Comparison between intra-lesional steroid injection versus autologous platelet-rich plasma therapy following surgical excision of aural keloid (Difference in effectiveness of intra lesional steroids and PRP for aural keloid treatment)

Comparison between intra-lesional steroid injection versus autologous platelet-rich plasma therapy following surgical excision of aural keloid (Difference in effectiveness of intra lesional steroids and PRP for aural keloid treatment) | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Comparison between intra-lesional steroid injection versus autologous platelet-rich plasma therapy following surgical excision of aural keloid (Difference in effectiveness of intra lesional steroids and PRP for aural keloid treatment) Nukhbat ullah Awan, Tooba Fida, Khadija Waheed, Uzma Malik FCPS, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3154595/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background : Keloids are benign growth of dense fibrous tissues from an abnormal healing response to a cutaneous injury, extending beyond the original borders of the wound. Intralesional triamcinolone acetonide (TA) is their first-line therapy, but commonly associated with side effects or recurrence. Platelet rich plasma (PRP) is an autologous blood-derived product with promising results in improving wound healing with lower keloid occurrence. Objective: To compare the efficacy of TA versus PRP in treatment of Aural keloid after excision. Place and Duration of Study: The department of Ear, Nose and Throat and Head and Neck Surgery, King Edward Medical University, Mayo Hospital, Lahore, from January 2021 to October 2021. Study Design: Randomized controlled trial Methods: Patients with aural keloids type I and II were enrolled in the study. 84 patients with aural keloids were divided randomly into two equal groups, A and B. Patients with aural keloids only type I and type II (acc. To Chang Park classification) and Patients without prior treatment were included and those presenting with Hypertrophic scars, Type III, IV, V (in accordance to Chang Park classification) and Pregnancy were excluded in our study. Group A received intralesional TA (20 mg/ml) after excision for 4 sessions, first on the day of surgery rest 3 sessions 1 week apart. Group B patients received intralesional PRP after excision in 4 sessions similar to TA. Evaluation was done after 3 months by The Patient and Scar Observer Assessment Scale (PSOAS). Results Of the 84 patients included in our study all 84 were females, having mean age around 22-23 years with 72% of them being unmarried. The mean scores of POSAS Patient scale for pain was found to be 15.65 in grp A and 27.23 in grp B, with color having mean score of 19.76 (grp A) and 27.24 (grp B), itching 19.5 (grp A) and 27.8 (grp B), stiffness 19.83 (grp A) and 27.8 (grp B), thickness 19.36 (A) and 28.81 (B), irregular scar 19.47 (A) and 27.3 (B). There was statistically significant improvement in all parameters of PSOAS of group B patients with their mean consistently being lower than group A patients i.e those receiving TA. Both groups had similar complications which were minor with hyperpigmentation being most of it all. Conclusion: We concluded that PRP is superior in preventing recurrence of aural keloid after surgical excision. Aural Keloid Platelet Rich Plasma Recurrence Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Key points To compare the efficacy of TA versus PRP in treatment of Aural keloid after excision. Patients with aural keloids type I and II were enrolled in the study and divided into two groups i.e. one receiving PRP and other steroids Evaluation was done after 3 months by The Patient and Scar Observer Assessment Scale (PSOAS). PRP is superior in preventing recurrence of aural keloid after surgical Introduction A keloid is described as a benign overgrowth of dense fibrous tissue that spreads beyond the original boundaries of the wound and results mainly from an aberrant healing process to a cutaneous or deeper injury.[ 1 ]Although the exact mechanism and pathogenesis has not been brought to light up to date yetit is known that it occurs as a result of the imbalance between the excessive synthesis of the collagen and extracellular matrix and decreased breakdown and removal of these products as a part of the normal healing process.[ 2 ]. A heightened and chronic background inflammatory reaction along with inflammatory mediators mainly transforrming growth factor, and fibroblast response that fosters an environment suitable for keloid formation. [ 3 ]. The importance of immunological responses has recently risen to the forefront as one of the causes of keloid formation, based on higher levels of immunoglobulins, lymphocytes and mast cells as well as the description of a keloid-associated lymphoid tissue (KALT) [ 4 ] The clinical appearance of keloid scars varies greatly, with the majority having the classic "claw-like" look and only a small minority resembling a butterfly lesion, polypoidal mass or nodule [ 5 ] They often present as a solid, bosselated, and frequently glossy mass that may also have hyperpigmentation. keloids can result in contracture as well as pruritus with pain symptoms, but majority of patients are more worried about cosmesis than they are about debilitation. The appearance can occasionally be extremely deforming, which can cause psychosocial problems and worse quality of life [ 6 ]. The importance of using good surgical technique and avoiding post-operative stress or friction cannot be overstated. With varying degrees of success, numerous methods including laser therapy, cryotherapy, interferon therapy, silicon dressings, compressive therapy, retinoids and corticosteroid injections, radiation, and surgical excision have all been tried to treat keloid growths.[ 7 ],[ 8 ],[ 9 ],[ 10 ]In addition to pressure treatment, physical therapies which include camouflage cosmetics, physiotherapy, massage, hydrotherapy and pressure sheets, magnets, pressure clips and buttons have been used [ 11 ],[ 12 ] Overall, these interventions have inadequate and uneven levels of evidence. KD has not yet been completely successfully treated and the only way to confidently and permanently lessen the suffering is to fully comprehend keloid development at the molecular level [ 13 ] Another important mode of treatment is the use of PRP to treat the keloids.Because of its capacity to transfer a high concentration of growth factors to the target tissues due to the components within the alpha and dense granules, PRP is already being employed in various disciplines for the treatment of acute and chronic wounds. In order to enhance tissue remodeling, angiogenesis, and wound healing, a bio-molecular cocktail is used. This restores the skin’ s balance to normal synthesis and cell proliferation which serves as the basis for its use in keloid treatment. Not much work has been done considering PRP and comparing it with other established treatment methods. The aim of our study is compare between intra-lesional steroid and PRP application in terms of recurrence rate, patient satisfaction and characteristics of post procedure keloids like vascularity, pigmentation, pliability and thickness etc. Materials and Methods This research is a randomized control trial studied at the department of ENT, KEMU/MAYO hospital, Pakistan and conducted in a duration of 12 months after the IRB approval of synopsis. SAMPLE SIZE: A Sample size of 84 patients (42 in a group) is estimated by using 5% level of significance,90% power of test with expected percentage of recurrence of keloid in Autologous platelet rich plasma as 29% and Intra-leisonal steroid as 11%. SAMPLING TECHNIQUE Non-Probability, convenient sampling SAMPLE SELECTION: Inclusion Criteria: Patients with aural keloids- only type I and type II (acc. To Chang Park classification) Patients without prior treatment Exclusion criteria: Hypertrophic scars Type III, IV, V (in accordance to Chang Park classification) Pregnancy. The use of long-term systemic corticosteroids, systemic chemotherapy, or immunosuppressive drugs. Hypersensitivity to adrenaline and local anaesthetics Patients with renal or liver diseases. Data collection procedure The study was approved by the board of studies & IRB committee, KEMU. A sample size of 84 patients categorized into two groups, A and B (42 in each) based on simple random technique was subjected to a prospective and comparative study. After obtaining a detailed written informed consent, history and clinical examination was done. patients fulfilling the inclusion criteria were enrolled in the study. All patients underwent Liver function tests and renal function tests. Patients within group A were treated with PRP, first injection at the time of excision before closure and three additional injections administered with a week’s intervals Patients within group B were treated with intra-lesional triamcinolone acetonide 40mg/ml along the suture line. First dose, at the time of excision after closure and then on post-operative weeks 1,2,3 Patients then were followed up weekly when they come for their next dose and last evaluation was done 45 days after their last dose. Evaluation of results for all the 84 patients was done on basis of POSAS Observer scale and response to treatment was calculated based on PSOAS Patient scale after 45 days and evaluation done then. Data analysis procedure: Spss 26 was used for data entry and accumulation. Quantitative variables like age, width, height were presented in the form of mean +- SD Qualitative variables like gender, pain, itching were presented as frequency and percentage. Comparison of recurrence of two groups score that is group A platelet rich plasma and group B intralesional steroid was done by paired T test. Significant difference was considered when p value will ≤ 0.05. Results The evaluation of patients was done on the basis of POSAS scale. Of the 84 patients included in our study all 84 were females, having mean age around 22–23 years with 72% of them being unmarried. The data gathered when analyzed cleathere is statistically significant improvement in all parameters of POSAS of group A patients with their mean consistently being lower than group B patients i.e those receiving TA. The parameters considered were pain, color, itching, stiffness, thickness and irregularity of scar. The results are shown individually for each variable in column chart and table forms Table 3 Table comparing the score for Color of both groups A and B. platelet rich plasma (A) Steroid (B) Mean Standard Deviation Mean Standard Deviation is the scar color different from the color of your normal skin at present? (FPS) 5.45 1.09 7.00 1.13 is the scar color different from the color of your normal skin at present? (SPS) 5.14 1.00 6.69 1.09 is the scar color different from the color of your normal skin at present? (TPS) 4.79 1.05 6.79 1.09 is the scar color different from the color of your normal skin at present? (FoPS) 4.38 1.15 6.76 1.21 total 19.76 27.24 Table 4 Table comparing the score for Stiffness of both groups A and B. platelet rich plasma (A) Steroid (B) Mean Standard Deviation Mean Standard Deviation is the stiffness of the scar different from your normal skin at present? (FPS) 5.57 .83 7.07 1.16 is the stiffness of the scar different from your normal skin at present? (SPS) 4.95 .99 6.81 1.21 is the stiffness of the scar different from your normal skin at present? (TPS) 4.95 1.08 6.93 .87 is the stiffness of the scar different from your normal skin at present? (FoPS) 4.36 1.03 6.74 1.15 total 19.83 27.8 Figure 7.:- column chart comparing the score for Overall opinion for patient scale of both groups A and B. Discussion Keloids are typically thought of as benign lesions and can be identified by excessive collagen synthesis, uncontrolled collagen deposition along with glycosaminoglycans, and increased proliferation of fibrogenic cells, leading to the formation of significant amounts of ECM around wounds on the skin's dermis(14). Although they remain to be challenging to cure due to their unclear etiology and rapid proliferative proliferation, patients frequently experience severe psychological anguish as a result of their appearance in addition to frequent pain and suffering. (15) Although these lesions have long presented treatment difficulties to cosmetic plastic surgeons, there is still no agreement throughout the surgical profession as to which approach yields the best results. Combination therapy, such as surgical excision combined with intralesional injections of antineoplastic drugs, botulinum toxin, corticosteroids, and pressure splints, has produced inconsistent results in prior studies.(16) PRP has been the focus of numerous investigations in a variety of medical domains involving tissue repair procedures for about 20 years. Numerous early growth factors, such as fibroblast growth factor, PDGF, and insulin-like growth factors, as well as more delayed growth factors, such as epidermal growth factor, vascular endothelium growth factor plus TGF-β, are released as a result of platelet activation. In addition to fibrinogen, vitronectin, and fibronectin, platelets also secrete additional proteins that are crucial for controlling cellular connections and spatial organization. Growth factors produced by platelets can stimulate the division of mesenchymal cells, such as fibroblasts plus endothelial cells, as well as the chemotaxis of macrophages, monocytes, and polymorphonuclear cells. (17) When these growth factors are released, they set off a variety of signaling pathways that stimulate angiogenesis, cell proliferation, differentiation, and the production of fresh ECM for tissue regeneration. Interleukin 1 levels and cartilage oligomeric matrix protein production were shown to decrease in PRP with high platelet counts and low leukocyte counts, indicating greater catabolism, and decreased matrix synthesis, including decreased collagen types I and III synthesis in the tissues. (18) Additionally, it has been demonstrated that PRP might reduce inflammatory signals and support tissue remodeling by encouraging a more orderly deposition of collagen. (19) As a result, PRP may significantly influence homeostasis through tissue repair by helping to re-establish a natural balance. A significant reduction in keloid recurrence and an improvement in the look of keloid scars, as seen after PRP injection in the surgical site following keloid excision. (20) It has been demonstrated that TA causes keloid regression via a wide range of pathways. By preventing leukocyte and monocyte movement and phagocytosis, it firstly reduces inflammation. Second, because it is a potent vasoconstrictor, less oxygen, and nutrients are delivered to the wound bed. Thirdly, it slows re-epithelization and the production of new collagen by inhibiting keratinocytes and fibroblasts through an anti-mitotic effect. Additionally, it might lower plasma protease inhibitors, enabling collagenase to destroy collagen by freeing up more protease. (21) Alpha-1-antitrypsin, and alpha-2-macroglobulin levels, are also significantly reduced by TA and these levels are typically higher in keloidal tissue, which naturally inhibits collagenase in human skin. (22) The effectiveness of autologous platelet concentrates as an adjunct therapy to surgical excision in the treatment of keloid scars resistant to standard treatments was assessed in a study by Hersant et al [99]. This study involved 17 patients having keloid scars who had extra-lesional keloid resections but had not responded to radiation or 4 cortisone injections. PRP was injected intraoperatively, followed by three times separated by a month. (P 0.001) The VSS significantly increased. They also reported improved discomfort and a significant reduction in scratching (P = 0.003). Additionally, throughout PRP injection sessions as well as two years following treatment, no side effects were recorded. (23) Jones et al., [100] evaluated 40 patients who underwent surgical excision plus PRP therapy to heal their keloid scars. Using the Kyoto Scar Assessment Scale (KSAS), this method received a 61% excellent rating, 24% good, 3% fair, and 12% poor rating during a three-month follow-up. Jones et al. [101] evaluated 49 patients with ear keloids in a different study and found that extralesional surgical excision followed by the application of autologous PRP to the wound site resulted in a 94% success rate. (24) Additionally, Azzam et al., [102] studied 50 patients with auricular keloids who had triple combination therapy, which included cryosurgery, PRP, and surgical excision. Using VSS, this method was evaluated 12 months after treatment and revealed a substantial improvement in keloid height and consistency (P 0.05), but not in pigmentation or vascularity. (25) The small sample size, a brief follow-up time, and the lack of information regarding PRP's platelet and leucocyte concentration have been the study's weaknesses. Based on the effectiveness of platelet-rich plasma that has been previously studied and the findings of our study, there are low risks of recurrence due to the consistently low score for all criteria when compared to steroids on the POSAS scale. In the current investigation, group A (steroid) showed higher telangiectasia than group B. In contrast to PRP, intralesional TA has been proven to cause problems including hypopigmentation, mixed pigmentation, telangiectasia, necrosis, and ulcerations when used to treat keloid lesions. There is a need to further study the comparison between intralesional steroid injection versus autologous platelet-rich plasma therapy following surgical excision of aural keloid for a greater duration and more sample size that might suggest variations. Conclusion One could draw the conclusion that PRP intralesional injection is a successful therapeutic approach for keloids. PRP is a potentially effective, affordable and easily accessible autologous elixir. It should therefore be regarded as the first line of treatment for keloids in addition to patients who are resistant to all other forms of cure and as a new choice in patients with challenging aural keloids. To verify our findings, larger prospective randomized studies and longer follow-ups are required. Declarations ETHICAL APPROVAL AND CONSENT TO PARTICIPATE This study was approved by the IRB ethical committee of King Edward medical university and Lady Aitchison Hospital, Lahore under approval number 1914/REG/KEMU/2022 dated 23/2/2022. Participants were informed about the potential risks and benefits of the study. The study was conducted in accordance with the Declaration of Helsinki, and all participants' confidentiality and anonymity were maintained. Participation in this study was voluntary, and participants had the right to withdraw from the study at any time without penalty. Participants' privacy and confidentiality was maintained, and their data was used for research purposes only. By signing the consent form, they indicated that you have read this information and voluntarily consent to participate in this study. CONFLICT OF INTEREST The article and its authors have no conflict of interest. CONSENT TO PUBLICATION Since the article and its data do not contain any material that gives away the identity of our participants so it is NOT APPLICABLE AVAILABILITY OF DATA AND MATERIALS All the data and materials have been properly stored and shall be available on demand . COMPETING INTEREST The article does not acknowledge any competing interests AUTHOR CONTRIBUTION Dr Nukhbat Awan: Conceptualization Dr Tooba Fida.: Data curation, Writing- Original draft preparation. Dr Khadija , Visualization, Investigation. Dr Ayesha; Methodology, Dr Uzma: Supervision. Dr Zain ul Abiddin: Software, Validation.data analysis Khansa Mehmood: Writing- Reviewing and Editing Dr Sauban : Reviewing and Editing FUNDING This research did not use any funding from either internal or external sources. ACKNOWLEDGEMENT Our article has not been funded from any source. We acknowledge the contributions of our research assistant, Dr. Tooba Fida and Dr Zain ul Abiddin, who assisted with data collection and analysis. We are grateful to Dr Khadija and Dr Uzma for their valuable work in the supervision of the whole process and validation and Dr. Nukhbat for the initial thought of the research question and Dr Ayesha for the detailed derivation of methods. Khansa Mehmood and Dr Sauban helped in the draft reviewing and editing., Finally, we thank our colleagues King Edward medical university and Mayo hospital Lahore, for their support and encouragement throughout this project References Jumper, N., Paus, R., & Bayat, A. (2015). Functional histopathology of keloid disease. Histology and histopathology , 30 (9), 1033–1057. https://doi.org/10.14670/HH-11-624 Betarbet, U., & Blalock, T. W. (2020). Keloids: A Review of Etiology, Prevention, and Treatment. The Journal of clinical and aesthetic dermatology , 13 (2), 33–43. Wang, Z. C., Zhao, W. Y., Cao, Y., Liu, Y. Q., Sun, Q., Shi, P., Cai, J. Q., Shen, X. Z., & Tan, W. Q. (2020). The Roles of Inflammation in Keloid and Hypertrophic Scars. Frontiers in immunology , 11 , 603187. https://doi.org/10.3389/fimmu.2020.603187 Ogawa R. The most current algorithms for the treatment and prevention of hypertrophic scars and keloids. Plastic and Reconstructive Surgery. 2010;125: 557-68. van Leeuwen MC, Stokmans SC, Bulstra AE, Meijer OW, Heymans MW, Ket JC, et al. Surgical Excision with Adjuvant Irradiation for Treatment of Keloid Scars: A Systematic Review. Plast Reconstr Surg Glob Open. 2015;3: e440. Shin JY, Lee JW, Roh SG, Lee NH, Yang KM. A Comparison of the Effectiveness of Triamcinolone and Radiation Therapy for Ear Keloids after Surgical Excision: A Systematic Review and Meta-Analysis. Plast Reconstr Surg. 2016;137: 1718-25. Nikitorowicz-Buniak J, Denton CP, Abraham D, Stratton R. Partially Evoked EpithelialMesenchymal Transition (EMT) Is Associated with Increased TGFbeta Signaling within Lesional Scleroderma Skin. PLoS One. 2015;10: e0134092. Piera-Velazquez S, Mendoza FA, Jimenez SA. Endothelial to Mesenchymal Transition (EndoMT) in the Pathogenesis of Human Fibrotic Diseases. J Clin Med. 2016;5. Sanchez-Duffhues G, Orlova V, Ten Dijke P. In Brief: Endothelial-to-mesenchymal transition. J Pathol. 2016;238: 378-80. Yan L, Cao R, Wang L, Liu Y, Pan B, Yin Y, et al. Epithelial-mesenchymal transition in keloid tissues and TGF-beta1-induced hair follicle outer root sheath keratinocytes. 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Available from: http://www.ncbi.nlm.nih.gov/books/NBK534261/ Jones ME, Hardy C, Ridgway J. Keloid Management: A Retrospective Case Review on a New Approach Using Surgical Excision, Platelet-Rich Plasma, and In-office Superficial Photon X-ray Radiation Therapy. Adv Skin Wound Care. 2016 Jul;29(7):303–7. Keloids: A Review of Etiology, Prevention, and Treatment - PMC [Internet]. [cited 2023 Mar 11]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7158916/ Morelli Coppola M, Salzillo R, Segreto F, Persichetti P. Triamcinolone acetonide intralesional injection for the treatment of keloid scars: patient selection and perspectives. Clin Cosmet Investig Dermatol. 2018 Jul 24;11:387–96. Hersant B, SidAhmed-Mezi M, Picard F, Hermeziu O, Rodriguez AM, Ezzedine K, et al. Efficacy of Autologous Platelet Concentrates as Adjuvant Therapy to Surgical Excision in the Treatment of Keloid Scars Refractory to Conventional Treatments: A Pilot Prospective Study. Ann Plast Surg. 2018 May 1;81:1. Alser OH, Goutos I. The evidence behind the use of platelet-rich plasma (PRP) in scar management: a literature review. Scars Burns Heal. 2018 Nov 18;4:2059513118808773. Azzam EZ, Omar SS. Treatment of auricular keloids by triple combination therapy: Surgical excision, platelet-rich plasma, and cryosurgery. J Cosmet Dermatol. 2018 Jun;17(3):502–10. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About In Review Editorial Policies Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3154595","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":217172125,"identity":"d6157438-db92-42ba-9ab8-cd46dd7a89e4","order_by":0,"name":"Nukhbat ullah Awan","email":"","orcid":"","institution":"FCPS ENT, Mayo Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Nukhbat","middleName":"ullah","lastName":"Awan","suffix":""},{"id":217172126,"identity":"83675801-b06e-435f-a49f-2406f0f1fedf","order_by":1,"name":"Tooba 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University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Khansa","middleName":"","lastName":"Mehmood","suffix":""},{"id":217172135,"identity":"75653b68-8291-492d-beb3-e71bf39e275f","order_by":6,"name":"Zain ul","email":"","orcid":"","institution":"MBBS, House Officer, Mayo Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Zain","middleName":"","lastName":"ul","suffix":""},{"id":217172136,"identity":"151f2b1e-cae8-43db-9abb-197552f87627","order_by":7,"name":"Sauban Mansoor Sadiq","email":"","orcid":"","institution":"Shaheed Zulfiqar Ali Bhutto Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Sauban","middleName":"Mansoor","lastName":"Sadiq","suffix":""}],"badges":[],"createdAt":"2023-07-09 21:44:11","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3154595/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3154595/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":40038319,"identity":"316ca10d-4c05-4f44-b23e-e5dcdfa3a9ff","added_by":"auto","created_at":"2023-07-14 14:47:41","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":25042,"visible":true,"origin":"","legend":"\u003cp\u003ecolumn chart comparing the score for pain of both groups A and B.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-3154595/v1/45e07e01a4d21a0f522aa716.png"},{"id":40038320,"identity":"53b6c6d3-29ae-4999-9a34-9a3bc990ba7a","added_by":"auto","created_at":"2023-07-14 14:47:41","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":23890,"visible":true,"origin":"","legend":"\u003cp\u003ecolumn chart comparing the score for Itching of both groups A and B.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-3154595/v1/34a6ed246e0f41c403d19271.png"},{"id":40037079,"identity":"680ead9e-1be9-4885-8b1d-47b31d599ea3","added_by":"auto","created_at":"2023-07-14 14:39:41","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":24017,"visible":true,"origin":"","legend":"\u003cp\u003ecolumn chart comparing the score for Color of both groups A and B.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-3154595/v1/d07e5379bd823ff67248de90.png"},{"id":40037085,"identity":"dd2ac840-abce-41ea-909a-b526138fb7d2","added_by":"auto","created_at":"2023-07-14 14:39:41","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":25402,"visible":true,"origin":"","legend":"\u003cp\u003ecolumn chart and table comparing the score for Stiffness of both groups A and B.\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-3154595/v1/9c73aa43993142bd9cb38694.png"},{"id":40039790,"identity":"21f53a4c-e29e-405d-8ad7-534960c4ff3a","added_by":"auto","created_at":"2023-07-14 14:55:41","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":23436,"visible":true,"origin":"","legend":"\u003cp\u003ecolumn chart comparing the score for Thickness of both groups A and B.\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-3154595/v1/d3526c4345ff87b91d54e5ac.png"},{"id":40037084,"identity":"011b7363-05b8-455d-936f-e93a08cb748b","added_by":"auto","created_at":"2023-07-14 14:39:41","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":22553,"visible":true,"origin":"","legend":"\u003cp\u003ecolumn chart comparing the score for Irregular Scar of both groups A and B.\u003c/p\u003e","description":"","filename":"6.png","url":"https://assets-eu.researchsquare.com/files/rs-3154595/v1/81b68d74bfa1addf3044286c.png"},{"id":40037081,"identity":"43f93a58-576b-4052-ba23-b3aba471c0e5","added_by":"auto","created_at":"2023-07-14 14:39:41","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":21550,"visible":true,"origin":"","legend":"\u003cp\u003ecolumn chart comparing the score for Overall opinion for patient scale of both groups A and B.\u003c/p\u003e","description":"","filename":"7.png","url":"https://assets-eu.researchsquare.com/files/rs-3154595/v1/0aa23ce4065d37125eb50e10.png"},{"id":40632272,"identity":"19ff9fcd-4b58-4c37-a1a6-2f5c64778f65","added_by":"auto","created_at":"2023-07-27 02:52:29","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":615171,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3154595/v1/4acfe6d2-eff6-4d40-997c-9a40c7c6f2d2.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Comparison between intra-lesional steroid injection versus autologous platelet-rich plasma therapy following surgical excision of aural keloid (Difference in effectiveness of intra lesional steroids and PRP for aural keloid treatment)","fulltext":[{"header":"Key points","content":"\u003cul\u003e\n \u003cli\u003eTo compare the efficacy of TA versus PRP in treatment of Aural keloid after excision.\u003c/li\u003e\n \u003cli\u003ePatients with aural keloids type I and II were enrolled in the study and divided into two groups i.e. one receiving PRP and other steroids\u003c/li\u003e\n \u003cli\u003eEvaluation was done after 3 months by The Patient and Scar Observer Assessment Scale (PSOAS).\u003c/li\u003e\n \u003cli\u003ePRP is superior in preventing recurrence of aural keloid after surgical\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Introduction","content":"\u003cp\u003eA keloid is described as a benign overgrowth of dense fibrous tissue that spreads beyond the original boundaries of the wound and results mainly from an aberrant healing process to a cutaneous or deeper injury.[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]Although the exact mechanism and pathogenesis has not been brought to light up to date yetit is known that it occurs as a result of the imbalance between the excessive synthesis of the collagen and extracellular matrix and decreased breakdown and removal of these products as a part of the normal healing process.[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. A heightened and chronic background inflammatory reaction along with inflammatory mediators mainly transforrming growth factor, and fibroblast response that fosters an environment suitable for keloid formation. [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The importance of immunological responses has recently risen to the forefront as one of the causes of keloid formation, based on higher levels of immunoglobulins, lymphocytes and mast cells as well as the description of a keloid-associated lymphoid tissue (KALT) [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] The clinical appearance of keloid scars varies greatly, with the majority having the classic \"claw-like\" look and only a small minority resembling a butterfly lesion, polypoidal mass or nodule [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] They often present as a solid, bosselated, and frequently glossy mass that may also have hyperpigmentation. keloids can result in contracture as well as pruritus with pain symptoms, but majority of patients are more worried about cosmesis than they are about debilitation. The appearance can occasionally be extremely deforming, which can cause psychosocial problems and worse quality of life [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe importance of using good surgical technique and avoiding post-operative stress or friction cannot be overstated. With varying degrees of success, numerous methods including laser therapy, cryotherapy, interferon therapy, silicon dressings, compressive therapy, retinoids and corticosteroid injections, radiation, and surgical excision have all been tried to treat keloid growths.[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e],[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e],[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e],[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]In addition to pressure treatment, physical therapies which include camouflage cosmetics, physiotherapy, massage, hydrotherapy and pressure sheets, magnets, pressure clips and buttons have been used [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e],[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] Overall, these interventions have inadequate and uneven levels of evidence. KD has not yet been completely successfully treated and the only way to confidently and permanently lessen the suffering is to fully comprehend keloid development at the molecular level [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eAnother important mode of treatment is the use of PRP to treat the keloids.Because of its capacity to transfer a high concentration of growth factors to the target tissues due to the components within the alpha and dense granules, PRP is already being employed in various disciplines for the treatment of acute and chronic wounds. In order to enhance tissue remodeling, angiogenesis, and wound healing, a bio-molecular cocktail is used. This restores the skin\u0026rsquo; s balance to normal synthesis and cell proliferation which serves as the basis for its use in keloid treatment. Not much work has been done considering PRP and comparing it with other established treatment methods.\u003c/p\u003e \u003cp\u003eThe aim of our study is compare between intra-lesional steroid and PRP application in terms of recurrence rate, patient satisfaction and characteristics of post procedure keloids like vascularity, pigmentation, pliability and thickness etc.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eThis research is a randomized control trial studied at the department of ENT, KEMU/MAYO hospital, Pakistan and conducted in a duration of 12 months after the IRB approval of synopsis.\u003c/p\u003e\n\u003cp\u003eSAMPLE SIZE: A Sample size of 84 patients (42 in a group) is estimated by using 5% level of significance,90% power of test with expected percentage of recurrence of keloid in Autologous platelet rich plasma as 29% and Intra-leisonal steroid as 11%.\u003c/p\u003e\n\u003cp\u003e\u003cimg src=\"https://myfiles.space/user_files/122228_c8a1650c59388082/122228_custom_files/img1689237952.png\"\u003e\u003c/p\u003e\n\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n \u003cp\u003e\u003cstrong\u003eSAMPLING TECHNIQUE\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eNon-Probability, convenient sampling\u003c/p\u003e\n \u003cdiv id=\"Sec4\" class=\"Section3\"\u003e\n \u003ch2\u003eSAMPLE SELECTION:\u003c/h2\u003e\n \u003cdiv id=\"Sec5\" class=\"Section4\"\u003e\n \u003ch2\u003eInclusion Criteria:\u003c/h2\u003e\n \u003cul\u003e\n \u003cli\u003e\n \u003cp\u003ePatients with aural keloids- only type I and type II (acc. To Chang Park classification)\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003ePatients without prior treatment\u003c/p\u003e\n \u003c/li\u003e\n \u003c/ul\u003e\n \u003c/div\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e\n \u003ch2\u003eExclusion criteria:\u003c/h2\u003e\n \u003cul\u003e\n \u003cli\u003e\n \u003cp\u003eHypertrophic scars\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eType III, IV, V (in accordance to Chang Park classification)\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003ePregnancy.\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eThe use of long-term systemic corticosteroids, systemic chemotherapy, or immunosuppressive drugs. Hypersensitivity to adrenaline and local anaesthetics\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003ePatients with renal or liver diseases.\u003c/p\u003e\n \u003c/li\u003e\n \u003c/ul\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e\n \u003ch2\u003eData collection procedure\u003c/h2\u003e\n \u003cp\u003eThe study was approved by the board of studies \u0026amp; IRB committee, KEMU.\u003c/p\u003e\n \u003cp\u003eA sample size of 84 patients categorized into two groups, A and B (42 in each) based on simple random technique was subjected to a prospective and comparative study.\u003c/p\u003e\n \u003cp\u003eAfter obtaining a detailed written informed consent, history and clinical examination was done. patients fulfilling the inclusion criteria were enrolled in the study. All patients underwent Liver function tests and renal function tests.\u003c/p\u003e\n \u003cp\u003ePatients within group A were treated with PRP, first injection at the time of excision before closure and three additional injections administered with a week\u0026rsquo;s intervals\u003c/p\u003e\n \u003cp\u003ePatients within group B were treated with intra-lesional triamcinolone acetonide 40mg/ml along the suture line. First dose, at the time of excision after closure and then on post-operative weeks 1,2,3\u003c/p\u003e\n \u003cp\u003ePatients then were followed up weekly when they come for their next dose and last evaluation was done 45 days after their last dose. Evaluation of results for all the 84 patients was done on basis of POSAS Observer scale and response to treatment was calculated based on PSOAS Patient scale after 45 days and evaluation done then.\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003ch2\u003eData analysis procedure:\u003c/h2\u003e\n \u003cp\u003eSpss 26 was used for data entry and accumulation.\u003c/p\u003e\n \u003cp\u003eQuantitative variables like age, width, height were presented in the form of mean +- SD\u003c/p\u003e\n \u003cp\u003eQualitative variables like gender, pain, itching were presented as frequency and percentage.\u003c/p\u003e\n \u003cp\u003eComparison of recurrence of two groups score that is group A platelet rich plasma and group B intralesional steroid was done by paired T test. Significant difference was considered when p value will\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026le;\u003c/span\u003e\u0026thinsp;0.05.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe evaluation of patients was done on the basis of POSAS scale.\u003c/p\u003e\n\u003cp\u003eOf the 84 patients included in our study all 84 were females, having mean age around 22\u0026ndash;23 years with 72% of them being unmarried. The data gathered when analyzed cleathere is statistically significant improvement in all parameters of POSAS of group A patients with their mean consistently being lower than group B patients i.e those receiving TA. The parameters considered were pain, color, itching, stiffness, thickness and irregularity of scar.\u003c/p\u003e\n\u003cp\u003eThe results are shown individually for each variable in column chart and table forms\u0026nbsp;\u003c/p\u003e\u003cp\u003e\u003cimg src=\"https://myfiles.space/user_files/122228_c8a1650c59388082/122228_custom_files/img1689285126.png\"\u003e\u003c/p\u003e\n\u003cp\u003e\u003cimg src=\"https://myfiles.space/user_files/122228_c8a1650c59388082/122228_custom_files/img1689238161.png\"\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cimg src=\"https://myfiles.space/user_files/122228_c8a1650c59388082/122228_custom_files/img1689238179.png\"\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003c/p\u003e\u0026nbsp;\u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eTable comparing the score for Color of both groups A and B.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eplatelet rich plasma (A)\u003c/span\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eSteroid (B)\u003c/span\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eStandard Deviation\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eStandard Deviation\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eis the scar color different from the color of your normal skin at present? (FPS)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eis the scar color different from the color of your normal skin at present? (SPS)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.09\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eis the scar color different from the color of your normal skin at present? (TPS)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.09\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eis the scar color different from the color of your normal skin at present? (FoPS)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003etotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e19.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e27.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003e\u003c/p\u003e\u0026nbsp;\u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eTable comparing the score for Stiffness of both groups A and B.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eplatelet rich plasma (A)\u003c/span\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eSteroid (B)\u003c/span\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eStandard Deviation\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eStandard Deviation\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eis the stiffness of the scar different from your normal skin at present? (FPS)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eis the stiffness of the scar different from your normal skin at present? (SPS)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eis the stiffness of the scar different from your normal skin at present? (TPS)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.87\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eis the stiffness of the scar different from your normal skin at present? (FoPS)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003etotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e19.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e27.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003e\u003cimg src=\"https://myfiles.space/user_files/122228_c8a1650c59388082/122228_custom_files/img1689238254.png\"\u003e\u003c/p\u003e\n\u003cp\u003e\u003cimg src=\"https://myfiles.space/user_files/122228_c8a1650c59388082/122228_custom_files/img1689238269.png\"\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Figure 7.:- column chart comparing the score for Overall opinion for patient scale of both groups A and B.\u003c/p\u003e\n\u003cp\u003e\u003cimg src=\"https://myfiles.space/user_files/122228_c8a1650c59388082/122228_custom_files/img1689238295.png\"\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eKeloids are typically thought of as benign lesions and can be identified by excessive collagen synthesis, uncontrolled collagen deposition along with glycosaminoglycans, and increased proliferation of fibrogenic cells, leading to the formation of significant amounts of ECM around wounds on the skin's dermis(14). Although they remain to be challenging to cure due to their unclear etiology and rapid proliferative proliferation, patients frequently experience severe psychological anguish as a result of their appearance in addition to frequent pain and suffering. (15) Although these lesions have long presented treatment difficulties to cosmetic plastic surgeons, there is still no agreement throughout the surgical profession as to which approach yields the best results. Combination therapy, such as surgical excision combined with intralesional injections of antineoplastic drugs, botulinum toxin, corticosteroids, and pressure splints, has produced inconsistent results in prior studies.(16)\u003c/p\u003e \u003cp\u003ePRP has been the focus of numerous investigations in a variety of medical domains involving tissue repair procedures for about 20 years. Numerous early growth factors, such as fibroblast growth factor, PDGF, and insulin-like growth factors, as well as more delayed growth factors, such as epidermal growth factor, vascular endothelium growth factor plus TGF-β, are released as a result of platelet activation. In addition to fibrinogen, vitronectin, and fibronectin, platelets also secrete additional proteins that are crucial for controlling cellular connections and spatial organization.\u003c/p\u003e \u003cp\u003eGrowth factors produced by platelets can stimulate the division of mesenchymal cells, such as fibroblasts plus endothelial cells, as well as the chemotaxis of macrophages, monocytes, and polymorphonuclear cells. (17) When these growth factors are released, they set off a variety of signaling pathways that stimulate angiogenesis, cell proliferation, differentiation, and the production of fresh ECM for tissue regeneration. Interleukin 1 levels and cartilage oligomeric matrix protein production were shown to decrease in PRP with high platelet counts and low leukocyte counts, indicating greater catabolism, and decreased matrix synthesis, including decreased collagen types I and III synthesis in the tissues. (18) Additionally, it has been demonstrated that PRP might reduce inflammatory signals and support tissue remodeling by encouraging a more orderly deposition of collagen. (19)\u003c/p\u003e \u003cp\u003eAs a result, PRP may significantly influence homeostasis through tissue repair by helping to re-establish a natural balance. A significant reduction in keloid recurrence and an improvement in the look of keloid scars, as seen after PRP injection in the surgical site following keloid excision. (20)\u003c/p\u003e \u003cp\u003eIt has been demonstrated that TA causes keloid regression via a wide range of pathways. By preventing leukocyte and monocyte movement and phagocytosis, it firstly reduces inflammation. Second, because it is a potent vasoconstrictor, less oxygen, and nutrients are delivered to the wound bed. Thirdly, it slows re-epithelization and the production of new collagen by inhibiting keratinocytes and fibroblasts through an anti-mitotic effect. Additionally, it might lower plasma protease inhibitors, enabling collagenase to destroy collagen by freeing up more protease. (21)\u003c/p\u003e \u003cp\u003eAlpha-1-antitrypsin, and alpha-2-macroglobulin levels, are also significantly reduced by TA and these levels are typically higher in keloidal tissue, which naturally inhibits collagenase in human skin. (22)\u003c/p\u003e \u003cp\u003eThe effectiveness of autologous platelet concentrates as an adjunct therapy to surgical excision in the treatment of keloid scars resistant to standard treatments was assessed in a study by Hersant et al [99]. This study involved 17 patients having keloid scars who had extra-lesional keloid resections but had not responded to radiation or 4 cortisone injections. PRP was injected intraoperatively, followed by three times separated by a month. (P 0.001) The VSS significantly increased. They also reported improved discomfort and a significant reduction in scratching (P\u0026thinsp;=\u0026thinsp;0.003). Additionally, throughout PRP injection sessions as well as two years following treatment, no side effects were recorded. (23)\u003c/p\u003e \u003cp\u003eJones et al., [100] evaluated 40 patients who underwent surgical excision plus PRP therapy to heal their keloid scars. Using the Kyoto Scar Assessment Scale (KSAS), this method received a 61% excellent rating, 24% good, 3% fair, and 12% poor rating during a three-month follow-up.\u003c/p\u003e \u003cp\u003eJones et al. [101] evaluated 49 patients with ear keloids in a different study and found that extralesional surgical excision followed by the application of autologous PRP to the wound site resulted in a 94% success rate. (24)\u003c/p\u003e \u003cp\u003eAdditionally, Azzam et al., [102] studied 50 patients with auricular keloids who had triple combination therapy, which included cryosurgery, PRP, and surgical excision. Using VSS, this method was evaluated 12 months after treatment and revealed a substantial improvement in keloid height and consistency (P 0.05), but not in pigmentation or vascularity. (25) The small sample size, a brief follow-up time, and the lack of information regarding PRP's platelet and leucocyte concentration have been the study's weaknesses.\u003c/p\u003e \u003cp\u003eBased on the effectiveness of platelet-rich plasma that has been previously studied and the findings of our study, there are low risks of recurrence due to the consistently low score for all criteria when compared to steroids on the POSAS scale.\u003c/p\u003e \u003cp\u003eIn the current investigation, group A (steroid) showed higher telangiectasia than group B.\u003c/p\u003e \u003cp\u003eIn contrast to PRP, intralesional TA has been proven to cause problems including hypopigmentation, mixed pigmentation, telangiectasia, necrosis, and ulcerations when used to treat keloid lesions. There is a need to further study the comparison between intralesional steroid injection versus autologous platelet-rich plasma therapy following surgical excision of aural keloid for a greater duration and more sample size that might suggest variations.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eOne could draw the conclusion that PRP intralesional injection is a successful therapeutic approach for keloids. PRP is a potentially effective, affordable and easily accessible autologous elixir. It should therefore be regarded as the first line of treatment for keloids in addition to patients who are resistant to all other forms of cure and as a new choice in patients with challenging aural keloids.\u003c/p\u003e \u003cp\u003eTo verify our findings, larger prospective randomized studies and longer follow-ups are required.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eETHICAL APPROVAL AND CONSENT TO PARTICIPATE\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the IRB ethical committee of King Edward medical university and Lady Aitchison Hospital, Lahore under approval number 1914/REG/KEMU/2022 dated 23/2/2022. Participants were informed about the potential risks and benefits of the study. The study was conducted in accordance with the Declaration of Helsinki, and all participants\u0026apos; confidentiality and anonymity were maintained.\u003c/p\u003e\n\u003cp\u003eParticipation in this study was voluntary, and participants had the right to withdraw from the study at any time without penalty. Participants\u0026apos; privacy and confidentiality was maintained, and their data was used for research purposes only. By signing the consent form, they indicated that you have read this information and voluntarily consent to participate in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCONFLICT OF INTEREST \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe article and its authors have no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCONSENT TO PUBLICATION \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSince the article and its data do not contain any material that gives away the identity of our participants so it is NOT APPLICABLE\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eAVAILABILITY OF DATA AND MATERIALS \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll the data and materials have been properly stored and shall be available on demand .\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCOMPETING INTEREST\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe article does not acknowledge any competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAUTHOR CONTRIBUTION\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDr Nukhbat Awan: Conceptualization\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDr Tooba Fida.: Data curation, Writing- Original draft preparation.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Dr Khadija , Visualization, Investigation.\u003c/p\u003e\n\u003cp\u003eDr Ayesha; Methodology,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDr Uzma: Supervision.\u003c/p\u003e\n\u003cp\u003eDr Zain ul Abiddin: Software, Validation.data analysis\u003c/p\u003e\n\u003cp\u003eKhansa Mehmood: Writing- Reviewing and Editing\u003c/p\u003e\n\u003cp\u003eDr Sauban : \u0026nbsp; \u0026nbsp; \u0026nbsp;Reviewing and Editing\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eFUNDING \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research did not use any funding from either internal or external sources.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;ACKNOWLEDGEMENT\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOur article has not been funded from any source. We acknowledge the contributions of our research assistant, Dr. Tooba Fida and Dr Zain ul Abiddin, who assisted with data collection and analysis. We are grateful to Dr Khadija and Dr Uzma for their valuable work in the supervision of the whole process and validation and Dr. Nukhbat for the initial thought of the research question and Dr Ayesha for the detailed derivation of methods. Khansa Mehmood and Dr Sauban helped in the draft reviewing and editing., Finally, we thank our colleagues King Edward medical university and Mayo hospital Lahore, for their support and encouragement throughout this project\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003e Jumper, N., Paus, R., \u0026amp; Bayat, A. (2015). Functional histopathology of keloid disease. \u003cem\u003eHistology and histopathology\u003c/em\u003e, \u003cem\u003e30\u003c/em\u003e(9), 1033\u0026ndash;1057. https://doi.org/10.14670/HH-11-624 \u003c/li\u003e\n\u003cli\u003eBetarbet, U., \u0026amp; Blalock, T. W. (2020). Keloids: A Review of Etiology, Prevention, and Treatment. \u003cem\u003eThe Journal of clinical and aesthetic dermatology\u003c/em\u003e, \u003cem\u003e13\u003c/em\u003e(2), 33\u0026ndash;43.\u003c/li\u003e\n\u003cli\u003eWang, Z. C., Zhao, W. Y., Cao, Y., Liu, Y. Q., Sun, Q., Shi, P., Cai, J. Q., Shen, X. Z., \u0026amp; Tan, W. Q. (2020). The Roles of Inflammation in Keloid and Hypertrophic Scars. \u003cem\u003eFrontiers in immunology\u003c/em\u003e, \u003cem\u003e11\u003c/em\u003e, 603187. https://doi.org/10.3389/fimmu.2020.603187\u003cu\u003e \u003c/u\u003e\u003c/li\u003e\n\u003cli\u003eOgawa R. The most current algorithms for the treatment and prevention of hypertrophic scars and keloids. Plastic and Reconstructive Surgery. 2010;125: 557-68.\u003c/li\u003e\n\u003cli\u003evan Leeuwen MC, Stokmans SC, Bulstra AE, Meijer OW, Heymans MW, Ket JC, et al. Surgical Excision with Adjuvant Irradiation for Treatment of Keloid Scars: A Systematic Review. Plast Reconstr Surg Glob Open. 2015;3: e440.\u003c/li\u003e\n\u003cli\u003eShin JY, Lee JW, Roh SG, Lee NH, Yang KM. A Comparison of the Effectiveness of Triamcinolone and Radiation Therapy for Ear Keloids after Surgical Excision: A Systematic Review and Meta-Analysis. Plast Reconstr Surg. 2016;137: 1718-25.\u003c/li\u003e\n\u003cli\u003eNikitorowicz-Buniak J, Denton CP, Abraham D, Stratton R. Partially Evoked EpithelialMesenchymal Transition (EMT) Is Associated with Increased TGFbeta Signaling within Lesional Scleroderma Skin. PLoS One. 2015;10: e0134092.\u003c/li\u003e\n\u003cli\u003ePiera-Velazquez S, Mendoza FA, Jimenez SA. Endothelial to Mesenchymal Transition (EndoMT) in the Pathogenesis of Human Fibrotic Diseases. J Clin Med. 2016;5.\u003c/li\u003e\n\u003cli\u003eSanchez-Duffhues G, Orlova V, Ten Dijke P. In Brief: Endothelial-to-mesenchymal transition. J Pathol. 2016;238: 378-80.\u003c/li\u003e\n\u003cli\u003eYan L, Cao R, Wang L, Liu Y, Pan B, Yin Y, et al. Epithelial-mesenchymal transition in keloid tissues and TGF-beta1-induced hair follicle outer root sheath keratinocytes. Wound repair and regeneration : official publication of the Wound Healing Society [and] the European Tissue Repair Society. 2015;23: 601-10.\u003c/li\u003e\n\u003cli\u003eKalluri R, Neilson EG. Epithelial-mesenchymal transition and its implications for fibrosis. The Journal of clinical investigation. 2003;112: 1776-84.\u003c/li\u003e\n\u003cli\u003eLamouille S, Xu J, Derynck R. Molecular mechanisms of epithelial\u0026ndash;mesenchymal transition. Nature reviews Molecular cell biology. 2014;15: 178.\u003c/li\u003e\n\u003cli\u003eBajracharya A. Outcome of combined surgical and intralesional steroids injection therapy for management of ear keloid. Journal of Kathmandu Medical College. 2020 Mar 31;9(1):43-8.\u003c/li\u003e\n\u003cli\u003eMohammadi AA, Kardeh S, Motazedian GR, Soheil S. Management of Ear Keloids Using Surgical Excision Combined with Postoperative Steroid Injections. World J Plast Surg. 2019 Sep;8(3):338\u0026ndash;44.\u003c/li\u003e\n\u003cli\u003ede Virgilio C. Question Sets and Answers. Surgery. 2014 Jul 19;591\u0026ndash;699.\u003c/li\u003e\n\u003cli\u003eByun HJ, Park JH, Lee JH. Combination Treatment of Intra/Perilesional Botulinum Toxin-A Injection and Ablative Fractional Laser for Better Clinical Outcomes of Hypertrophic Fibrotic Thyroidectomy Scars Following Fractional Ablative Laser Resurfacing. Ann Dermatol. 2021 Apr;33(2):170\u0026ndash;7.\u003c/li\u003e\n\u003cli\u003eEverts P, Onishi K, Jayaram P, Lana JF, Mautner K. Platelet-Rich Plasma: New Performance Understandings and Therapeutic Considerations in 2020. Int J Mol Sci. 2020 Oct 21;21(20):7794.\u003c/li\u003e\n\u003cli\u003eSzwedowski D, Szczepanek J, Paczesny Ł, Zabrzyński J, Gagat M, Mobasheri A, et al. The Effect of Platelet-Rich Plasma on the Intra-Articular Microenvironment in Knee Osteoarthritis. Int J Mol Sci. 2021 May 23;22(11):5492.\u003c/li\u003e\n\u003cli\u003eSchultz GS, Chin GA, Moldawer L, Diegelmann RF. Principles of Wound Healing. In: Fitridge R, Thompson M, editors. Mechanisms of Vascular Disease: A Reference Book for Vascular Specialists [Internet]. Adelaide (AU): University of Adelaide Press; 2011 [cited 2023 Mar 11]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK534261/\u003c/li\u003e\n\u003cli\u003eJones ME, Hardy C, Ridgway J. Keloid Management: A Retrospective Case Review on a New Approach Using Surgical Excision, Platelet-Rich Plasma, and In-office Superficial Photon X-ray Radiation Therapy. Adv Skin Wound Care. 2016 Jul;29(7):303\u0026ndash;7.\u003c/li\u003e\n\u003cli\u003eKeloids: A Review of Etiology, Prevention, and Treatment - PMC [Internet]. [cited 2023 Mar 11]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7158916/\u003c/li\u003e\n\u003cli\u003eMorelli Coppola M, Salzillo R, Segreto F, Persichetti P. Triamcinolone acetonide intralesional injection for the treatment of keloid scars: patient selection and perspectives. Clin Cosmet Investig Dermatol. 2018 Jul 24;11:387\u0026ndash;96.\u003c/li\u003e\n\u003cli\u003eHersant B, SidAhmed-Mezi M, Picard F, Hermeziu O, Rodriguez AM, Ezzedine K, et al. Efficacy of Autologous Platelet Concentrates as Adjuvant Therapy to Surgical Excision in the Treatment of Keloid Scars Refractory to Conventional Treatments: A Pilot Prospective Study. Ann Plast Surg. 2018 May 1;81:1.\u003c/li\u003e\n\u003cli\u003eAlser OH, Goutos I. The evidence behind the use of platelet-rich plasma (PRP) in scar management: a literature review. Scars Burns Heal. 2018 Nov 18;4:2059513118808773.\u003c/li\u003e\n\u003cli\u003eAzzam EZ, Omar SS. Treatment of auricular keloids by triple combination therapy: Surgical excision, platelet-rich plasma, and cryosurgery. J Cosmet Dermatol. 2018 Jun;17(3):502\u0026ndash;10.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Aural Keloid, Platelet Rich Plasma, Recurrence","lastPublishedDoi":"10.21203/rs.3.rs-3154595/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3154595/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: Keloids are benign growth of dense fibrous tissues from an abnormal healing response to a cutaneous injury, extending beyond the original borders of the wound. Intralesional triamcinolone acetonide (TA) is their first-line therapy, but commonly associated with side effects or recurrence. Platelet rich plasma (PRP) is an autologous blood-derived product with promising results in improving wound healing with lower keloid occurrence.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003e To compare the efficacy of TA versus PRP in treatment of Aural keloid after excision.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePlace and Duration of Study:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe department of Ear, Nose and Throat and Head and Neck Surgery, King Edward Medical University, Mayo Hospital, Lahore, from January 2021 to October 2021.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy Design:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRandomized controlled trial\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatients with aural keloids type I and II were enrolled in the study. 84 patients with aural keloids were divided randomly into two equal groups, A and B. Patients with aural keloids only type I and type II (acc. To Chang Park classification) and Patients without prior treatment were included and those presenting with Hypertrophic scars, Type III, IV, V (in accordance to Chang Park classification) and Pregnancy were excluded in our study. Group A received intralesional TA (20 mg/ml) after excision for 4 sessions, first on the day of surgery rest 3 sessions 1 week apart. Group B patients received intralesional PRP after excision in 4 sessions similar to TA. Evaluation was done after 3 months by The Patient and Scar Observer Assessment Scale (PSOAS).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOf the 84 patients included in our study all 84 were females, having mean age around 22-23 years with 72% of them being unmarried. The mean scores of POSAS Patient scale for pain was found to be 15.65 in grp A and 27.23 in grp B, with color having mean score of 19.76 (grp A) and 27.24 (grp B), itching 19.5 (grp A) and 27.8 (grp B), stiffness 19.83 (grp A) and 27.8 (grp B), thickness 19.36 (A) and 28.81 (B), irregular scar 19.47 (A) and 27.3 (B).\u003c/p\u003e\n\u003cp\u003eThere was statistically significant improvement in all parameters of PSOAS of group B patients with their mean consistently being lower than group A patients i.e those receiving TA. Both groups had similar complications which were minor with hyperpigmentation being most of it all.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e We concluded that PRP is superior in preventing recurrence of aural keloid after surgical excision.\u003c/p\u003e","manuscriptTitle":"Comparison between intra-lesional steroid injection versus autologous platelet-rich plasma therapy following surgical excision of aural keloid (Difference in effectiveness of intra lesional steroids and PRP for aural keloid treatment)","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-07-14 14:39:36","doi":"10.21203/rs.3.rs-3154595/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"73909c49-17e2-41e4-9fc8-20ae23e624a1","owner":[],"postedDate":"July 14th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2023-07-27T02:44:22+00:00","versionOfRecord":[],"versionCreatedAt":"2023-07-14 14:39:36","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3154595","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3154595","identity":"rs-3154595","version":["v1"]},"buildId":"pf3fE39SIOqb-0xH_OWvX","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}