Efficacy and safety of glucocorticoid-based therapies in the management of keloids: a systematic review and meta-analysis of clinical outcomes

Background Hypertrophic scars and keloids are fibroproliferative conditions that are resistant to treatment and recur often. The effectiveness and safety of glucocorticoid-based treatments and their combinations in the treatment of keloid disease were objectively assessed in this systematic review and meta-analysis. Methods 42 randomized and comparative clinical studies were considered. Intralesional, topical, or aided glucocorticoid delivery were eligible treatments. Results The use of corticosteroids alone in intervention methods (SMD = 1.28; 95% CI: 1.05–1.51; p < 0.05; I 2 = 43%). The use of 5-FU-based treatments yielded the same results (SMD = 1.15; 95% CI: 0.97–1.34; p < 0.05) with very low level of inconsistency. The laser treatment approach significantly improved the scar condition (SMD = 0.99; 95% CI: 0.81–1.16; p < 0.05). CCD interventions had been significant changes and improvements (SMD = 1.07; 95% CI: 0.97–1.18; p < 0.05; I 2 = 47%). Techniques with and without delivery, such as steroids + 5-FU, laser-assisted delivery, microneedling, or cryotherapy-assisted corticosteroid delivery, provided consistently better results. The GRADE evaluation indicated that the certainty of evidence was poor for microneedle and cryotherapy-aided techniques, medium for recurrence rate, cosmetic results, and negative consequences, and excellent for scar volume decrease, pain, and pruritus relief. The adverse outcomes, primarily telangiectasia and moderate atrophy, were temporary and self-resolving. Conclusion The best and safest treatment for keloid management is intralesional TAC, based upon the data at hand. The mainstay of clinically proven scar therapy is still multimodal, glucocorticoid-centered regimens that show consistent therapeutic outcomes.