Could 5-Fluorouracil or Triamcinolone Be an Effective Treatment Option for Keloid After Surgical Excision? A Meta-Analysis

BackgroundTriamcinolone acetonide (TAC) is used frequently in the treatment of keloid scars, but has presented controversial results. In this study, we aim to evaluate the effectiveness of TAC compared with other common therapies used in keloid treatment.MethodsMEDLINE, Embase, Web of Science and the Cochrane Library databases were searched until January 2018. Key data were extracted from eligible randomized controlled trials. Both pairwise and network meta-analyses were conducted for synthesizing data from eligible studies.ResultsTen randomized controlled trials were included in this meta-analysis. The relative risk of keloids associated with seven adjuvants was analyzed, including placebo, pulsed dye laser (PDL), 5-fluorouracil (5-FU), silicone, verapamil, TAC+5-FU and TAC+5-FU+PDL. Patients treated with the following adjuvants appeared to not have significantly reduced risk of keloid in relation to those treated with TAC: placebo (OR=1.86, 95% CI 1.12–2.61), PDL (OR=1.32, 95% CI 0.53–3.30), 5-FU (OR=1.13, 95% CI 0.48–2.68), silicone (OR=1.28, 95% CI 0.59–2.78), verapamil (OR=1.86, 95% CI 0.67–5.14), TAC+5-FU (OR=0.77, 95% CI 0.38–1.58) and TAC+5-FU+PDL (OR=0.80, 95% CI 0.16–4.03). The surface under the cumulative ranking curve values for each adjuvant were as follows: TAC, 59.9%; placebo, 17.4%; PDL, 46.3%; 5-FU, 48.9%; silicone, 56.2%; verapamil, 84.7%; TAC+5-FU, 68.5% and TAC+5-FU+PDL, 18.1%.ConclusionThere were no differences between the efficacy of TAC and other common therapies in keloid treatment. TAC also acts as an effective alternative modality in the prevention and treatment of keloids. Incorporating adjuvants particularly verapamil appeared to be significantly associated with a decreased risk of keloids.

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“… 31 Shin et al found 5-FU was more effective than TAC in keloid treatment after surgical excision. 33 …”

Section: Discussionmentioning

confidence: 99%

Effects and safety of triamcinolone acetonide-controlled common therapy in keloid treatment: a Bayesian network meta-analysis

Zhang

Cao

Wang

et al. 2018

TCRM

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“…A recent meta‐analysis reported whether triamcinolone intralesional injection following surgical excision prevented the recurrence of keloids 65 . Researchers analyzed four studies comprising 254 patients and found that surgery combined with TAC was not effective in lowering the rate of keloid recurrence with a pooled risk difference of 0.06 (95% CI, −0.16 to 0.28; P, not significant) 65 . However, the location of the keloid may be associated with the success of TAC following excision.…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…5‐Fluorouracil is an antineoplastic pyrimidine analog that has an inhibitory effect on fibroblasts 65 . Shin and Kim conducted a meta‐analysis on whether 5‐FU prevents keloid recurrence following surgical excision 65 . Following analysis of two studies with a total of 107 patients, keloid recurrence was statistically lower in patients treated with 5‐FU (risk ratio, 0.18; 95% CI, 0.04–0.75; P = 0.02) 65 .…”

Section: Resultsmentioning

confidence: 99%

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Keloids: a review of therapeutic management

et al. 2020

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Keloid scar formation arises from a disorganized fibroproliferative collagen response that extends beyond the original wound margins because of excessive production of extracellular matrix (ECM). Despite treatment options for keloid scars including medical and surgical therapies, such as intralesional steroid injection and surgical excision, the recurrence rate remains high. Herein we consolidate recently published narrative reviews, systematic reviews, and meta‐analyses to provide an overview of updated treatment recommendations for keloidal scar formation. PubMed search engine was used to access the MEDLINE database to investigate updates regarding keloid incidence and treatment. More than 100 articles were reviewed. Keloid management remains a multimodal approach. There continues to be no gold standard of treatment that provides a consistently low recurrence rate; however, the increasing number of available treatments and synergistic combinations of these treatments (i.e., laser‐based devices in combination with intralesional steroids, or 5‐fluorouracil (5‐FU) in combination with steroid therapy) is showing favorable results. Future studies could target the efficacy of novel treatment modalities (i.e., autologous fat grafting or stem cell‐based therapies) for keloid management. This review article provides updated treatment guidelines for keloids and discusses insight into management to assist patient‐focused, evidence‐based clinical decision making.

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“…9 Numerous case series and randomized controlled trials have demonstrated excellent safety and efficacy of 5-FU alone and in combination with steroids for the treatment of keloids and hypertrophic scars. [10][11][12][13][14][15][16][17][18][19][20][21][22] The drug's inhibition of TGF-beta is believed to be responsible for its activity on keloid and hypertrophic scars, both of which are characterized by the abnormal organization of collagen fibers. 23 5-FU is effective for both treatment and prevention of exuberant scarring and treatment response is improved when scars are newer.…”

Section: General Considerationsmentioning

confidence: 99%

Use of 5-Fluorouracil for Management of the Thick-Skinned Nose

Irvine¹,

Nassif

2018

Facial plast Surg

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Patients with a thick nasal skin and soft tissue envelope can have unpredictable results and irregular scarring after rhinoplasty surgery. These patients typically have sebaceous tissue over the nasal tip and are particularly susceptible to soft tissue polly beak formation and excess scar tissue in the radix, tip, and septum. Targeted injections of 5-fluorouracil alone or mixed with low concentrations of steroid can be useful to prevent and treat excess postoperative scar tissue deposition. Ideally, four to six injections are performed every 1 to 4 weeks beginning 1 week postoperatively. The injections are most beneficial when performed within the first 3 months after surgery. Even a single injection may improve outcomes with minimal side effects.

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Could 5-Fluorouracil or Triamcinolone Be an Effective Treatment Option for Keloid After Surgical Excision? A Meta-Analysis

Cited by 19 publications

References 37 publications

Effects and safety of triamcinolone acetonide-controlled common therapy in keloid treatment: a Bayesian network meta-analysis

Effects and safety of triamcinolone acetonide-controlled common therapy in keloid treatment: a Bayesian network meta-analysis

Keloids: a review of therapeutic management

Use of 5-Fluorouracil for Management of the Thick-Skinned Nose

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