EFFICACY OF INTRALESIONAL VARAPAMIL WITH TRIAMCINOLONE IN THE TREATMENT OF EAR KELOIDS IN SOUTH INDIAN POPULATION : A PROSPECTIVE STUDY .
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Keywords
Keloid, Verapamil, Triamcinolone Acetonide, Intralesional Therapy, Vancouver Scar Scale, Combination Therapy
Abstract
Background: Keloids are benign fibroproliferative disorders characterized by excessive collagen deposition extending beyond the original wound margins. Intralesional triamcinolone acetonide (TAC) is considered first-line therapy; however, recurrence and adverse effects remain concerns. Verapamil, a calcium channel blocker, has shown promise in modulating fibroblast activity with fewer side effects.
Objective: To evaluate the efficacy and safety of intralesional verapamil combined with triamcinolone acetonide in the management of ear keloids in a South Indian population.
Methods: This prospective study included 30 patients with ear keloids treated at a tertiary care center from Dec2017- Dec2019. Patients received intralesional verapamil (2.5 mg/mL) combined with triamcinolone acetonide (40 mg/mL) in a 9:1 ratio at 0.1 mL/cm of lesion every three weeks for six sessions. Clinical outcomes were assessed using the Vancouver Scar Scale (VSS) at baseline and during follow-up. Statistical analysis was performed using SPSS v21.0, with Wilcoxon signed-rank test applied. A p-value <0.05 was considered significant.
Results: The mean age was 31 years. All patients were female. Bilateral involvement was observed in 53%. The most common symptom was hyperpigmentation (66.6%), followed by itching (40%). Mean VSS score significantly decreased from 7.68 ± 1.89 at baseline to 4.28 ± 2.21 at 18 weeks (p < 0.05), representing a 46.2% improvement. Recurrence was observed in 26% during follow-up (13% at 6 months; 13% at 1 year). Pain was universal post-injection, and ulceration occurred in 27%.
Conclusion: Intralesional verapamil combined with triamcinolone acetonide is an effective and relatively safe treatment modality for ear keloids, demonstrating significant reduction in VSS scores with acceptable recurrence rates. Combination therapy may serve as a first-line approach in selected patients.
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Dr Mahesh A
Department of Plastic surgery and Department of Ear, Nose and Throat . Dr B R Ambedkar Medical College and Hospital, Bangalore , Karnataka, India.
Champion Venkateshalu Srinivas
Department of Plastic surgery and Department of Ear, Nose and Throat . Dr B R Ambedkar Medical College and Hospital, Bangalore , Karnataka, India.
Lakshmi Menon Ravunniarth
Department of Plastic surgery and Department of Ear, Nose and Throat . Dr B R Ambedkar Medical College and Hospital, Bangalore , Karnataka, India.
