مجله دانشکده پزشکی اصفهان (Mar 2012)
New Combination of Triamcinolone, 5-Fluorouracil, and Pulsed-Dye Laser for the Treatment of Keloid andHypertrophic Scars
Abstract
Background: Keloids and hypertrophic scars are benign growths of dermal collagen that usually cause major physical, psychological and cosmetic problems. Methods: In this 12-week single-blinded clinical trial, 69 patients were randomly assigned into three study groups. In Group 1, intralesional triamcinolone acetonide (TAC, 10 mg/mL) was injected at one-week intervals for a total of 8 weeks. In Group 2, 0.1 mL of 40 mg/mL TAC was added to 0.9 mL of 5-Fluorouracil (5FU, 50mg/mL). This combination was injected weekly for 8 weeks. In Group 3, in addition to weekly TAC and 5FU injections for 8 weeks, lesions were irradiated by 585-nm flashlamp-pumped pulsed-dye laser (PDL, 5–7.5 J/cm2) at the 1st, 4th, and 8th weeks. Lesions were assessed for erythema, pruritus, pliability, height, length and width. Findings: Sixty patients completed the study. At the 8- and 12-week follow-up visits, all groups showed improvements in nearly all of the outcome measures; but in comparison between groups, the improvements were statistically more significant in the TAC-5FU and TAC-5FU-PDL groups (P < 0.05 for all outcome measures). At the end of the study, the erythema score was significantly lower, and itch reduction was statistically higher in the TAC-5FU-PDL group (P = 0.05 for both). The percent of the patients who reported good to excellent improvements (50% improvement) were as follows: 20% in Group 1, 55% in Group 2, and 75% in Group 3 (P = 0.05). Good to excellent responses in each group that were reported by a blinded observer were as follows: 15% in Group 1, 40% in Group 2, and 70% in Group 3 (P = 0.05). Atrophy and telangiectasia were seen in 37% of patients in TAC group. Conclusion: Overall efficacy of TAC-5FU was comparable with TAC-5FU-PDL; but the TAC-5FU-PDL combination was better tolerated by the patients and produced better results. Its reducing effect on the erythema of the lesions was also promising. The TAC-5FU-PDL combination seems to be the best approach for treatment of keloid and hypertrophic scars.
