Fractional Laser Assisted Steroid Therapy vs Intralesional Steroids in the Treatment of Keloids

Study Overview
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Brief Summary
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The purpose of this study is to compare the effects of fractional carbon dioxide (CO2) laser therapy immediately followed by intralesional steroid therapy against intralesional steroid therapy alone for the treatment of keloids.

Detailed Description
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Intralesional corticosteroids remain the gold standard treatment for keloids. However, more effective therapies are desperately desired. Ablative fractional laser (AFL) treatment facilitates delivery of intralesional steroid more deeply and uniformly into the skin by creating vertical channels. Recent studies have showed that fractional laser assisted steroid therapy can be effective in the treatment of keloids. However the studies are lacking in comparing this treatment modality to the gold standard of intralesional steroids.

Official Title
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Fractional Laser Assisted Steroid Therapy vs Intralesional Steroids in the Treatment of Keloids

Conditions
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Keloid

Intervention / Treatment
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* Device: The Lutronic electronic carbon dioxide (eCO2) Plus laser system
* Drug: Intralesional Triamcinolone Acetonide


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Male or female older than 17 at the screening visit; The subject is healthy, as determined by the investigator based on a medical evaluation including medical history; The subject has at least two keloids of comparative size and texture located on the same general anatomic location (trunk or back); The subject is willing and able to comply with the requirements of the protocol. In particular, subject must adhere to the visits schedule and concomitant therapy. The subject is willing to comply with the 4 week washout period; The subject has understood and signed an Informed Consent Form approved by the Institutional Review Board (IRB) prior to any investigational procedure Exclusion Criteria: Any subject who is meeting one or more of the following exclusion criteria at the screening visit and/or at the baseline visit will not be included in this study: The subject has an underlying known disease, a surgical or medical condition that in the opinion of the investigator might put the subject at risk The subject is pregnant or breastfeeding at the time of enrollment or is planning to become pregnant at any point during the study period The subject has a past history of coagulopathy The subject has an underlying dermatological disease that in the opinion of the investigator could interfere with the study evaluations The subject has used prohibited topical or systemic treatments without sufficient protocol-defined wash-out period prior to Baseline (checked at Screening and Baseline) or is unwilling to refrain from use during the study The subject is treated with anticoagulants or antiplatelet therapies The subject has a known allergy or sensitivity to any local anesthetic drug (e.g. EMLA or tetracaine 7%/lidocaine 23%) or a local antiseptic planned to be used for the laser. The subject is in an exclusion period from a previous study or is participating in another clinical trial The subject is an adult under guardianship or is hospitalized in a public or private institution, or is deprived of freedom The subject is unable to communicate or cooperate with the Investigator due to language problems, poor mental development, or impaired cerebral function

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: CO2 ablative laser plus intralesional triamcinolone acetonide<br>A topical eutectic mixture of local anesthetics (EMLA) cream or tetracaine 7%/lidocaine 23% will be applied to the both treatment sites and after sufficient anesthesia is attained, one keloid will be treated with the fractional CO2 laser using standard protocol as practiced in our clinics followed by intralesional triamcinolone acetonide. One lesion would be treated with fractional CO2 ablative laser followed with intralesional triamcinolone acetonide at 4 weeks intervals | Device: The Lutronic electronic carbon dioxide (eCO2) Plus laser system<br>* CO2 ablative laser plus intralesional triamcinolone acetonide A topical EMLA cream or tetracaine 7%/lidocaine 23% will be applied to the both treatment sites and after sufficient anesthesia is attained, one keloid will be treated with the fractional CO2 laser using standard protocol as practiced in our clinics followed by intralesional triamcinolone acetonide. One lesion would be treated with fractional CO2 ablative laser followed with intralesional triamcinolone acetonide at 4 weeks intervals<br>Drug: Intralesional Triamcinolone Acetonide<br> <br> |
| Active Comparator: Intralesional triamcinolone acetonide alone<br>A topical EMLA cream or tetracaine 7%/lidocaine 23% will be applied to the both treatment sites and after sufficient anesthesia is attained, one keloid will be treated with the fractional CO2 laser using standard protocol as practiced in our clinics followed by intralesional triamcinolone acetonide. The other chosen lesion would be treated with intralesional triamcinolone acetonide alone at 4 week intervals. | Drug: Intralesional Triamcinolone Acetonide<br> <br> |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Mean Change in Composite Observer Score for Patient and Observer Scar Assessment Scale (POSAS) | Data from POSAS Observer Scale will be collected and reported to assess vascularity, pigmentation, thickness, relief, pliability, and surface area of the keloids chosen for the research study. Total score range: 6-60; Higher scores mean a worse outcome. Mean composite score of the final visit was compared to the mean baseline score. | Once every 4 weeks for 16 weeks | 
| Mean Change in Composite Patient Score for Patient and Observer Scar Assessment Scale (POSAS) | Data from POSAS Observer Scale will be collected and reported to assess vascularity, pigmentation, thickness, relief, pliability, and surface area of the keloids chosen for the research study. Total score range: 6-60; Higher scores mean a worse outcome. Mean composite score of the final visit was compared to the mean baseline score. | Once every 4 weeks for 16 weeks |