Intralesional Vitamin D versus Triamcinolone Acetonide for the Treatment of Keloids: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Abstract

Intralesional triamcinolone acetonide (TAC) remains the standard nonsurgical treatment for keloids but is limited by steroid-related adverse effects. Intralesional vitamin D has recently emerged as a potential alternative. This meta-analysis evaluated the comparative efficacy and safety of vitamin D versus TAC in keloid management. A systematic search of PubMed, Embase, and the Cochrane library identified randomized controlled trials comparing these treatments. The primary outcome was scar improvement assessed using validated scales, while secondary outcomes included lesion flattening and treatment-related adverse events. Four trials were included. TAC demonstrated superior efficacy in improving scar severity (MD = -9.72; 95% CI -17.41 to -2.02; p = 0.013) and lesion flattening (RR = 0.68; 95% CI 0.48 to 0.96; p = 0.028). Vitamin D was associated with significantly lower risks of pigmentation changes (RR = 0.23; 95% CI 0.07 to 0.78; p = 0.018) and skin atrophy (RR = 0.51; 95% CI 0.32 to 0.82; p = 0.006), with no significant differences in pain, erythema, telangiectasia, or blister formation. While TAC appeared more effective for scar regression and lesion flattening, vitamin D was associated with a more favorable safety profile, particularly regarding skin atrophy and dyspigmentation. Vitamin D may be considered in selected patients who are particularly concerned about steroid-related adverse effects or lesions located in cosmetically sensitive areas, although these findings should be interpreted cautiously given the limited evidence base.