8. General discussion 200 Keloids are fibroproliferative scars that are regarded as chronic inflammatory skin disorders.1 Patients with keloids constitute a highly heterogenous group of individuals, having mild to very severe keloids. Severe keloids can be extremely resistant to treatment, generally cause significant pain, itch and restriction of movement, resulting into a marked decrease in quality of life.2 Over the past decades, multiple treatment approaches have been suggested for keloids, with the gold standard being intralesional treatment with corticosteroids using conventional needles.3 This treatment can be effective, but is often associated with procedure-related pain. Unfortunately, minimally invasive, efficacious and patient-friendly alternatives to conventional needle-injections are currently not common in clinical practice. In addition, severe forms of keloids also referred to as ‘recalcitrant’ keloids, may be extremely difficult to treat, with high recurrence rates posing a major clinical problem. In the past decades, electronically controlled needle-free injectors were developed that may help to overcome many problems related to the use of conventional needles. As there are multiple knowledge gaps with regard to the treatment of keloids and hypertrophic scars with needle-free jet injectors, the aim of this thesis was not restricted to a single type of research. We designed and performed studies from bench to bedside: preclinical, literature, prospective and retrospective clinical studies. In this general discussion we aim to integrate the most important findings of this thesis and elaborate on perspectives for keloid treatment, leading the way to more high-quality research and ultimately the improvement of patient care in clinical practice.
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