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J Plast Reconstr Aesthet Surg. 2019 Jan;72(1):4-11. doi: 10.1016/j.bjps.2018.05.052. Epub 2018 Jun 25.

Treatment of keloid scars with intralesional triamcinolone and 5-fluorouracil injections - a randomized controlled trial.

Author information

1
Department of Musculoskeletal Surgery and Diseases, Tampere University Hospital, Tampere, Finland; Central Finland Health Care District, Jyväskylä, Finland. Electronic address: kristiina.hietanen@ksshp.fi.
2
Department of Musculoskeletal Surgery and Diseases, Tampere University Hospital, Tampere, Finland; School of Medicine, University of Tampere, Tampere, Finland.
3
Faculty of Social Sciences, University of Tampere, Tampere, Finland.
4
Department of Pathology, Fimlab Laboratories, Tampere University Hospital, Tampere, Finland.
5
Department of Plastic Surgery, Helsinki University Hospital, Helsinki, Finland.
6
Department of Musculoskeletal Surgery and Diseases, Tampere University Hospital, Tampere, Finland.

Abstract

Keloids have high recurrence rates. Current first-line therapy is triamcinolone (TAC) injection, but it has been suggested that approximately 50% of keloids are steroid resistant. We compared the efficacy of intralesional 5-fluorouracil (5-FU) and triamcinalone injections in a double-blind randomized controlled trial. Forty-three patients with 50 keloid scars were treated with either intralesional TAC or 5-FU-injections over 6 months. There was no statistically significant difference in the remission rate at 6 months between the 5-FU and TAC groups (46% vs 60%, respectively). Local adverse effects were higher in the TAC group compared to the 5-FU group. Occurrence of skin atrophy in TAC group was 44% and in the 5-FU group 8% (p < 0.05). Also the occurrence of telangiectasia in the TAC group was 50% and in the 5-FU 21% (p < 0.05). Vascularity of the keloids, assessed by spectral imaging and immunohistochemical staining for blood vessels, after treatment decreased in the TAC group, but not in the 5-FU group (p < 0.05). Fibroblast proliferation evaluated by Ki-67 staining significantly decreased in the TAC group (p < 0.05) but increased in the 5-FU group (p < 0.05). TAC and 5-FU injections did not differ in their clinical effectivity in this randomized study, but 5-FU injections lead to increased proliferation rate and did not affect vascular density in histological assessment. Due to the greater number of adverse effects observed after TAC treatment, 5-FU injections may be preferable for cosmetically sensitive skin areas.

KEYWORDS:

5-fluorouracil; Immunohistochemistry; Keloid; Scar treatment; Triamcinolone

PMID:
30448246
DOI:
10.1016/j.bjps.2018.05.052

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