrophy. In Conclusions, intralesional verapamil injection after ear keloid excision was an effective and non-inferior treatment compared intralesional triamcinolone injection, resulting in reduced post-treatment complications.