{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,12]],"date-time":"2026-11-12T08:22:17Z","timestamp":1794471737363,"version":"4.9.1"},"reference-count":55,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2025,2,25]],"date-time":"2025-02-25T00:00:00Z","timestamp":1740441600000},"content-version":"unspecified","delay-in-days":24,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,1,21]]},"published-print":{"date-parts":[[2025,2]]},"abstract":"<jats:sec>\n<jats:title>Background<\/jats:title>\n<jats:p>Intralesional corticosteroid injection (ILCSI) has been proven to successfully treat hypertrophic scars (HTSs) and keloids and attain remission in 50% of keloids. Pain is a significant problem with ILCSI, which can affect treatment compliance and effectiveness. To date, many techniques involving ILCSI have been described and used to achieve scar treatment while reducing side effects. The injection technique remains the most widely available method in many healthcare centres.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Objective<\/jats:title>\n<jats:p>This scoping review explores strategies for alleviating pain while administering ILCSIs for hypertrophic scarring and keloid management. ILCSI is a second-line treatment for HTSs and a first-line treatment for keloids.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Eligibility criteria<\/jats:title>\n<jats:p>This scoping review included studies where HTSs and keloids were treated with ILCSI and considered diverse demographics and injection methods. This review excludes other methods of corticosteroid drug delivery where injection is not involved and where the pain assessed is unrelated to injection or infiltration of the scar.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Sources of evidence<\/jats:title>\n<jats:p>This review systematically searched critical databases from inception to December 2023, including ScienceDirect, PubMed and Web of Science, and handpicked articles traced from available review papers. Only English-language publications focused on pain management during ILCSIs for HTSs and keloids were included. All levels of scientific evidence were considered. An in-depth evaluation of the injection technique, type of analgesia or anaesthesia administered, effectiveness of pain management and overall treatment outcomes was conducted.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Charting methods<\/jats:title>\n<jats:p>Citations were compiled in an Excel spreadsheet, with three authors screening the titles and abstracts based on inclusion criteria. Decisions were finalised collaboratively, exclusions were documented and results were presented using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>16 prospective studies, 2 retrospective studies, 1 case study and 15 journal articles were included. These studies examined ILCSI for hypertrophic scarring and keloid treatment. No differences in pain intensity between HTSs and keloids were reported. 11 studies systematically explored pain reduction methods such as topical analgesia, cryoanaesthesia, mixing triamcinolone acetonide with local analgesics, slow infiltration techniques, vibration analgesia and needle-free injectors.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Pain can significantly impact patient compliance and treatment outcomes. This review offers a foundational reference for healthcare providers and researchers in the field of scar management, providing insights into current practices and highlighting areas for future research and development.<\/jats:p>\n<\/jats:sec>","DOI":"10.1136\/bmjopen-2024-092800","type":"journal-article","created":{"date-parts":[[2025,2,26]],"date-time":"2025-02-26T10:24:57Z","timestamp":1740565497000},"page":"e092800","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Scoping review for pain mitigation during intralesional injections of corticosteroid for hypertrophic scar and keloid treatment"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7691-7136","authenticated-orcid":false,"given":"Ahmad Sukari","family":"Halim","sequence":"additional","affiliation":[{"name":"Reconstructive Sciences Unit, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophia","family":"Heng","sequence":"additional","affiliation":[{"name":"Reconstructive Sciences Unit, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia"},{"name":"Plastic, Aesthetic and Reconstructive Surgery, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ainna Qistina","family":"Saipolamin","sequence":"additional","affiliation":[{"name":"Reconstructive Sciences Unit, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,2,26]]},"reference":[{"key":"2025070104271025000_15.2.e092800.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2004.07.054"},{"key":"2025070104271025000_15.2.e092800.2","doi-asserted-by":"crossref","first-page":"828","DOI":"10.1097\/CM9.0000000000002093","article-title":"Risk factors associated with the progression from keloids to severe keloids","volume":"135","author":"Liu","year":"2022","journal-title":"Chin Med J (Engl)"},{"key":"2025070104271025000_15.2.e092800.3","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1007\/s40257-016-0175-7","article-title":"Keloids and Hypertrophic Scars: A Spectrum of Clinical Challenges","volume":"17","author":"Trace","year":"2016","journal-title":"Am J Clin Dermatol"},{"key":"2025070104271025000_15.2.e092800.4","doi-asserted-by":"crossref","DOI":"10.12688\/f1000research.18293.1","article-title":"Toward understanding scarless skin wound healing and pathological scarring","volume":"8","author":"Karppinen","year":"2019","journal-title":"F1000Res"},{"key":"2025070104271025000_15.2.e092800.5","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1111\/j.1742-481X.2012.01118.x","article-title":"Are keloid and hypertrophic scar different forms of the same disorder? 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