Background: Numerous treatment modalities have been used to treat keloids and hypertrophic scars, but the optimal treatment has not been established. Objectiv e: The aim of this study was to determine the efficacy and safety of intralesion al jet injection of bleomycin as therapy for keloids and hypertrophic scars that are unresponsive to intralesional steroid injection. Methods: The study include d 14 patients with 15 keloids or hypertrophic scars that had not responded to a minimum of three intralesional injections of triamcinolone acetonide. Multiple j et injections of 0.1 ml of bleomycin (1.5 IU/ml) were administered to each lesio n, with injection sites spaced 0.5 mm apart. Injections were repeated each month . Scar height was measured, and scar pliability and erythema were scored at base line and then monthly during the treatment and followup periods. Patients’self -assessments of subjective symptoms (pruritus and pain)were also scored. Clinic al improvementwas defined primarily on the basis of scar height reduction (perce ntage reduction from baseline), and was classified using the following scale: co mplete flattening (100%), highly significant flattening (> 90%), significant f lattening (75-90%), moderate flattening (50-75%), and minimal flattening (< 50%). Preand post-treatment mean values for scar height, scar pliability, eryt hema, pruritus and pain were statistically compared. Results: The number of sess ions required to successfully treat the lesions ranged from two to six. Eleven l esions (73.3%) showed complete flattening, one (6.7%) showed highly significan t flattening, two (13.3%) showed significant flattening, and one scar (6.7%) s howed moderate flattening. The mean scar height was significantly lower, and the mean scores for scar pliability and erythema were significantly better at the e nd of treatment (P < 0.001, P < 0.001 and P < 0.001, respectively). The mean sco res for pruritus and pain also improved significantly (P < 0.001 and P=0.01, res pectively). The observed side-effects were hyperpigmentation (four lesions) and skin atrophy (three lesions). No recurrences were noted during follow up (mean duration of 19 months). Conclusions: Intralesional jet injection of bleo mycin is an effective and safe method of treating keloids and hypertrophic scars that are unresponsive to intralesional steroid therapy.
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