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, which helps to flatten and soften the scar tissue. They are considered a first-line therapy for keloids due to their efficacy in improving scar appearance and symptoms such as pruritus and pain NICE CKS Yin et al. 2023.

The recommended method of administration is direct injection of corticosteroids into the keloid lesion. This is typically performed using a fine needle to deliver the corticosteroid evenly throughout the scar tissue, often at intervals of 3 to 4 weeks depending on clinical response and tolerance NICE CKS Yin et al. 2023.

Triamcinolone acetonide is the most commonly used corticosteroid for intralesional injection in keloids. The dose and frequency are tailored to the size and thickness of the keloid, with care taken to avoid complications such as skin atrophy or hypopigmentation NICE CKS Bi et al. 2019.

Recent studies suggest that combining intralesional corticosteroids with other modalities, such as pulsed dye laser therapy, may enhance treatment outcomes compared to corticosteroids alone. This combination can improve scar texture and reduce recurrence rates, although corticosteroid injection remains the cornerstone of treatment Rutnin et al. 2025.