Comparison of efficacy and safety of intralesional triamcinolone and combination of triamcinolone with 5-fluorouracil in the treatment of keloids and hypertrophic scars: Randomised control trial

Khalid, Farrukh Aslam; Mehrose, Muhammad Younas; Saleem, Muhammad; Yousaf, Muhammad Amin; Mujahid, Abdul Malik; Rehman, Saif Ur; Ahmad, Sania; Tarar, Moazzam Nazeer

doi:10.1016/j.burns.2018.08.011

Cited by 76 publications

(97 citation statements)

References 27 publications

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“…A total of nine studies were found suitable for this analysis. Of these nine studies, four compared the effect of intralesional injections, whereof three analyzed triamcinolone (TAC) injection vs intralesional TAC + 5‐FU 40‐42 and one investigated the intralesional injection of TAC opposed to that of verapamil 43 . Two studies investigated the effect of topical ointments (silicone 44 and enalapril 45 ), one that of short‐term massage, 46 one that of topical silicone dressing, that of pressure therapy and a combination thereof 47 .…”

Section: Resultsmentioning

confidence: 99%

“…Interestingly, three of them (33% of all level‐of‐evidence‐I‐graded studies) chose to follow the same treatment protocol. While the first 41 and third 40 published studies used the Patient and Observer Scar Assessment Scale (POSAS), 49 and the scar height as primary end points, the second study by Ali et al focused on the scar height, exclusively 42 . They all used an injection of 10 mg TAC once a week for 8 weeks in one group and a combination of 4 mg TAC and 45 mg 5‐FU once a week for 8 weeks in the other group.…”

Section: Discussionmentioning

confidence: 99%

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Evidence‐based therapy in hypertrophic scars: An update of a systematic review

Nischwitz

Rauch²,

Luze

et al. 2020

Wound Repair Regeneration

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Hypertrophic scars are still a major burden for numerous patients, especially after burns. Many treatment options are available; however, no evidence‐based treatment protocol is available with recommendations mostly emerging from experience or lower quality studies. This review serves to discuss the currently available literature. A systematic review was performed and the databases PubMed and Web of Science were searched for suitable publications. Only original articles in English that dealt with the treatment of hypertrophic scars in living humans were analyzed. Further, studies with a level of evidence lower than 1 as defined by the American Society of Plastic Surgeons were excluded. After duplicate exclusion, 1638 studies were screened. A qualitative assessment yielded 163 articles eligible for evidence grading. Finally nine studies were included. Four of them used intralesional injections, four topical therapeutics and one assessed the efficacy of CO2‐laser. Intralesional triamcinolone + fluorouracil injections, and topical pressure and/or silicone therapy revealed significant improvements in terms of scar height, pliability, and pigmentation. This systematic review showed that still few high‐quality studies exist to evaluate therapeutic means and their mechanisms for hypertrophic scars. Among these, most of them assessed the efficacy of intralesional triamcinolone injections with the same treatment protocol. Intralesional injection appears to be the best option for hypertrophic scar treatment. Future studies should focus on a possible optimization of infiltrative therapies, consistent end‐point evaluations, adequate follow‐up periods, and possibly intraindividual treatments.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Evidence‐based therapy in hypertrophic scars: An update of a systematic review

Nischwitz

Rauch²,

Luze

et al. 2020

Wound Repair Regeneration

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“…30 A subsequent randomized trial published afterwards also found superior reduction in scar height and recurrence of keloids in 120 patients randomized to injected triamcinolone versus triamcinolone and 5-FU. 31 It is important to note that 5-FU is contraindicated in hematologic conditions such as anemia, leukopenia, thrombocytopenia, or bone marrow depression, as well as pregnancy, or infection. 22…”

Section: -Fluorouracilmentioning

confidence: 99%

Management of Complications from Skin Cancer Reconstruction

Vila

Thomas

2020

Facial Plast Surg

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Reconstruction of facial cutaneous defects from skin cancer surgery is a commonly done procedure in the hands of many facial plastic surgeons. Excellent surgical technique should always be employed to reduce the risk of a poor result. However, complications do occur and can be devastating for both the patient and surgeon. We review a range of postoperative management options, and the evidence for each modality, so that reconstructive surgeons can stay up to date on current literature.

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“…After the publication of meta‐analysis, RCTs addressing the therapeutic value of TAC and 5‐FU injections in keloids have been published. Khalid et al and Srivastava et al both found that combination treatment with TAC and 5‐FU may be superior to monotherapy with TAC . Khalid et al published their study on 108 patients with 22 months follow‐up, whereas Srivastava et al published their data on 60 patients with 30 weeks follow‐up .…”

Section: Introductionmentioning

confidence: 99%

“…Khalid et al and Srivastava et al both found that combination treatment with TAC and 5‐FU may be superior to monotherapy with TAC . Khalid et al published their study on 108 patients with 22 months follow‐up, whereas Srivastava et al published their data on 60 patients with 30 weeks follow‐up . However, neither of these RCT studies addressed the cellular responses taking place in keloids in response to these drugs.…”

Section: Introductionmentioning

confidence: 99%

Histopathology and immunohistochemical analysis of 5‐fluorouracil and triamcinolone treated keloids in double‐blinded randomized controlled trial

Hietanen

Järvinen

Tolonen

et al. 2020

Wound Repair Regeneration

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Keloids are a major complication related to surgical wound healing and very challenging condition to treat. Many treatment options are available, but the efficacy of the treatment is poor in most of cases and some keloids do not respond to the treatment at all. We compared the efficacy of intralesional 5-fluorouracil (5-FU) and triamcinolone (TAC) injections in a double-blind randomized controlled trial (RCT). Forty-three patients with 50 keloid scars were treated with either intralesional TAC or 5-FUinjections over 6 months. We wanted to find out whether biological features (cell density, cell proliferation rate, vascular density, myofibroblast numbers, steroid hormone receptor expression) in keloids could be used to predict the response to therapy and define the biological changes that take place in patients receiving a response. As there was no statistically significant difference in the remission rate between TAC and 5-FU treatments, all patients were combined and analyzed as responders and nonresponders. Although responders have slightly more myofibroblasts than the nonresponders in their keloids in the pretreatment biopsy samples, we could not identify a single predictive factor that could identify those patients that respond to drug injections. The good clinical response to therapy is associated with the simultaneous reduction of myofibroblasts in the keloid. This study demonstrates that myofibroblasts are reduced in number in those keloids that were responsive to therapy, and that both 5-FU and TAC injections are useful for keloid treatment.

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Comparison of efficacy and safety of intralesional triamcinolone and combination of triamcinolone with 5-fluorouracil in the treatment of keloids and hypertrophic scars: Randomised control trial

Cited by 76 publications

References 27 publications

Evidence‐based therapy in hypertrophic scars: An update of a systematic review

Evidence‐based therapy in hypertrophic scars: An update of a systematic review

Management of Complications from Skin Cancer Reconstruction

Histopathology and immunohistochemical analysis of 5‐fluorouracil and triamcinolone treated keloids in double‐blinded randomized controlled trial

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