Applied Evidence
Keloids: Which treatment is best for your patient?
Corticosteroid injections have proven effective for many patients, but other options may be more appropriate depending on the keloid’s location....
I did not see the use of plain lidocaine (without epinephrine) included in “Keloids: Which treatment is best for your patient?” (J Fam Pract. 2013;62: 227-233) as one option to manage keloids. Treating keloids with intralesional 2% lidocaine plain has been very rewarding for my patients and for me.
This approach has a distinct advantage over injections containing steroids because it can be repeated more frequently (every 2-4 weeks) without fear of subcutaneous atrophy, telangiectasias, or pigment change. I no longer see sections of excessive scar atrophy with uneven, patchy, “skipped” areas from the nconsistent effect that steroids can have on lesions. Lidocaine is infiltrated superficially and forced into the mid and deep sections of the keloid; the underlying and immediate neighboring subcutaneous tissue is treated as well. With repeated injections, there typically is more uniform shrinkage and color change that closely matches that of the surrounding skin.
The mechanism of action of lidocaine in the scar is a matter of conjecture. Clinicians with experience in treating keloids in such a manner believe that the lidocaine has a weak antiinflammatory effect and may serve as an irritant to stimulate the healing process.
Louis A. Kazal Jr, MD, FAAFP
Hanover, NH