What role do intralesional corticosteroids play in the treatment of keloid scars, and how should they be administered?

Intralesional corticosteroids play a central role in the treatment of keloid scars by reducing inflammation, fibroblast proliferation, and collagen synthesis, thereby helping to flatten and soften the scar tissue. They are considered a first-line treatment option for keloids due to their efficacy in improving scar appearance and symptoms such as pruritus and pain NICE CKS. The recommended method of administration is direct injection into the keloid scar tissue, typically using a fine needle to deliver the corticosteroid evenly throughout the lesion. This approach ensures high local drug concentration with minimal systemic absorption Yin et al. 2023. Treatment is often repeated at intervals of 3 to 4 weeks depending on response and tolerance NICE CKS.

Recent studies support combining intralesional corticosteroids with other modalities, such as pulsed dye laser therapy, to enhance outcomes, especially in resistant or post-surgical keloids Rutnin et al. 2025. Additionally, systematic reviews comparing intralesional corticosteroids to other agents like botulinum toxin type A confirm corticosteroids’ superior or comparable efficacy in scar volume reduction and symptom relief Bi et al. 2019. However, corticosteroid injections may be associated with side effects such as skin atrophy, hypopigmentation, and telangiectasia, which require careful technique and monitoring NICE CKS.