The efficacy of skin cooling for pain relief during intralesional steroid injection for keloid treatment: A randomized cross-over study

Background: An intralesional corticosteroid injection is one of the most effective and popular treatment for keloid, however severe pain during injection is the most complaint. Objective: To evaluate if pre-treatment skin cooling can reduce the pain during steroid injection. Materials and Methods: A randomized cross-over study was conducted between September 2015 and October 2016. This study received ethical approval ID035904 No. MURA2016/152. Forty-four subjects with keloid that needed intralesional steroid injection were divided into three pretreatment groups, no treatment, skin cooling with ice pack, and skin applying with a mixture of lidocaine 2.5% and prilocaine 2.5% (EMLA®), in random order. Pain intensity was measured by using 100-mm visual analogue scale (VAS). The satisfaction levels were assessed with orderly interval rating scale from 1 to 5. Repeated-measure analysis of variance (ANOVA) and Bonferroni pairwise comparison were used for data analyses. Results: The mean VAS score at the time of needle puncturing into the skin and during steroid infiltration was statistically significant lower in skin cooling compared to no treatment group (p<0.001) and EMLA group (p<0.05). The satisfaction level was also statistically significant higher in skin cooling compared to no treatment group (p<0.001) and EMLA group (p<0.001). Thirty-seven patients (84%) selected skin cooling method as the most favorable pre-anesthetic method for intralesional steroid injection. Conclusion: Skin cooling with ice before intralesional steroid injection of keloid effectively reduces pain and patients are also satisfied.