Treatment of Keloids and Hypertrophic Scars with Bleomycin and Electroporation

Background: Keloids and hypertrophic scars are the result of abnormal healing responses and dermal tissue proliferation; current surgical procedures can give rise to exuberant scarring and permanent functional loss or disfigurement. Considering the promising results reported when treating keloids and hypertrophic scars with intralesional bleomycin injection and the enhanced effect of bleomycin when combined with electroporation, the authors hypothesized that electrochemotherapy should be used to treat keloids and hypertrophic scars when other treatments have failed. Methods: Twenty patients with keloids or hypertrophic scars were treated with one or more sessions of electrochemotherapy and followed prospectively. Bleomycin was administered intravenously followed by application of electrical pulses to the lesion site. Treatment efficacy was determined either by clinical evaluation (e.g., volume, flattening, pliability, erythema) or by the patient’s self-reported symptomatology (e.g., pruritus, pain). Results: Treatment was well tolerated by patients, and no serious adverse events were observed. A median reduction of 87 percent (range, 41 to 100 percent) was observed in volume size, and 33 lesions (94 percent) showed a volume reduction of more than 50 percent. Scar pliability and erythema scores were also significantly reduced (p < 0.0001). A reduction in hitching was observed in 89 percent of patients (p < 0.0001), and a reduction in pain was observed in 94 percent (p < 0.0001). Only one recurrence was observed after 18 months. Conclusion: Electroporation in combination with bleomycin is an effective treatment for patients affected by large keloids or hypertrophic scars or patients who are nonresponders to other treatments. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.