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Depth control with needle plastic cap in radiofrequency-assisted fractional thermolysis for keloids: A modified technique
*Corresponding author: Avik Mondal, Department of Dermatology and Venereology, All India Institute of Medical Sciences, Kalyani, West Bengal, India. avik.mondal11@gmail.com
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Received: ,
Accepted: ,
How to cite this article: Mondal A, Tripathy PK. Depth control with needle plastic cap in radiofrequency-assisted fractional thermolysis for keloids: A modified technique. J Skin Sex Transm Dis. 2025;7:243-4. doi: 10.25259/JSSTD_149_2025
Dear Editor,
Radiofrequency-assisted fractional thermolysis for drug delivery in keloids has recently been established; it is effective for achieving even distribution of the drug and for reducing the likelihood of disproportionate reduction in the height of the keloid.[1] However, the existing technique lacks precision in depth control, relying solely on the subjective feel of loss of resistance when creating channels into the keloid with a pointed-tip probe.[1] As a result, beginners may struggle to accurately assess the required depth.
First, we measured the length of the metal monopolar probe, which may vary, and also measured the height of the keloid from the surface of the skin. Then, we marked the needle’s plastic cap, keeping in mind that the free end of the metal probe’s tip, extending beyond the cap cover, should be equal to the height of the keloid. A hole was created at the top of the plastic cap, allowing the base of the probe to fit into the hole and providing stability [Figure 1].
- Showing a plastic cap that fits onto the monopolar radiofrequency probe, a pre-procedure picture of pre-sternal keloids.
After administering local infiltrative anesthesia with lignocaine and adrenaline, multiple macropores were created, serving as channels for drug delivery into the keloid, by keeping the power at 20 watts in coagulation mode (KLS Martin, Tuttlingen, Germany). After pouring 40 mg/mL of triamcinolone acetonide into channels, an occlusive film dressing was placed and left on for 24 h [Video 1]. Patient removed the occlusive dressing after 24 h and applied triamcinolone (40 mg/mL) at home for the next 1 week, along with oral antibiotics and pain medication as part of the post-operative advice.[1] All sizes of syringes and needle caps can be utilized with this approach, and cutting the cap with a scalpel blade is relatively easy.[2] There was about a 50% homogenous reduction in size and height of keloids in 2 sessions, 4 weeks apart [Pre-session – Figures 1; post-session – Figure 2a and b].
Video 1:
Video 1:Controlling depth with needle plastic cap in radiofrequency-assisted fractional thermolysis for drug delivery in keloids. Video available online at: https://doi.org/10.25259/JSSTD_149_2025
- (a): Reduction in size after two sessions (Top view); (b): Reduction in height of the keloid after 2 sessions (Side view).
Ethical approval:
Institutional Review Board approval is not required.
Declaration of patient consent:
The authors certify that they have obtained all appropriate patient consent.
Conflicts of interest:
There are no conflicts of interest.
Use of artificial intelligence (AI)-assisted technology for manuscript preparation:
The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated.
Financial support and sponsorship: Nil.
References
- Radiofrequency-assisted fractional thermolysis for drug delivery in Keloids. Indian J Dermatol Venereol Leprol. 2024;90:842-3.
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- Creating a guard with a needle cover to control the depth of intralesional injections. J Am Acad Dermatol. 2016;75:e67-8.
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