Table 2.
Study design
| Author, year, country | Patients and keloids that received TAC, n | Location (keloids, n) | Outcome measure(s) | Follow-up (F), recurrence (R) | Adverse events |
|---|---|---|---|---|---|
| Belie et al. (2021) [40], Nigeria | 40 patients, number of keloids NS | Head and neck, trunk, upper limb, lower limb | Length, width, height Pain score Pruritus score | F: 3 months R: NS | Skin atrophy and hypopigmentation: 75% Ulceration: 5% Pain following drug injection: number NS |
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| Serag-Eldin et al. (2021) [28], Egypt | 10 patients with 10 keloids | Head and neck (1), chest (1), upper limb (6), lower limb (1), back (1) | VSS VRS pain and itch Patient satisfaction | F: 3 months R: none | Atrophy: 60% Hypopigmentation: 60% Telangiectasia: 80% TAC precipitations: 70% Striae: 10% |
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| Neinaa et al. (2021) [36], Egypt | 20 patients with 20 keloids | Head and neck (4), trunk (10), extremities (6) | VSS Clinical efficacy, defined by degree of VSS improvement Dermoscopic examination Histopathological and immunohistochemical assessments | F: NS R: none | Hypopigmentation: 20%, after the third treatment session |
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| Albalat et al. (2021) [44], Egypt | 40 patients with >40 keloids | Below the region of the neck and head | POSAS Efficacy, defined >50% decrease of POSAS | F: 6 weeks R: none | Hypopigmentation: 70% Telangiectasia: 20% Pain: 100% |
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| Ali et al. (2021) [38], Pakistan | 75 patients with 75 keloids | NS | Mean size (mm) Efficacy, defined >75% reduction in keloid size | F:±2 weeks R: NS | NS |
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| Kaushal et al. (2020) [6], India | 30 patients with 30 keloids | Chest and shoulder | POSAS Grade of improvement defined by reduction in POSAS score | F: 18 weeks R: 6 of 30 patients, from 27 weeks onward | Hypopigmentation: 16.6% Pain: 13.3% |
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| Hewedy et al. (2020) [42], Egypt | 20 patients with 20 keloids | Head and neck (2), chest (6), upper limb (9), lower limb (1), back (2) | VSS VRS pain VRS itch Patient satisfaction | F: 3 months R: NS | Atrophy: 35% Hypopigmentation: 50% Telangiectasia: 50% TAC precipitations: 80% |
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| Gamil et al. (2020) [41], Egypt | 26 patients with >26 keloids | Ear (10), chest (5), back (3), upper limb (6), lower limb (2) | Stony Brook Scar Evaluation Scale, i.e., improvement of width, height, color, suture marks, overall appearance Color Doppler ultrasound Patient satisfaction | F: 6 months R: none | Skin atrophy: 7.7% Pain du ring injection: 11.5% |
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| Manzoor et al. (2020) [24], Pakistan | 30 patients with 30 keloids | Earlobes, back, shoulders, front of chest | Efficacy, defined 51-100% improvement of flattening and decrease in size of lesion | F: none R: NS | NS |
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| Taweepraditpol (2020) [32], Thailand | 15 patients with 15 keloids | Face (1), ear (1), chest (3), shoulder (4), knee (5), leg (1) | Volume reduction VSS VAS pain | F: 4 weeks R: NS | NS |
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| Huu et al. (2019) [10], Vietnam | 65 patients, number of keloids NS | NS | Clinical evaluation criteria of Henderson (1998) and El-Tonsy (1996), based on height, stiffness, color, symptoms, recurrence, and side effects | F: NS R: NS | 7.5 mg/cm2: ulcers - 3.0%. Menstrual disorders: 5.6%. Hypertension: 3.0% 15 mg/cm2: ulcers - 18.6%. Acnes: 6.4%. Menstrual disorders: 25%. Hypertension: 3.1% |
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| Khan et al. (2019) [45], Pakistan | 82 patients, number of keloids NS | Below head and neck region | POSAS Efficacy, defined >50% reduction POSAS compared to baseline | F: NS R: NS | Skin atrophy: 70% Hypopigmentation: 29% Telangiectasias: 21% |
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| Rasaii et al. (2019) [34], Iran | 23 patients, with 23 keloids | NS | VSS VAS pain. VAS pruritus | F: 1 month R: NS | NS |
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| Khalid et al. (2018) [11], Pakistan | 34 patients, number of keloids NS | Mostly pre-sternal, head and neck with especially ears | Efficacy defined as >50% reduction in height Height, patient and observer assessment scale for height reduction | F: NS for keloids R: NS for keloids | NS for keloids |
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| Aggarwal et al. (2018) [31], India | 16 patients, number of keloids NS | Facial keloids excluded | Clearance defined as reduction in height of keloid to <1 mm Height, VSS VAS patient, VAS doctor | F: none R: NS | Atrophy depigmentation: 31.25% Telangiectasia: 31.25% Overall side effects: 50% |
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| Hietanen et al. (2019) [33], Finland | 25 patients with 25 keloids | Chest (6), shoulder (6), upper back (10), abdomen (3) | Remission defined as keloid flattening where no injections were feasible or needed POSAS Hemoglobin concentration, blood vessel density, fibroblast proliferation | F: none R: NS | Skin atrophy: 44% Telangiectasia: 50% |
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| Srivastava et al. (2018 Jan) [18], India | 20 patients with 20 keloids | Pre-sternal (11), trunk (5), extremities (3), face (1) | VSS VRS pain and pruritus | F: final evaluation 30 weeks after first dose R: none | Skin atrophy: 20% Telangiectasia: 15% Pain at injection site: 24% |
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| Srivastava et al. (2018 Jun) [37], India | 20 patients with 20 keloids | Pre-sternal (8), trunk (6), extremities (4), face (2) | VSS | F: NS R: NS | Skin atrophy: 5% Telangiectasia: 10% Pain at injection site: 40% |
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| Wang et al. (2018) [7], Taiwan | 17 patients with 17 keloids | Extremity (17) | POSAS, VRS pain, itching Blood perfusion scan, Masson trichrome stain, collagen I, collagen II, collagen III, collagen X Angiogenesis: VEGF, CD31. Inflammatory cytokines: TGF-ß1, IL-6 Apoptosis: MMP-13, TUNEL. Proliferation: PCNA, fibronectin, MMP-13 | F:48 weeks R: NS | NS |
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| Chen et al. (2017) [17], China | Number of patients and keloids NS (±23) | NS | Patient self-assessment, improvement ≥50% Observer assessment, improvement >50% Reduction in erythema, toughness, and pruritus | F: none R: NS | Skin atrophy and telangiectasia: 36% Almost all injections were painful |
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| Nor et al. (2017) [25], Malaysia | 21 patients with 21 keloids | Shoulders (10), chest (7), forearm (2), stomach (2) | POSAS VAS pain Patient preferring | F: NS R: NS | Skin atrophy: 23.5% Hypopigmentation: 35.3% Telangiectasia: 41.2% Pain: 100%. Erythema: 41.2%. Bleeding: 17.6%. Cutaneous necrosis: 70.6% |
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| Saleem et al. (2017) [43], Pakistan | 50 patients, number of keloids NS | NS | VSS Efficacy | F: 12 weeks R: none | Pain at time of injection, number NS |
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| Ali et al. (2016) [16], Pakistan | 19 keloids, number of patients NS | NS | Efficacy defined >50% reduction in initial keloid in terms of observer scar, absence of all complications (i.e., skin atrophy, hypopigmentation, telangiectasias, and skin ulcerations) | F:4 weeks R: NS | NS |
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| Shaarawy et al. (2015) [30], Egypt | 12 patients, number of keloids NS | NS | Volume (cm3). Height (scale: 0-3) Hardness (scale: 0-3). Redness (scale: 0-3) Itching (scale: 0-3). Pain (scale: 0-3). Tenderness (scale: 0-3). Patient satisfaction | F: 1 month R: NS | Skin atrophy and telangiectasia: 25% Mild pain or discomfort during and few hours after the procedure, number NS |
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| Payapvipapong et al. (2015) [12], Thailand | 3 patients with 3 keloids | Abdomen, back, chest, extremities | POSAS Patient satisfaction Scar thickness | F: NS for keloids R: NS | NS for keloids |
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| Uzair et al. (2015) [26], Pakistan | 40 patients with 40 keloids | NS | VSS | F: 3 months R: none | Hypopigmentation: 12.5% Pain: almost all patients, number NS Irregular menstrual cycles: 5% |
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| Khan et al. (2014) [13], Pakistan | 33 patients with 33 keloids | NS | Effectivity defined >50% reduction in initial scar height | F: 4 weeks to a maximum of 6 month; R: none | Skin atrophy and telangiectasia: 30.30% |
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| Saha (2012) [35], India | 24 patients with >24 keloids | Upper aspect of the back, chest, arms | Reduction of volume Reduction in pain Reduction in itching | F: 1 year or until recurrence R: 8 of 22 (36.36%) <6 months of last treatment | Hyperpigmentation: 12.5% Pain at injection site: 4.17% |
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| Sadeghinia (2012) [19], Iran | Number of patients and keloids NS (±20) | Face and neck, trunk, upper and lower limbs | Height (mm). Surface (mm2) Erythema (5-point scale). Induration (5-point scale) Pruritus (5-point scale). Patient self-assessment. Observer assessment | F: 32 weeks R: NS | None |
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| Prabhu et al. (2012) [23], India | 15 patients with 15 keloids | Shoulder (7), upper limb (1), chest (6), back (1) | Volume VAS pain Consistency Clinical appearance (atrophic, hypertrophic, nodular) | F: 6 months R: none | Increased pruritus: 6.7% |
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| Salem et al. (2009) [29], Egypt | 10 patients with 10 keloids | Neck, face, breast, forearm, earlobe, mastoid region, deltoid region | Flattening and size reduction VEGF expression | F: 1 year R: none | Pain: 40% Hypertrichosis: 20% |
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| Anchlia et al. (2009) [20], India | 11 patients, number of keloids NS | NS | Volume Overall response to therapy (%) | F: 3 months R: NS | NS |
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| Koc et al. (2008) [14], Turkey | 9 patients with 9 keloids | Head or neck (2), upper extremity (4), thorax (7) | NS for keloids | F: 2 months R: NS | None |
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| Berman et al. (2008) [27], USA | 9 patients, number of keloids NS | NS | Lesion size Lesion induration, erythema, pigmentary alteration, pain, pruritus Cosmetic assessment: investigator, patient Patient satisfaction scale | F: 4 weeks R: NS | None |
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| Layton et al. (1994) [39], UK | 11 patients, number of keloids NS | Face, back, chest | Degree of response (%) | F: 8 weeks R: NS | Discomfort at the time of administration |
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| Usanakornkul (2017) [21], Thailand | 40 patients with 40 keloids | Ear lobule (10), shoulders (18), sternum (18) | VAS pain Pain relief duration | NA | NS |
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| Wang et al. (2017) [15], China | 17 patients with 21 keloids | Chest (9), shoulder (3), back (1), arm (3), mandible (1) | VAS pain Verbal descriptor scale | NA | NS |
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| Jong kajorn pong (2021) [22], Thailand | 17 patients with 21 keloids | Ear (10), neck (1), back (2), chest (10), abdomen (5), upper extremities (11), lower extremities (4) | VAS pain | NA | None for ice packing |
Table 2 presents study design-related data including outcome measures, follow-up period, recurrence, and adverse events. NS, not specified; NA, not applicable; VSS, Vancouver Scar Scale, POSAS, Patient and Observer Scar Assessment Scale; VRS, verbal rating scale; IQR, interquartile range; SEM, standard error of the mean. *Data difficult to acquire from graph or diagram.