ABSTRACT
Aim/Introduction: The keloids are benign dermal fibroproliferative tumors. Recalcitrant keloids are those that are unresponsive or recurred multiple times on the standard routine treatment. We analyzed the effect of the 32P skin patch on recalcitrant keloids in the Indian population. Material(s) and Method(s): 32P skin patch was applied locally for 3 hours, so to deliver 30 Gy of total radiation dose to the patients. Then patients were follow-up at 2 months, 4 months, and 6 months intervals. On each follow-up, HR USG was done for assessing the change in the dimensions of the lesion (thickness, length, and breath). VAS scores of pain and pruritis were also noted in all patients. Result(s): We found that there is a reduction in the thickness of recalcitrant keloids after applying a 32P skin patch with 30 Gy of the total dose in this single-arm trial using RM Anova with the post hoc test. Friedman's test was used for analyzing the VAS for pain and pruritis. Because of missed follow-ups in COVID, we analyzed the patients as two datasets: one with 6 months followup (recalcitrant lesions, n=9) and another with 4 months follow-up (n=24). There was a significant difference in thickness of recalcitrant keloids over 6 months and 4 months(p<0.01). The percent change from baseline on first, second, and third follow-up was 21%,28%, and 43%, respectively, for 9 recalcitrant keloids. The percent change from baseline on first and second follow-up was 22.1 % and 31.1%, respectively, for 24 recalcitrant keloids. So upon 30 Gy of dose by P32 skin patch, it showed a 22- 43% reduction in recalcitrant keloid thickness. However, visually, all patients showed complete resolution. There is a decrease in pruritis upon patch application over 4 months. The pain was uncommentable because 20/27 lesions had no pain during the baseline (VAS score of 0/10). All the patients experienced subjective symptomatic relief in pain and pruritis after the patch therapy. Conclusion(s): The decrease in thickness implies the effect of the 32P skin patch on recalcitrant keloids. Hence there was an optimum change of thickness from baseline with 6 months follow-up. No recurrence up to 6 months was observed during the follow-up. All the patients experienced subjective symptomatic relief in pain and pruritis after the patch therapy. So 32P skin patch is a cheap, non-invasive, effective treatment for recalcitrant keloids.