British Journal of Dermatology (1994) 130. 498-501. A comparison of intralesional triamcinolone and cryosurgery in the treatment of acne keloids A.M.LAYTON. J.YIP AND W.J.CUNLIFFE Department of Dermatoloijif. The General Infirmary at f^eds. Great George Street. Leeds LSI 3EX. U.K. Accepted for publication 22 September 199 J Summary Keloid scarring presents a difficult therapeutic problem. It is a recognized sequel to acne vulgaris. and may be extensive and disfiguring. Tbe data from this double-blind study, in wbich intralesional triamcinolone or cryosurgery were used as treatment for keloids, demonstrate that by treating early, and in particular vascular, keloids witb tbe latter, 8 5% will show a moderate to good response in terms of flattening. Treatment with intralesional triamcinolone was also beneficial, but the response to cryosurgery was significantly better in early, vascular lesions. Keloid scars are notoriously difficult to treat. Those which follow acne are generally more common on the trunk than the face.'^ Many treatment regimens have been advocated in the past, including intralesional triamcinolone,' '' cryosurgery.''"** and a combination of these two modalities.^'" However, there have not been any controlled trials to compare the efficacy of intralesio- nal triamcinolone with cryosurgery in the treatment of acne keloids. The aim of this study was therefore to compare these two treatment modalities in a double- blind fashion. Methods Eleven patients {seven male and four female) with multiple acne keloids were included in the study (Table 1). Demographic details, past medical history, relevant family history, medication, and duration of scars were recorded by one observer. No previous treatment for acne keloids had been administered. Assessments of the keloids were made pretreatment, at 4 and 8 weeks during treatment, and at 8 weeks post-therapy. The assessments included a clinical evaluation and objective measurements. The clinical examination was performed by the same observer, and included an evaluation of the Table 1. Demographic details of patients included in the study Males Females Number of patients Mean age (years) Mean duration of keloids (years) 7 20 2 4 28 2 site, number and palpability of the keloids. The palpabi- lity was allocated a grade, as follows: 0, nil; 1. minimal: 2, moderate; i, severe. Objective assessments consisted of photography under uniform lighting conditions, measurement of the maximum diameter with calipers, and assessment of depth using tikrasound examination (ALT Ultramark 9). The blood flow within the keloid, and in apparently normal skin around the periphery of the keloid. was assessed using laser-Doppler flowmetry. The difference between lesional and perilesional blood flow was calcu- lated, and used in subsequent analyses. Non-parametric statistics with Mann-Whitney U and Spearman rank correlation tests were used to interpret the results. The keloids were divided randomly into two groups on each site in each patient. Treatment was also randomly allocated to one or other group, and administered by an independent physician. Cryosurgery was administered with a Cryoderma Spray (nozzle diameter C; CRYAC. Brymill Corporation Alcon Pharmaceuticals Ltd.) as two 15-s freeze-thaw cycles. This was performed according to the spot freeze technique, i,e. allowing the ice-ball to reach the outer limit of the treatment area, including a small rim of normal tissue, before counting began. Injections were administered as 1 ml triamcinolone (5 mg/ml) into each allocated keloid. One keloid in each area was left untreated as a control. Results Response to therapy was similar in both sexes. There was no significant change in diameter with either 498