4. Effects of keloid properties on treatment efficacy 101 4. History of recurrence One study involving 26 patients investigated treatment history.18 After intralesional cryotherapy a volume reduction of 40% versus 1% was observed in respectively naïve versus recurrent (previous corticosteroid injections or excision) keloids. Baseline VSS core One study involving 60 patients investigated baseline Vancouver Scar Scale (VSS).8 Higher efficacy was reported in keloids with higher baseline VSS scores compared to keloids with lower baseline VSS scores. However, no specific cut-off point for VSS and sub-analysis per treatment group (il botulinum toxin type-A, il platelet rich plasma, and il TCA) were mentioned. Other keloid properties Fitzpatrick skin type (n=2; 324 patients),4,6 baseline Patient & Observer Scar Assessment Scale (POSAS)-score (n=1; 164 patients),6 ethnicity (n=1; 39 patients),17 etiology (n=1; 50 patients),7 keloid thickness (n=1; 90 patients),11,14 and number of lesions (n=1; 44 patients),13 did not show a significant correlation with treatment efficacy. Risk of bias assessment The overall risk of bias was rated as “high” in eight studies, “some concerns” in seven studies, and “low” in one study (Fig. 2). Methodological quality was particularly poor due to bias arising from the randomization process, deviations from the intended intervention and selective reporting.
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