Electroablation Plus Pharmacotherapy Leads to Reduction in Keloid Volume

Combining electrocoagulation with pharmacotherapy is efficacious in reducing keloid scar volume, according to a study published in the Journal of Cosmetic Dermatology.¹

This efficacy is achieved due to the combination therapy's ability to inhibit collagen deposition, angiogenesis, and cell proliferation.

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Background and Methods

Corticosteroid monotherapy delivered via intralesional injection, though considered a first-line therapy for keloid scarring, is often hindered by limited efficacy, according to a study published in Systematic Reviews.² In the review, researchers noted that previous literature has supported the clinical improvements achieved by corticosteroid monotherapy; however, the degree of improvement was reportedly variable and inconsistent in nature.

Citing a previous study (Wu et al; 2021) demonstrating the efficacy of electrocoagulation in unresectable ampullary tumors, researchers Zhao et al sought to assess the efficacy of combining electrocoagulation with a pharmacotherapy approach.

Fresh porcine liver tissue underwent electrocoagulation via a high-frequency electrosurgical unit with a 32.5 mm long and 0.6 mm wide needle for thermal ablation. Ablation was performed at power settings of 20 to 80 watts for 0.5, 1, and 2 seconds.

Human keloid specimens, cleared of epidermal and adipose tissues, were cut into blocks and implanted subcutaneously into nude mice. Mice with implanted keloid tissues were divided into treatment groups: control, electrocoagulation, pharmacotherapy, and combined treatment. One week post-treatment, researchers analyzed keloid tissues for volume and weight changes.

In addition, 6 human patients at least 18 years of age were invited to participate in a portion of the clinical trial involving routine skin disinfection, local anesthesia with lidocaine, and electrocoagulation of the keloid using a needle electrode. A mixture of betamethasone and 5-fluorouracil was injected locally based on the tissue size in 3 sessions over a 3-week period.

Findings

In mice, the combined treatment (electrocoagulation + glucocorticoid + 5-fluorouracil) significantly reduced keloid volume by approximately 40% compared to the control group.

A histological analysis showed a significant decrease in fibroblast numbers and collagen fiber disarray in treated tissues, and immunohistochemistry revealed reduced CD31 expression and microvessel density, indicating decreased angiogenesis. Additionally, the proportion of PCNA-positive cells dropped significantly in the treatment group.

Within the human clinical trial setting, researchers measured the efficacy of combined treatment was measured using the Vancouver Scar Scale (VSS) and Patient and Observer Scar Assessment Scale (POSAS).

Post-treatment, patients showed significant reductions in total VSS scores, particularly in pigmentation, vascularity, height, and pliability.

Both patient and observer scores improved significantly. Patients reported decreases in thickness, relief, pliability, and surface area, while observers noted reductions in pain, pruritus, stiffness, thickness, and irregularity.

Conclusions

"Ablation combined with pharmacotherapy significantly reduces the volume of keloids by inhibiting angiogenesis, proliferation, and deposition of the extracellular matrix and promoting collagen degradation with high efficacy and safety," according to Zhao et al.

Potential limitations of the study included its limited sample size and brief follow-up period, and its lack of exploration of the applicability of other types of thermal ablation and drugs or the molecular mechanisms of combining ablation with pharmacotherapy.

However, researchers noted that the study served as validation of the efficacy of needle-assisted electroablation plus traditional, first-line therapies, prompting further research.

References

1. Zhao J, Zhai X, Xu Z, et al. Novel needle-type electrocoagulation and combination pharmacotherapy: basic and clinical studies on efficacy and safety in treating keloids. J Cosmet Dermatol. July 18, 2024. https://doi.org/10.1111/jocd.16453
2. Walsh LA, Wu E, Pontes D, et al. Keloid treatments: an evidence-based systematic review of recent advances. Syst Rev. 2023;12(1):42. March 14 2023. doi:10.1186/s13643-023-02192-7