Hemostasis, inflammation, proliferation and remodelling enable wound healing. Scarring occurs when fibrosis is either reduced or excessive. Keloid fibroblasts continue to produce connective tissue beyond the expected period for normal scars and they do not undergo apoptosis. TGF beta regulates fibroblast proliferation and collagen synthesis. Keloids show over production and inadequate regulation of TGF beta activity.

Pirfenidone is an anti fibrotic anti inflammatory drug that causes suppression of keloid derived fibroblast contraction through inhibition of the TGF beta one pathway, serving as a potential therapeutic agent for keloids.

There are various treatments available using both surgical and non surgical techniques however, optimal results are difficult to predict. Intralesional triamcinolone injections are most commonly used worldwide, however they come with numerous side effects such as pain, skin thinning, subcutaneous tissue atrophy, steroid acne, capillary dilation, development of secondary hypopigmentation and high recurrence rates. 

Often, a combination therapy works more efficiently than monotherapy in keloids. We aim to combine the positive effects of intralesional triamcinolone and pirfenidone 8 percent gel in better management of the condition and asses if this combination might reduce the side effects seen with steroid monotherapy.