The Emerging Role of Antineoplastic Agents in the Treatment of Keloids and Hypertrophic Scars

Abstract

The management of keloids and hypertrophic scars continues to challenge health-care providers. Though both forms of pathologic scarring are distinct entities at the macro and microscopic level, their etiologies and treatment are often similar. Potential treatment approaches are progressing, and combinations of treatment options have been proposed in the literature with promising outcomes. The treatment evolution has reached a level where molecular therapeutic modalities are being investigated. Currently, no gold standard treatment exists. Overall success rates and patient satisfaction seem to be slowly climbing, but additional investigational studies must continue to be performed. Several studies have investigated antineoplastic agents, and there seems to be a marked improvement in rates of recurrence, patient satisfaction, and overall quality of scar when these agents are used. Intralesional injection and/or wound irrigation with interferon-a2b, interferon-g, mitomycin-C, bleomycin, or 5-fluorouracil seems to have a positive effect on the reduction of pathologic scars. There is mounting evidence that these drugs used alone or in combination therapy, have the potential to be an integral part of the treatment paradigm for hypertrophic scars and keloids.

Update on hypertrophic scar treatment

“…Although intralesional bleomycin is a promising treatment option for keloids and HTSs, further investigation and efficacy trials are needed before this agent can be included in future treatment protocols (88). …”

“…In particular, alpha and gamma inhibit the synthesis of collagen types I and III, acting on mRNA in the cell and reducing the levels of TGF-β. However, interferon application is very painful and it is a costly drug (88). …”

In vitro study of ethosome penetration in human skin and hypertrophic scar tissue

“…5-Fluorouracil (5-FU) has been proven to possess antiscarring activity and is widely recommended in clinical practice. [18][19][20][21][22] The administration route is mainly intralesional injection. Disadvantages of this treatment are severe pain caused by the injections (despite the use of anesthesia).…”

Preliminary results of antiscarring therapy in the prevention of postendoscopic esophageal mucosectomy strictures

“…MMC is an antimitotic chemotherapy agent that has been used for years. Its new role as an antiscarring agent shows promise by inhibiting fibroblast proliferation and activity [13, 14]. Lastly, because excess type I collagen deposition is associated with fibrosis, Hal (inhibits collagen α I expression and matrix metalloproteinase 2) can change the remodeling phase of wound healing and potentially decrease scar formation [15].…”