الفهرس 
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Abstract
Keloid is a benign fibroproliferative disorder characterized by abnormal deposition of collagen within a wound, however it may develop spontaneously. This skin “tumor” spreads beyond the margin of the original wound, continues to grow with time, commonly recurs following excision, and rarely regress spontaneously; however, with treatment, they may become softer and less symptomatic. Many modalities are available for managing keloid, yet no definitive treatment protocol exists. The standard treatment is an intralesional corticosteroid injection, but post-treatment recurrence of lesions has been documented. Vitamin D is well known for its anti- inflammatory role in preventing tissue fibrosis, it was recently recommended in the treatment of keloid scars. In the last few decades, studies showed that PRP contains plentiful various peptides, including enzymes, enzyme inhibitors, growth factors, and immune system messengers. These proteins have anti-inflammatory, neuropathic pain control, and tissue repair activities so it was recommended as a treatment for keloid scar. The aim of the present study was to evaluate the efficacy and safety of intralesional injection of Vit. D3 versus PRP versus their combination in treatment of keloid. Methods: This study included 60 patients presented with keloid. They had been divided randomly into 3 matched groups as follows: • group I: It included 20 patients treated by intralesional injection of Vit. D3. • group II: It included 20 patients treated by intralesional injection of autologous PRP. • group III: It included 20 patients treated by intralesional injection of Vit. D3 in a session followed by autologous PRP in the next session and so on. - All patients in all groups received treatment sessions biweekly until clinical cure or for a maximum of 4 successive sessions with follow up for 3 months after their last treatment session. Assessment of the treatment modalities: All patients were assessed before treatment and at the end of follow up period as follows: • Clinical evaluation according to VSS and VRS. • Dermoscopic examination. • Radiological assessment of keloid thickness by ultrasound. • Histopathological assessment by H&E and immunohistochemical assessment of Cav-1 expression. • Patient’s overall satisfaction score. • Safety and follow up assessment. Results: 1- Clinical results: The current study showed significant clinical improvement of keloid assessed by VSS and VRS at the end of follow up period in the three studied groups. Remarkably, the percentage of improvement in VSS was significantly higher in the patients’ group treated by combined Vit. D3 and PRP injection followed by those treated by Vit. D3 injection monotherapy, and the least were those treated by PRP injection monotherapy. There was statistically significant improvement in VRS after treatment in all studied groups compared to that before treatment (p value <0.001) with best improvement observed in PRP group monotherapy, but with nonsignificant difference between the three studied groups. 2- Dermoscopic results: Before treatment, the most common vascular pattern was a combined pattern in the form of more than one vascular pattern, followed by linear blood vessels alone and then, arborizing blood vessels alone. Obviously, after treatment, all studied groups showed remarkable improvement of all vascular patterns. However, there was no statistically significant difference in degree of improvement between the three studied groups. 3- Radiological results: Regarding ultrasound assessment of keloid thickness, there was a statistically significant reduction of keloid scars’ thickness after treatment compared to before in each of the three studied groups (p value <0.001) mostly observed in combined group followed by Vit. D monotherapy group and the least was PRP monotherapy group. These radiological findings confirm our clinical outcomes. 4- Histopathological and immunohistochemical results: Histopathological examination of the three studied groups showed significant reduction of collagen deposition, with more compact orientation of its bundles. The immunohistochemical evaluation of keloid specimens in the three studied groups showed a significant increase of Cav-1 expression in keloid scars after treatment compared to that before treatment with the strongest expression detected in the combined group followed by Vit. D3 monotherapy group and the least was PRP monotherapy group. These findings pointed to the possibility of using Cav-1 as an improvement indicator of keloid. 5- Patient’s overall satisfaction score: After treatment, there was statistically significant difference in satisfaction of patients between the three studied groups. The highest degree of patient’s satisfaction was observed in combined group, followed by Vit. D monotherapy group and the least was PRP monotherapy group. 6- Safety and follow up assessment: Side effects in all studied groups were mild, tolerable in the form of erythema, swelling, pain, and stinging that resolved in few days. No recurrence was reported at the end of follow up period in all the studied groups.