Bleomycin Injection Combined with Punch Excision and X-ray Radiotherapy for Treating Medium to Large Keloids: A Retrospective Study

BACKGROUND: Keloids are an inflammatory skin disorder caused by dysregulated wound healing after cutaneous injury or irritation,often accompanied by pruritus and pain. Therapeutic challenges include high recurrence rates and treatment resistance, particularly in medium-to-large keloids. Current guidelines recommend combination therapies, yet standardized protocols remain elusive. This study compares the efficacy and safety of bleomycin versus triamcinolone combined with punch excision and SXRT(superficial X-ray therapy). METHODS: A retrospective analysis of 69 patients (137 keloid lesions) treated at the Dermatology Hospital of Southern Medical University was conducted. All subjects underwent punch excision with intraoperative intralesional injection (bleomycin or triamcinolone) followed by 4 sessions of postoperative SXRT. Outcomes were assessed using VSS at baseline and 12 months post-treatment, alongside recurrence rates, satisfaction, and adverse events. Data were analyzed using SPSS 26.0 (P < 0.05). RESULTS: At 12 months, both groups showed significant VSS improvement (P < 0.05). The bleomycin group showed greater VSS reduction than the triamcinolone group (68% vs 58.82%, p<0.05).The bleomycin group exhibited higher response rates (82.5% vs. 60.0%) and satisfaction (P < 0.05), with fewer adverse events (P < 0.05): ulceration (2 cases), hyperpigmentation (5 cases).While in the triamcinolone group, adverse events included ulceration (1 case), telangiectasia (5 cases), hyperpigmentation (4 cases), and hypopigmentation (6 cases),Intralesional calcification deposition (4 cases). Recurrence rates were 1.16% (bleomycin) and 3.92% (triamcinolone) (P > 0.05). CONCLUSIONS: B-P-X therapy is a novel combined treatment modality incorporating punch excision, bleomycin injection, and SXRT for medium-to-large keloids, demonstrating excellent clinical efficacy, low recurrence rates, and minimal adverse effects. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, Ⅳ.