Efficacy and safety of thermomechanical fractional injury‐assisted corticosteroid delivery versus intralesional corticosteroid injection for the treatment of hypertrophic scars: A randomized split‐scar trial

Abstract

Background: Disruption of the natural skin barrier in a controlled manner may be used to deliver drugs that enhance scar resolution. Objective: To compare the efficacy and safety of thermomechanical fractional injury (TMFI)-assisted topical corticosteroid delivery with corticosteroid injection in the treatment of hypertrophic scar (HTS). Materials and Methods: This was a randomized, split-scar, double-blinded study. Twenty-one subjects with HTS on the abdomen received five split-scar treatments of TMFI + Steroid and steroid injection alone. Changes in scar thickness, scar volume, and Vancouver Scar Scale (VSS) were analyzed. Patient self-assessment, VAS scores, and adverse effects were also evaluated. Results: Scar thickness, volume, and VSS scores of both segments improved significantly compared to baseline. On every follow-up visit, there were no significant differences in mean scar thickness reduction between the two treatment groups except at the 6-month follow-up where the mean scar thickness reduction of the steroid injection segment was significantly lower than that of the TMFI + Steroid segment (95% confidence interval [CI], 0.09-0.35; p = 0.002). Scar volume, VSS scores, and patient self-assessment also showed no significant differences between both segments on all visits. The steroid injection segment was significantly more painful than the TMFI + Steroid segment (95% CI, −2.16 to −1.29; p < 0.001). Adverse effects of skin atrophy, telangiectasia, and postinflammatory hyperpigmentation were noted in the steroid injection segment, while no adverse effects were observed at the TMFI + Steroid segment. Conclusions: TMFI-assisted topical corticosteroid delivery is an effective treatment for HTS with a lower risk of adverse effects compared with corticosteroid injection.

Comparing Combination Triamcinolone Acetonide and 5-Fluorouracil with Monotherapy Triamcinolone Acetonide or 5-Fluorouracil in the Treatment of Hypertrophic Scars: A Systematic Review and Meta-Analysis

“…This has been a commonly reported outcome measure in primary studies. [15][16][17][18][19][20][21][22] Assessment into treatment efficacy involved grading of overall improvement on a five-point scale by either the patient or observer. Primary outcome objective assessment commonly used five-point scales derived from the degree of lesion flattening and size reduction.…”

“…(See Figure, Supplemental Digital Content 4, which shows a flow diagram of selection of included studies, http://links.lww.com/PRS/ G708.) The remaining 13 studies were included, comprising 12 RCTs [15][16][17][18][19][20][21][22][23][24][25]30 and a nonrandomized study. 31 The 12 RCTs were included in the metaanalyses performed; the remaining study, a nonrandomized controlled trial, was not included as it would introduce substantial heterogeneity to the analysis given the difference in methodology.…”

Curcumin alleviates hypertrophic scarring by inhibiting fibroblast activation and regulating tissue inflammation

“…Intralesional steroid injections are widely applied in clinic but limited by complications such as skin atrophy, telangiectasia, and hyperpigmentation. 5 Many herbal ingredients have been found to possess biological activity against hypertrophic scar (HS) with negligible side effects. Curcumin is a natural polyphenolic compound extracted mainly from the rhizomes of Curcuma longa (Zingiberaceae).…”

“…Treatment strategies for pathological scars mainly include physical compression, drug therapy, laser therapy and surgery. Intralesional steroid injections are widely applied in clinic but limited by complications such as skin atrophy, telangiectasia, and hyperpigmentation 5 . Many herbal ingredients have been found to possess biological activity against hypertrophic scar (HS) with negligible side effects.…”

Safety and Efficacy of a Thermomechanical Fractional Injury Device for Periorbital Rhytides

“…Recently, thermomechanical fractional injury has gained more attention in the dermatologic and aesthetic field, especially as a promising treatment modality for skin rejuvenation. [3][4][5][6][7][8][9] A recent chart review evaluated improvements in skin complexion, periorbital wrinkling, blood vessels and erythema, pigmentation and toning, pore size, vitality, and laxity with this device. 3 All measures were ultimately found to have overall clinical improvement.…”