A Hospital Based Randomized Controlled Trial Comparing the Efficacy of Intralesional Triamcinolone versus Alternating Intralesional Triamcinolone and Insulin in the Management of Keloids

Keloids are benign fibroproliferative growths that arise due to an exaggerated wound healing response following cutaneous injury. They represent a significant therapeutic challenge owing to their high recurrence rates and variable response to conventional modalities. Intralesional corticosteroids, particularly Triamcinolone acetonide (TAC), are widely regarded as the first-line treatment; however, they are often limited by suboptimal efficacy and local adverse effects. Insulin has been reported to possess tissue remodeling, angiogenic, and anti-fibrotic properties that may enhance scar maturity and improve clinical outcomes. This randomized controlled trial aims to compare the efficacy of intralesional Triamcinolone alone versus alternating intralesional Triamcinolone and Insulin in the management of keloids. Patients will receive monthly sessions of either intralesional Triamcinolone or alternating intralesional Triamcinolone and Insulin for 18 weeks, followed by a 12 weeks observation period. The therapeutic response will be evaluated using the Patient and observer scar assessment scale(POSAS) at baseline, 18 weeks, and 30 weeks.