Bleomycin tattooing as a promising therapeutic modality in large keloids and hypertrophic scars

BACKGROUND Cryotherapy combined with intralesional triamcinolon injection is the most common traditional therapy for hypertrophic scars and keloids. The literature contains few articles on the use of bleomycin tattoo for treatment of these conditions. OBJECTIVE This study compares the efficacy of bleomycin tattoo with that of cryotherapy combined with intralesional triamcinolon injection for the treatment of keloids and hypertrophic scars. MATERIALS AND METHODS Forty-five patients with hypertrophic scars or keloids were randomly divided into two groups. Group A was treated with bleomycin tattoo, and group B, with cryotherapy combined with intralesional triamcinolon injection. There were four therapeutic sessions at 1-month intervals. All patients were followed for 3 months after the end of treatment. RESULTS Therapeutic response in lesions less than 100 mm(2) was higher than 88% in both groups, but in larger lesions, the therapeutic response to bleomycin was significantly better than cryotherapy combined with intralesional triamcinolon injection (p=.03). In group A, no relationship was observed between therapeutic response and lesion size (p=.58); however, in group B smaller lesions (< 100 mm(2)) displayed better therapeutic response (p=.007). CONCLUSIONS Bleomycin tattoo may be more effective than cryotherapy combined with intralesional triamcinolon injection in treatment of larger keloids and hypertrophic scars (size > 100 mm(2)).