Imiquimod for Preventing Keloid Recurrence

Study Overview
=================
Brief Summary
-----------------
This is an open-label, single-arm, pilot study on the effects of topical imiquimod treatment in preventing keloid recurrence after surgical excision. Keloids are abnormal scars that form in certain genetically predisposed individuals following trauma to the skin. They can be physically disabling and cause social impairment. Many therapies have been proposed and trialed for the permanent removal of keloids, but they all have limited efficacy. Topical imiquimod therapy has been reported to decrease keloid recurrence following keloidectomy in human patients. Given all previous reports of adjuvant imiquimod therapy to keloidectomy initiated imiquimod therapy after keloidectomy, the investigators would like to test the efficacy of topical imiquimod pre-treatment in preventing keloid recurrence after surgical excision. Therefore, the investigators are initiating an open-label pilot study of 10 patients age 18 or greater with keloids on the trunk and extremities excluding the groin and hands and feet who present to the dermatology clinic for standard of care keloid excision. Key exclusion criteria include vulnerable populations, immunocompromised state, hypersensitivity to study drug components, and keloids outside of specified areas. The main study intervention will be 6 weeks of treatment with topical 5% imiquimod cream, starting 1 week prior to surgical excision.

Official Title
-----------------
Open-label, Single-arm Pilot Study of the Effects of Topical 5% Imiquimod Cream on Preventing Keloid Recurrence After Surgical Keloidectomy

Conditions
-----------------
Keloid

Intervention / Treatment
-----------------
* Drug: Imiquimod 5% cream


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Age 18 or greater Men and women who present clinically with keloids requesting excision Any number of keloids Keloid no larger than 5cm in diameter at the base Clinical findings consistent with keloid formation Location of keloid in low-risk areas - areas other than above the neck, hands, feet, or groin Able and willing to give informed consent Exclusion Criteria: Age < 18 Hypersensitivity to Imiquimod or to any of the excipients (methylhydroxybenzoate, propylhydroxybenzoate, cetyl alcohol, and stearyl alcohol) Involvement in a trial of another experimental intervention within 30 days Life threatening disease Use of immunosuppressive medications such as oral corticosteroids Bleeding disorders Not available for follow-up for 10 weeks Pregnant, intention to become pregnant during treatment phase of trial, or breastfeeding

Ages Eligible for Study
-----------------
Minimum Age: 18 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Prevention
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Imiquimod<br>5% Imiquimod cream once daily to keloid area 5-times a week for 6 weeks, starting 1-week prior to keloid excision | Drug: Imiquimod 5% cream<br>* Imiquimod 5% Cream application to keloid skin area 5-times per week for 6 weeks, starting 1-week before keloid excision<br>* Other names: Aldara;|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Keloid Recurrence | To assess the efficacy of 5% Imiquimod cream on decreasing keloid recurrence after excision when initiated prior to excision | 12 weeks after surgical excision | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Tolerability - Local Site Reaction Rated on a Scale | tolerability of 5% imiquimod cream - clinical evaluation of local site reactions by clinicians for symptoms such as redness, discomfort, swelling, and ulceration at the site of drug application on the following scale with none being the best and severe the worst: none (no reaction in application site), mild (slight redness in application site), moderate (redness with swelling and pain in application site), severe (redness, swelling, ulceration in application site) | 12 weeks after surgical excision |