6. Needle-free electronically-controlled jet injector treatment with bleomycin and lidocaine is effective and welltolerated in patients with recalcitrant keloids. 155 6. Figure 4 Clinical images of keloids before and after EPI-assisted treatment with bleomycin and lidocaine. (A) Keloid lesions on the shoulder before treatment. (B) Keloid lesions on the shoulder after three EPI-assisted bleomycin treatments. The GAIS was assessed as “improved.” (C) Keloid lesion on the chest before treatment. (D) Keloid lesion on the chest after three EPI-assisted bleomycin treatments. The GAIS was assessed as “very improved.” EPI, electronically-controlled pneumatic jet-injector; GAIS, Global Aesthetic Improvement Scale Tolerability The median NRS pain score during the test treatment was significantly lower with the EPI compared to conventional needle injections (2.0 [IQR 1.5−2.5] vs. 7.0 [IQR 5.5−9.0], p < 0.001) (Table S3). The median pain score for all consecutive EPI-assisted treatments was 3.0 (IQR 2.0−5.0). The most frequently (40%, 6/15) reported adverse event was local hyperpigmentation (Table S4). Other local and transient adverse effects after treatment included local pain and sensitivity (13%, 2/15), transient local itching (7%, 1/15), hematoma (20%, 3/15), scab formation (13%, 2/15) and acneiform inflammation of the keloid (7%, 1/15). No severe adverse reactions were reported.
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