From the FDA Drug Label
The intralesional administration of Betamethasone Sodium Phosphate and Betamethasone Acetate Injectable Suspension is indicated for alopecia areata; discoid lupus erythematosus; keloids; localized hypertrophic, infiltrated, inflammatory lesions of granuloma annulare, lichen planus, lichen simplex chronicus (neurodermatitis), and psoriatic plaques; necrobiosis lipoidica diabeticorum In intralesional treatment, 0. 2 mL/cm2 of Betamethasone Sodium Phosphate and Betamethasone Acetate Injectable Suspension is injected intradermally (not subcutaneously) using a tuberculin syringe with a 25-gauge, 1/2-inch needle.
The best steroid for keloid injection is betamethasone, specifically the intralesional administration of Betamethasone Sodium Phosphate and Betamethasone Acetate Injectable Suspension, with a recommended dose of 0.2 mL/cm2 injected intradermally 1.
From the Research
The most effective steroid for keloid injection treatment is a combination of bleomycin and triamcinolone acetonide, as it has been shown to achieve significant flattening and symptom relief in refractory keloids. This combination has been demonstrated to be more effective than triamcinolone acetonide alone or in combination with other treatments such as 5-fluorouracil 2. The standard approach involves injecting the medication directly into the keloid at intervals of 4-6 weeks until adequate response is achieved. The dose depends on the size of the keloid, with larger lesions requiring higher concentrations.
Some key points to consider when using this combination include:
- The mixture of bleomycin (1 u/cc) with triamcinolone acetonide (13.3 mg/cc) has been shown to be effective in achieving significant flattening and symptom relief in refractory keloids 2
- Patients should expect some pain during injection, and possible side effects include skin atrophy, hypopigmentation, and telangiectasia, particularly with higher concentrations or frequent treatments
- For optimal results, the combination of bleomycin and triamcinolone acetonide may be used in conjunction with other treatments such as silicone sheets, pressure therapy, or cryotherapy
- Multiple sessions are typically required, and improvement is gradual over several months
- While complete resolution is not always possible, significant flattening and symptom relief (including reduced itching and pain) can be achieved in many cases
It's worth noting that other treatments, such as silicone gel sheeting, have been shown to have limited effectiveness in treating keloid scars, with very low-certainty evidence due to risk of bias, indirectness, and imprecision 3. Additionally, triamcinolone acetonide alone has been shown to be effective in reducing the size of keloid scars, but may not be as effective as the combination of bleomycin and triamcinolone acetonide 4, 5.