1. General introduction 26 performed a systematic review, in which we describe the available evidence for clinically relevant keloid properties. Chapter 5 The fifth chapter describes the clinical application of EPI-assisted bleomycin in in vivo severe and recalcitrant keloids. In this chapter we performed a double-blinded, randomized, placebo-controlled trial with split-lesion design, to investigate the efficacy and safety of EPI-assisted bleomycin compared to placebo in patients with severe keloids. Chapter 6 The sixth chapter describes the findings of a retrospective cohort study that investigated the effectiveness, tolerability and patient satisfaction of EPI-assisted bleomycin combined with lidocaine in patients with recalcitrant keloids in a real-world setting. Chapter 7 The seventh chapter describes treatment with the EPI in children, to explore a traumafree, minimally invasive treatment option in children with keloids and hypertrophic scars. In this chapter we performed a retrospective cohort study in children, to study the effectiveness, tolerability and patient satisfaction of EPI-assisted triamcinolone in children with keloids or hypertrophic scars.
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