The efficacy of bleomycin for treating keloid and hypertrophic scar: A systematic review and meta‐analysis

Kim, Woo Il; Kim, Soo‐Young; Cho, Sung Woo; Cho, Moon Kyun

doi:10.1111/jocd.13390

Cited by 16 publications

(25 citation statements)

References 24 publications

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“…These results suggest that BLM is a more effective treatment option for keloid or hypertrophic scars than TAC and 5-FU or their combined therapies. However, the adverse reaction rate of BLM was higher (80). Interestingly, these findings are not in line with the current study's findings.…”

Section: Discussioncontrasting

confidence: 99%

“…Also, it significantly reduced post-injection pain ( 79 ). A recent meta-analysis evaluating the efficacy and safety of BLM, TAC, 5-FU, TAC combined with 5-FU, and TAC combined with cryotherapy found that BLM significantly improved the treatment of pathological scars than TAC or 5-FU combined with cryotherapy ( 80 ). There was no significant difference between the BLM group and the TAC combined with 5-Fu group.…”

Section: Discussionmentioning

confidence: 99%

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Network Meta-Analysis of Different Clinical Commonly Used Drugs for the Treatment of Hypertrophic Scar and Keloid

Yang

Luo

2021

Front. Med.

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Background: There is no uniform treatment for pathological scars, including keloids and hypertrophic scars, in clinic currently. Previously, multiple randomized controlled trials have examined the clinical efficacy of different treatments. Nonetheless, the results are inconsistent, and many treatments have not been directly compared. This makes it difficult to conclude which approach is more favorable, in terms of efficacy and safety, for the treatment of pathological scarring. This study aimed at evaluating the efficacy of different injection and topical treatment strategies for hypertrophic scar and keloid.Methods: Relevant literature from PubMed, Medline, Embase, Scopus, the Cochrane Central Register of Controlled Trials (CCRCT), and WHO International Clinical Trials Registry Platform (WHO-ICTRP) were searched, from database inception through November 2020. Randomized clinical trials evaluating different treatment strategies of pathological scars, including triamcinolone acetonide (TAC), verapamil (VER), 5-fluorouracil (5-FU), botulinum toxin A (BTA), bleomycin (BLM), and silicone gels were included in the study.Results: The network meta-analysis included a total of 2,009 patients from 29 studies. A network meta-analysis of injection and topical treatment strategies showed that the efficacy of TAC combined with BTA was best in the treatment of pathological scars. Combination therapies of TAC with 5-FU and TAC with BTA significantly improved the clinical efficiency. However, there was no statistically significant difference between other treatment strategies. The order of efficacy predicted by the surface under the cumulative ranking (SUCRA) curve was as follows: TAC+BTA (82.2%) > TAC+5-FU (69.8%) > BTA (67.3%) > 5-FU+silicone (59.4%) > TAC+silicone (58.3%) > 5-FU (49.8%) > BLM (42.0%) > TAC (26.7%) > VER (26.2%) > silicone (18.3%). There was no publication bias revealed based on the funnel diagram.Conclusion: This study recommends intralesional injection of TAC-BTA and TAC-5-FU combined therapies. But for patients who cannot tolerate the side effects, the use of silicone gels in combination with TAC is recommended. However, these conclusions need to be further confirmed by more randomized controlled trials.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Network Meta-Analysis of Different Clinical Commonly Used Drugs for the Treatment of Hypertrophic Scar and Keloid

Yang

Luo

2021

Front. Med.

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“…A meta-analysis 99 of five trials showed that bleomycin injections improved hypertrophic scars and keloids more effectively than triamcinolone acetonide and/or 5-fluorouracil injections. A 14-study review on topical onion extract gel (a nonsteroidal antiinflammatory drug) reported that 11 detected beneficial effects on hypertrophic scars and keloids.…”

Section: Hypertrophic Scar Treatmentmentioning

confidence: 99%

The Most Current Algorithms for the Treatment and Prevention of Hypertrophic Scars and Keloids: A 2020 Update of the Algorithms Published 10 Years Ago

Ogawa

2021

Plastic &Amp; Reconstructive Surgery

178

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Background: In 2010, this Journal published my comprehensive review of the literature on hypertrophic scars and keloids. In that article, I presented evidence-based algorithms for the prevention and treatment of these refractory pathologic scars. In the ensuing decade, substantial progress has been made in the field, including many new randomized controlled trials. To reflect this, I have updated my review. Methods: All studies were evaluated for methodologic quality. Baseline characteristics of patients were extracted along with the interventions and their outcomes. Systematic reviews, meta-analyses, and comprehensive reviews were included if available. Results: Risk factors that promote hypertrophic scar and keloid growth include local factors (tension on the wound/scar), systemic factors (e.g., hypertension), genetic factors (e.g., single-nucleotide polymorphisms), and lifestyle factors. Treatment of hypertrophic scars depends on scar contracture severity: if severe, surgery is the first choice. If not, conservative therapies are indicated. Keloid treatment depends on whether they are small and single or large and multiple. Small and single keloids can be treated radically by surgery with adjuvant therapy (e.g., radiotherapy) or multimodal conservative therapy. For large and multiple keloids, volume- and number-reducing surgery is a choice. Regardless of the treatment(s), patients should be followed up over the long term. Conservative therapies, including gel sheets, tape fixation, topical and injected external agents, oral agents, and makeup therapy, should be administered on a case-by-case basis. Conclusions: Randomized controlled trials on pathologic scar management have increased markedly over the past decade. Although these studies suffer from various limitations, they have greatly improved hypertrophic scar and keloid management. Future high-quality trials are likely to improve the current hypertrophic scar and keloid treatment algorithms further.

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“…At our tertiary academic hospital, we frequently treat patients with recalcitrant common warts, keloids, and hypertrophic scars with intralesional BLM using SLI 13,15 …”

Section: Discussionmentioning

confidence: 99%

“…In dermatological practice, jet injectors are used for intralesional delivery of triamcinolone acetonide for the treatment of hypertrophic scars, keloids, and alopecia areata 6–9 . Off‐label intralesional chemotherapy with jet injectors, however, have also shown efficacy, such as 5‐fluorouracil for the treatment of keloids and hypertrophic scars, methotrexate for non‐melanoma skin cancer, and bleomycin (BLM) for recalcitrant warts 10–15 . Of these chemotherapeutics, lung toxicity has been reported after high cumulative dosages of intravenous BLM (400 U) resulting in lung fibrosis 16,17 .…”

Section: Introductionmentioning

confidence: 99%

Needle‐free jet injection‐induced small‐droplet aerosol formation during intralesional bleomycin therapy

et al. 2021

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Objectives: Needle-free jet injectors are frequently used in dermatological practice. Injection-generated small-droplet aerosols could be harmful upon inhalation when chemotherapeutics, like bleomycin, are used. Here, we aim to explore jet injector-induced small-droplet aerosol formation of bleomycin in relation to air ventilation and to provide safety measures for clinical practice. Materials and Methods: With a professional particle sensor, we measured airborne aerosol particles (0.2-10.0 µm) after electronic pneumatic injection (EPI), springloaded jet injection (SLI), and needle injection (NI) of bleomycin and saline (100 μl) on ex vivo human skin. Three levels of air ventilation were explored: no ventilation, room ventilation, and room ventilation with an additional smoke evacuator. Results: EPI and SLI induced significant small-droplet aerosol formation compared with none after NI (0.2-1.0 µm; no ventilation). The largest bleomycin aerosol generation was observed for the smallest particles (0.2-1.0 µm) with 673.170 (528.802-789.453) aerosol particles/liter air (EPI; no ventilation). Room ventilation and smoke evacuation led to a reduction of ≥99% and 100% of measured aerosols, respectively. Conclusion: Jet injectors generate a high number of small-droplet aerosols, potentially introducing harmful effects to patients and healthcare personnel. Room ventilation and smoke evacuation are effective safety measures when chemotherapeutics are used in clinical practice.

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The efficacy of bleomycin for treating keloid and hypertrophic scar: A systematic review and meta‐analysis

Cited by 16 publications

References 24 publications

Network Meta-Analysis of Different Clinical Commonly Used Drugs for the Treatment of Hypertrophic Scar and Keloid

Network Meta-Analysis of Different Clinical Commonly Used Drugs for the Treatment of Hypertrophic Scar and Keloid

The Most Current Algorithms for the Treatment and Prevention of Hypertrophic Scars and Keloids: A 2020 Update of the Algorithms Published 10 Years Ago

Needle‐free jet injection‐induced small‐droplet aerosol formation during intralesional bleomycin therapy

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