7. Needle-free jet Injector-assisted triamcinolone treatment of keloids and hypertrophic scars is effective and well tolerated in children. 189 7. substantial, they are considerably lower than the cost related to repetitive treatments under general anesthesia, which also carries significant additional safety risks. Lastly, a substantial amount of residue on the skin was observed directly after EPI-assisted injections. However, a previous ex-vivo study demonstrated that EPI-assisted injections distribute more evenly and consistently in the dermis than CN-assisted injections.19 For this reason, a smaller dose might be needed with EPI. Eventually, this smaller dose may also declare a smaller number of mild adverse events compared with Acosta et al.14 The strengths of this study include the real-world treatment setting using a local standard operating procedure with a predefined treatment interval and device settings. Another strength is the usage of both patient- and physician-reported outcomes. We used a childcentered approach, by proactively involving the children with their treatment. Moreover, we consistently used a VAS tool for the assessment of patient symptoms (pain and itch) and procedure-related pain, which was easy to understand for our population. The limitations of this study are the retrospective design, the lack of a control group, and a small sample size. A follow-up time of 4–6 weeks has been maintained. However, a longer follow-up time is needed to evaluate the long-term effect of this treatment. Moreover, selection bias might play a role in the patient satisfaction and pain scores, as most patients had needle phobia.
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