Fractional Radiofrequency With Streroids Versus Fractional CO2 Laser With Steroids in the Treatment of Keloids

Keloids are an abnormal proliferation of scar tissue that forms at the site of cutaneous injury (e.g., on the site of a surgical incision or trauma); it does not regress with time, but it tends to grow beyond the original margins of the scar. They are benign dermal fibroproliferative tumors with no malignant potential. It results from excessive proliferation of normal tissue at healing processes with loss of the control mechanisms that normally regulate the fine balance of tissue repair and regeneration. The collagen fibrils in keloids are more irregular, abnormally thick, and have unidirectional fibers arranged in a highly stressed orientation. They are initially manifest as erythematous papules, plaques or nodules devoid of hair follicles and other normal glandular tissue. They are usually purplish-red in color, firm, smooth, raised and itchy. The consistency can range from soft, doughy, rubbery and hard. Most keloids tend to grow slowly over months to a year, extending past the initial area of injury. Treatments for keloids includes; occlusive dressings, compression, intralesional steroid injections, excisional surgery, radiation, cryosurgery Laser therapy, interferon therapy, 5-fluorouracil injected intralesionally and imiquimod therapy.

Corticosteroids contribute by many mechanisms in treatment of keloids. They inhibit leukocyte functions causing tissue hypoxia. They also inhibit cellular proliferation, decreasing collagen deposition and increase collagenase that breaks down collagen fibers. They were used both topically and intralesionally, with triamcinolone acetate being the most common used type. Triamcinolone acetate treatment significantly reduce the size of keloid compared to untreated control. Reduction in size was statistically different in favor ofTriamcinolone acetonide compared to silicone gel sheet, it also showed improvement in vascularity and scar pliability and reduced scar thickness. Trans epidermal drug delivery is a novel method of drug delivery in dermatology, through the formation of micro-channels in the epidermis to increase the delivery of various substances into the skin. Many devices have been used for this method of drug delivery including microneedling devices(dermapen,dermaroller), fractional co2 laser, radiofrequency devices (RF). Radiofrequency microneedling is a well-studied, energy-based method delivering radiofrequency at \~1-2 MHz via insulated or non-insulated needles. They are fine needles that create controlled micro-injuries in the epidermis and dermis, these microchannels trigger a wound-healing cascade, stimulating collagen and elastin production.

Insulated radiofrequency microneedling delivers a focused, local injury to the dermis, sparing epidermal injury that can cause undesirable erythema, changes in pigmentation, and scarring that is often seen with laser treatments and traditional microneedling.

Radiofrequency has been used as a way of trans epidermal of drugs as in delivery of retinoic acid for treatment of atrophic scars and stretch marks, Triamcinolone acetonide for treatment of hypertrophic scars.

Radiofrequency has been used in the treatment of keloids, as it causes keloidal tissue volume reduction by inducing controlled protein denaturation or necrosis in soft tissue structures using very low levels of radiofrequency energy, then wound healing will take its normal process with scar formation and retraction of tissue, resulting in an overall reduction of volume in the treated area. The newly formed scar tissue is partially resorbed by the body over time, causing further volume reduction. It has been used in combination with steroids in treating keloids .