9. English and Dutch summaries 224 SUMMARY Chapter 1 is the general introduction of this thesis. This chapter focuses on the importance of an innovative, effective, safe and patient-friendly treatment for keloids. Keloids are pathologically-growing scars that develop after inflammation or trauma. These fibroproliferative scars can cause a reduced quality of life due to symptoms such as pain, itching and restriction of movement. The patient population with keloids is diverse and keloids can cause limited to serious complaints. Patients with severe keloids in particular can experience many symptoms. Nevertheless, these keloids are difficult to treat. This chapter introduces why needle-free injections with bleomycin could potentially be a good alternative in this patient population. The current standard treatment consists of conventional needle injections with triamcinolone acetonide (TCA). However, treatment with needle injections and TCA has several limitations. On one hand, administering medication through needle injections is suboptimal. Needle injections can be painful and are not suitable for patients with needle phobia. Keloids, and especially severe keloids, also often consist of very stiff tissue. As a result, high resistance in keloid can be expected, which hinders successful drug administration. Treatment with needle injections is also associated with high interoperability, which can lead to differences in effectiveness. On the other hand, treatment with TCA often leads to keloid recurrence due to the temporary effects of TCA. Therefore, a treatment with long-lasting effects is desirable. In contrast to TCA, treatment with bleomycin can achieve a longer lasting effect. Chapter 2 describes the clinical evidence for the effectiveness and safety of needle-free jet injectors for the treatment of dermatological conditions. Both traditional spring loaded jet injectors and more innovative electronic pneumatic jet injectors (EPI) are used in dermatology. Unlike traditional jet injectors, the EPI allows to adjust the pressure and volume of the injections. This means that you can achieve controlled drug release with an EPI. The findings of this chapter demonstrate that needle-free jet injectors are used for a variety of dermatological indications, such as recalcitrant warts, skin cancer and pathological scars such as keloid. Most evidence was found for good effectiveness and
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