Background and Importance Keloid scars represent an abnormality in wound repair in predisposed individuals. They are distinguished by an excessive synthesis of connective tissue. The treatment is difficult, recent studies have shown that the mixture of bleomycin, lidocaine and epinephrine (BLE) can be useful in the treatment of these lesions. The addition of lidocaine has an anaesthetic effect and also improves the cytotoxicity of bleomycin. Epinephrine has a vasopressor effect that prevents the passage of bleomycin and lidocaine into the blood.

Aim and Objectives To evaluate the efficacy and safety of the administration of the BLE mixture, by superficial puncture in a patient with keloid scars. Describe the preparation of the mixture in the Pharmacy Service.

Material and Methods Retrospective observational study of a patient to whom the BLE mixture was applied to keloid scars. The variables collected were: sex, age, size and location of the lesions, previous and concomitant treatments and data related to treatment with the BLE mixture (concentration, dose, frequency of administration, duration of treatment, effectiveness and safety). The clinical response to treatment was described with the following scale: complete crushing, very significant crushing, significant crushing. The patient‘s clinical history and the preparation protocol for the BLE mixture were reviewed.

Results A 14-year-old patient presented with keloid scars in the right cervical, scapular, and left thigh areas. He previously received intralesional punctures of corticosteroids, botulinum toxin and treatment with topical mometasone. The concentration of the BLE mixture was: bleomycin (0.75 g/l), lidocaine (3.5 g/l) and epinephrine (3.5 mg/l). 0.5 to 2 ml was administered in each puncture, monthly, making a total of 4 punctures. The clinical response was described as very significant crushing, with more inactive and whitish scars being observed. No adverse effect was observed.

The mixture was prepared in a vertical laminar flow hood. For this, a vial of bleomycin 15 mg/5 ml, 7 ml lidocaine hydrochloride 1% and 7 ml of diluted adrenaline 0.01 mg/ml were loaded into a 20 ml syringe. It was made up to 20 ml with 0.9% physiological serum.

Conclusion and Relevance The use of the BLE mixture was effective and safe in the treatment of the patient‘s keloid scars.

Conflict of Interest No conflict of interest