Keloid refers to an abnormal overgrowth of collagen in the process of wound healing. Intralesional Triamcinolone Acetonide (TA) injection is the first-line treatment, with the main disadvantage of being painful that may result in patients dissatisfaction and treatment refusal. The methods to relieve pain during steroid injection has been inconclusive.

The presented study aimed to compare the effectiveness of pretreatment application of topical anesthetics and 1:1 mixture of 1% lidocaine and TA intralesional injection for alleviating the pain during the keloid treatment. In this regard, researchers conducted a double-blind, randomized controlled trial and enrolled forty patients (mean age, 37.1 years). For the treatment, steroid injections were tested in combination with other types of treatments including control, lidocaine, topical, and combined.

A visual analog scale (VAS) was used to assess the needle-stick and injection pain among a group of patients. Further, data on pain duration after injection were also collected. The VAS scores of needle-stick pain in the control, lidocaine, topical, and combined groups were 4.18 ± 2.12, 3.82 ± 2.48, 2.03 ± 2.02, and 2.20 ± 1.99, respectively. The pain was statistically decreased in the topical and combined groups. Intralesional injection pain (VAS) scores in the control, lidocaine, topical, and combined groups were as follows: 4.97 ± 2.50, 4.97 ± 2.79, 4.10 ± 2.80, and 4.43 ± 2.68, respectively.

Significant differences in pain reduction were observed in all groups, but the researchers found that topical application of anesthetics provided more effective pain relief, especially at the sternum and auricular keloids, as the administration of lidocaine mixture did not reduce pain during injection.