The Efficacy of Combining Fractional Carbon Dioxide Laser With Verapamil Hydrochloride or 5-Fluorouracil in the Treatment of Hypertrophic Scars and Keloids: A Clinical and Immunohistochemical Study

Abstract

BACKGROUND Ablative fractional laser-assisted therapy is increasingly used to facilitate drug delivery and intensify clinical efficacy of topically applied drugs. OBJECTIVE To evaluate the effectiveness of combined ablative fractional CO2 laser and topically applied 5-fluorouracil (5-FU) or verapamil hydrochloride in the treatment of hypertrophic scars (HTSs) and keloids and to examine their possible effects on TGF-β1 expression. PATIENTS AND METHODS Thirty patients with HTSs and keloids were randomly treated with combined CO2 laser followed by topical verapamil or 5-FU application or CO2 laser monotherapy. All patients received 4 treatments at 1-month intervals. Subjective and objective assessment was obtained using the Vancouver Scar Scale (VSS). Histological changes and immunohistochemical staining for TGF-β1 were performed. RESULTS Compared with baseline, there was a significant reduction in the VSS 1 month after the last treatment session in all groups (p < .05). Laser-assisted 5-FU delivery tended to show a higher extent of improvement in scar characteristics than laser-assisted verapamil hydrochloride delivery, without significance. No significant side effects were reported in all patient groups. TGF-β1 expression was significantly decreased after laser sessions. CONCLUSION Combined fractional CO2 laser and topical 5-FU or verapamil hydrochloride offer a safe therapy for HTSs and keloids.

Assessment of laser‐assisted delivery vs intralesional injection of botulinum toxin A in treatment of hypertrophic scars and keloids

“…The study of Sabry et al 17 reported that the VSS significantly reduced 1 month following the last treatment session in all cases (P < .05).…”

“…The study of Sabry et al 17 subjected 30 cases suffering from HTSs and keloids to a monthly dose of one of the following treatment regimens for four successive months; (CO 2 laser alone or CO 2 laser followed by topical verapamil or 5‐flurouracil application) and reported that the VSS significantly reduced 1 month following the last treatment session in all cases ( P < .05).…”

Laser-assisted drug delivery in the treatment of keloids: A case of extensive refractory keloids successfully treated with fractional carbon dioxide laser followed by topical application and intralesional injection of steroid suspension

“…In the literature, several medications have been reported for laser-assisted drug delivery for keloids and hypertrophic scars and include verapamil hydrochloride, 3 5-fluorouracil,3, 4 and steroids 4, 5, 6, 7, 8. Different vehicles of steroids have been used following laser treatments (Table I).…”

A Review of Current Keloid Management: Mainstay Monotherapies and Emerging Approaches

“…While pain reduction was significantly higher in the CO 2 laser group, the authors largely found that these two treatments are equivalent [68]. Sabry et al found that the combination of CO 2 laser with either topical verapamil or 5-fluorouracil was more efficacious than laser alone, with no adverse effects [69]. A randomized controlled trial evaluating intralesional cryotherapy as compared to excision and steroid or excision and brachytherapy performed by Bijlard et al was stopped because of significantly inferior results in the intralesional cryotherapy group.…”