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Keloids and
Hypertrophic Scars with
the Dermo-Jet
CHARLES P. VALLIS, M.D., FA.C.S.* / Lynn,
Massachusetts
The use of steroids in the treatment of keloids and
hypertrophic scars has aroused considerable interest
during the past few years. In 1951 Conway and Stark1
showed that adrenocorticotropic hormone injected into
keloids relieved symptoms of pain and itching but
caused no apparent improvement in the appearance of
the scar. In 1963 Murray2 reported the use of
triamcinolone acetonide for the treatment of keloids. He
showed significant improvement by injecting the drug
into the wound margin after surgical excision or
dermabrasion of the keloid. In 1966 Griffith3 and
Ketchum and associates4 reported that significant relief
of symptoms and improvement of the appearance of
keloids resulted after the intralesional injection of
triamcinolone acetonide.
However, the injection of the solution into these
scars has presented a serious problem. Keloids and
hypertrophic scars are extremely firm and dense, and
injection of any solution into this type of tissue is
difficult and painful. A prior injection with a local
anesthetic around the scar is often necessary to prevent
the severe discomfort which results from distention of
the scar by the steroid. A series of injections over a
period of several weeks and months are frequently
necessary, making this method of treatment a rather
unpleasant and painful experience to the patient.
Method of Treatment
The technique is simple and is performed as an
office procedure. Several patients are usually done
simultaneously to prevent wastage of the solution. Only
the plastic cuff on the end of the instrument needs
sterilization between patients. No type of anesthesia is
required. The scar to be injected is sponged off with a
mild antiseptic solution. With each injection by the
Dermo-Jet, a pale white wheal measuring
approximately 1 to 1.5 cm. in diameter is attained. The
injections are spaced so that the wheals from each
injection more or less touch each other and fuse. The
entire scar is injected at one sitting. In the smaller scars
only 1 or 2 injections may be needed. As many as 25 to
30 injections have been done for some of the larger
scars. The instrument is placed vertically over the scar
so that the removable and easily sterilized plastic cuff
on the end touches the scar (fig. 2). Rarely, when there
is a small area to inject, the plastic cuff may obscure the
lesion. Then it is wise to remove it and keep the nozzle
of the instrument approximately cm. above the scar.
After the first treatment is completed, the
patient is advised to return again in 2 weeks, at which
time a second injection is done if necessary. After the
second injection series, the patient is advised to come
back in a month. Many patients do not require more
than 2 series of injections. However, the larger keloids
may require several doses. One had a total of 10 series
of injections spaced about 1 month apart.
For the initial injection it is best to acquaint the
patients with the machine and allow them to hear the
snap of the machine before giving the injection.
Many of the younger patients are frightened by the appearance of the machine and the snapping sound. This
sometimes makes them hypersensitive to the small
amount of pain caused by the injection. By and large,
these patients are much more cooperative for
subsequent injections.
Table I
Location
Left shoulder
Arms
Anterior chest wall
Face
Abdomen
Thigh
Foot
Hand
Mastoid
Neck
Back
Total
No. of Patients
6
6
4
3
3
1
1
1
1
1
1
28
Clinical Material
Since November 1965, 28 Caucasian patients
with keloid or hypertrophic scars have received a
combined total of 64 injection series of this mixture of
triamcinolone acetonide and Wydase.
The ages of 22 patients ranged between 6 and
29 years, and the other 6 patients were between 33 and
70 years of age. The average age was 22 years. Seven
were men and 21 were women.
Of the 22 patients in the younger age group, 14
had scars which were considered to be true keloids. All
the scars treated in the older age group were
hypertrophic scars. The locations of the scars are shown
in table 1.
The causes of the scars varied. Of the 14
keloids, 6 were the result of vaccinations, 3 resulted
after surgical excision of benign lesions, I from a burn,
2 from infection due to acne and 2 from injury. Of the
14 hypertrophic scars, 8 resulted from operative incisions, 3 from injuries, 2 from burns and 1 from
dermabrasion on the face. At the time of the initial
treatment of these patients, the lesions had been present
from 2 months to 10 years with an average of 3 years.
A total of 64 series of injections ranging from
1 to 10 were given to the 28 patients. Nine are still
under treatment. A total of 49 series were given to the
completed 19 cases, making an average of 2.6. Of the
28 patients treated, 14 had no symptoms referable to the
scars, and they were primarily interested in improving
the appearance of the scars. In the remaining 14, the
most common symptoms were chronic itching and pain.
Of these 14, 10 were interested in relief of symptoms
and improvement of the appearance of the scars. The
remaining 4 were interested only in relief of symptoms
Clinical Results
Relief of symptoms.
An analysis of the 4 patients seeking only
relief of symptoms proved interesting.
1.
2.
3.
4.
2.
3.
4.
5.
2.
Conclusion
The Dermo-Jet, a needleless pressure injection
instrument, has proven to be of great value for the
intralesional injection of keloids and hypertrophic scars.
The technique is simple and quick with minimal
discomfort to the patient.
41 Ocean Street
Lynn, Massachusetts 01902
REFERENCES