Background and Objectives: Recent studies have demonstrated the efficacy of pulsed dye laser treatment of keloids. The effect of intralesional corticosteroids is well established in the management of symptomatic keloids. To date, there has been no comparative study comparing the effects of these two treatment modalities. Additionally, we speculate that there may be an additive effect of the two treatments, though the ideal sequence of treatment is unknown. This study aims to compare 585nm pulsed dye laser treatment with intralesional corticosteroid injection in the management of symptomatic keloids by evaluating objective and subjective clinical effects.

Study Design/Patients and Methods: Twenty-two patients with multiple keloids were selected with symptomatic lesions ranging in size from 1.0cm to 22.5cm. One keloid site was treated with a series of 5 pulsed dye laser treatments monthly, the second received steroid injections simultaneous to the laser treatment, the third site received three laser treatments followed by two injections, and the last site received injections for three treatments followed by laser for two treatments. The patients were followed up at 3 months after the last treatment. Photographs were taken pre-operatively and at 3 months after the last session. They were used for objective and comparative analysis. The patients also completed a subjective questionnaire reporting their symptoms.

Results: Improvement was tabulated from the photographic assessment on an improvement scale from 0 (no change) to 4 (greater than 75% clearing). There were clinical improvements in all groups and the greatest improvement was found in the laser followed by injection group. This difference was statistically significant compared to the three other groups. Subjective reports found the laser alone treatment to have the greatest improvement. Purpura, pain, and crusting were most commonly reported after laser treatments. Hypopigmentation only occurred in one case, and there were no reports of hyperpigmentation or additional scarring.

Conclusions: This study demonstrates that the combination of pulsed dye laser treatment and steroid injection is more effective in reducing the size of symptomatic keloids than either treatment alone. Laser followed by injection is also better than the reverse order of treatment.