Comparative Study of a Combination of Intralesional Corticosteroid, 5-fluorouracil and/or Pulsed Dye Laser for the Treatment of Keloids and Hypertrophic Scars

Kim, Ho Youn; Lim, Hyun Jung; Jun, Jae Hun; Choe, Yoon Seok; Kim, Byung Soo; Lee, Weon Ju; Lee, Seok Jong; Kim, Do Won

Abstract

BACKGROUND: Despite the physical disfigurement, bothersome symptoms and psychological problemsfrom the proliferative scarring process of keloids and hypertrophic scars, there is currently no consensus regarding the best management of these lesions.
OBJECTIVE
The purpose of this study was to determine the therapeutic efficacy and safety of intralesional corticosteroid injection combined with 5-fluorouracil (5-FU) and/or pulsed dye laser (PDL) in Koreans with keloids or hypertrophic scars.
METHODS
Twenty-five patients with keloids and/or hypertrophic scars over 2 cm in size or who had more than 3 separated lesions were included in this study. Each scar was divided equally into 2 or more segments and these were treated with 1 of the following 3 different modalities: (1) intralesional injection of triamcinolone acetonide (TCA: 20 mg/ml weekly), (2) intralesional injection of TCA 0.1 ml (40 mg/ml) mixed with 5-FU 0.9 ml (50 mg/ml) weekly and (3) treatment #2 combined with PDL (585 nm, 5~7.5 J/cm2) at baseline and at the 3rd and 7th weeks. We estimated the change of the height, the erythema, the pliability, the pruritus, the pain/tenderness scores, the patient-self assessment and the complications. This study was an 8-week prospective study and the assessment of relapse was done at 4 and 12 weeks after the last treatment.
RESULTS
There was a statistically significant improvement of the clinical signs and symptoms in all the treated groups. However, the 5-FU-treated groups had more sustained effects compared to the group that underwent TCA monotherapy with respect to flattening and pliability. Complications such as ulcerations, crusts and hyperpigmentation were more frequent in the 5-FU-treated groups.
CONCLUSION
Although 5-FU may be preferable to TCA for improving the symptoms of keloids and hypertrophic scars, we believe it is prone to induce more complications in Koreans.