5. Needle-free electronically-controlled jet injector treatment with bleomycin is efficacious and well-tolerated in patients with severe keloids: results of a randomized, double-blind, placebo-controlled trial. 118 Intralesional administration of bleomycin with conventional needles has several disadvantages: it is not a patient-friendly treatment in patients with severe keloids because multiple painful injections are usually needed to achieve significant clinical improvement, and it cannot be used in patients with needle phobia.19 As an alternative for needle injections, less painful intralesional delivery methods such as needle-free electronic pneumatic assisted injection (EPI) were developed.20 A few retrospective studies showed that intralesional EPI-assisted triamcinolone acetonide (TCA) was effective, minimally painful and resulted in high treatment satisfaction in patients with keloids and hypertrophic scars.21,22 However, since intralesional TCA is associated with frequent recurrences, it is often less effective in severe keloids.23 Therefore, in this double-blind, randomized, vehicle-controlled, split-lesion trial, we investigated whether intralesional bleomycin delivered with an EPI is a patient-friendly delivery method with better treatment responses than placebo, in severe keloids.
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