Keloids Treatment Using Triple Medicine Combination

Abstract

Relevance. A lot of conservative approaches have been proposed to the management of keloids, but none of them provides a guaranteed positive result and a stable absence of relapse.
 Objective: to evaluate the effectiveness and side effects of triple keloid scar therapy.
 Materials and methods. Thirty-three patients aged 18-69 years, who received treatment of keloids by triple medicine combination therapy, were investigated retrospectively. All patients were divided into two groups. In first one (16 patients) intralesional injections of mixture of 5-fluorouracil, triamcinolone acetonide and bovine origin hyaluronidase were performed. In the second group (17 patients) instead of triamcinolone betamethasone suspension was used. Four sessions of therapy were performed with a monthly interval. Results were assessed 1 month and 6 months after the last session. The planimetric investigation and measurement of scars’ volume were performed. The influence of treatment on the number of telangiectasias within the scar was performed with the help of our method of computer processing of its digital photographs.
 Results. There was not statistically significant difference in linear size, area and volume of the scars in patients of two groups before beginning of the treatment. One month after the fourth session scars’ width increased statistically significantly. Their length and area also increased but difference did not reach statistically significant level. At the same time maximal height of the scars over surrounding tissues (p<0.001) and their volume (p=0.012 та 0.001) reduced significantly in both groups. There was not difference in percentage of scar volume reduction ((67.4±18.01) % and (74.3±14.71) % correspondingly, p=0.308) in different groups. The main negative effect of treatment was redness of the scars due to purpura and increase of telangiectasias number. Reliable increase of the part of the scars’ surface taken by the telangiectasias was registered in both groups without difference between them. Despite the overall improvement in self-esteem, the patients noted that the change in the color of the scar after the treatment came into the first plane among the factors causing aesthetic dissatisfaction. Supplementary methods of telangiectasias and hyperemia correction were used in 12 patients of the first and 11 patients of the second group. Pain syndrome and itching were eliminated in 11 out of 14 (78.6%) patients in the first group and in 11 out of 15 (73.3%) patients in the second group (p = 0.753). Performed treatment positively influenced patients’ quality of life. Their self-esteem increased essentially ((3.4±2.16) points, p=0.005 and (3.2±1.92) points, p=0.001 correspondingly). At re-examination 6 months after the termination of triple therapy, no statistically significant changes in the size of scars were found, pain and itching did not restore. The quality of life self-esteem remained unchanged.
 Conclusion. The combined use of 5-fluorouracil, glucocorticoid, and hyaluronidase reduced the protrusion and volume of not-burn keloids in patients of both groups (by (67.4 ± 18.01) % and (74.3 ± 14.71) % respectively (p = 0.308)). Triple medicine therapy permitted to eliminate the pain syndrome and itching in 78.6 % of patients of group where triamcinolone acetonide was used, and in 73.3% of patients who received mixture that included betamethasone suspension (p=0.753). Triple medicine therapy effectiveness, both in term scars’ resizing, and eliminating clinical symptoms and improving the quality of life, was the same for both variants of the combination of drugs. The main side effect, that somewhat worsened the aesthetic result of treatment, was the increase of telangiectasias number. The part of the scar area taken by telangiectasias increased from the (3.4±1.16) % to the (9.7±3.51) %, p<0.001 in the first group and from the (3.3±1.31) % to the (9.7±3.05) %, p<0.001 in the second one. The use of glucocorticoid in triple therapy, which to a lesser extent will stimulate the formation of telangiectasias, will improve the cosmetic result of the treatment.