8. General discussion 213 8. General conclusions This thesis presents the evaluation of an alternative patient-friendly treatment for patients with recalcitrant keloids using a needle-free electronic pneumatic jet-injector (EPI). The evaluation encompasses different types of research, including preclinical and clinical studies. The studies outlined in this thesis show the clinical applicability of EPI to treat several dermatologic indications, and specifically (recalcitrant) keloids. We found notably lower treatment efficacy in older keloids, keloids located on the chest, extremities, auricle, and shoulder, larger keloids, lower baseline Vancouver Scar Scale score, and keloids with history of recurrence. This thesis showed that EPI-assisted bleomycin is an effective and tolerable alternative option to treat patients with recalcitrant keloidal scars. The addition of lidocaine to EPI-assisted bleomycin results in a minimally painful and patient-friendly treatment. Furthermore, our results indicate that using EPI and triamcinolone acetonide to treat keloids and hypertrophic scars in children offers several benefits. However, both needle- and jet injections demonstrate large heterogeneity in biodistribution in severe keloids, leading to variability in treatment efficacy. Therefore, a minimally invasive needle-free drug delivery treatment that ensures more consistent biodistribution in severe keloids is needed.
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