Comparing the Efficacy of Intralesional Combination of Verapamil and Triamcinolone Vs Intralesional Triamcinolone for Treatment of Keloid

Muhammad Tayyab Iqbal; Qamar Uddin Khan; Hina Mazhar; Asma Malik; Madeeha Shaukat; Muhammad Farhan Shahid

doi:10.51253/pafmj.v76iSUPPL-3.14065

Authors

Muhammad Tayyab Iqbal Departments of Dermatology, Combined Military Hospital Lahore/National University of Medical Sciences (NUMS) Pakistan
Qamar Uddin Khan Departments of Dermatology, Combined Military Hospital Lahore/National University of Medical Sciences (NUMS) Pakistan
Hina Mazhar Departments of Dermatology, Combined Military Hospital Quetta/National University of Medical Sciences (NUMS) Pakistan
Asma Malik Departments of Dermatology, Combined Military Hospital Multan/National University of Medical Sciences (NUMS) Pakistan
Madeeha Shaukat Departments of Dermatology, KRL Hospital Kahuta Pakistan
Muhammad Farhan Shahid Departments of Dermatology, Combined Military Hospital Multan/National University of Medical Sciences (NUMS) Pakistan

DOI:

https://doi.org/10.51253/pafmj.v76iSUPPL-3.14065

Keywords:

Intralesional, Keloid, Triamcinolone, Verapamil

Abstract

Objective: To compare intralesional combination of verapamil with triamcinolone versus intralesional triamcinolone for resolution of keloid in terms of mean change in Vancouver Scar Scale (VSS).

Study Design: Randomized Controlled Trial (Trial Registration: TCTR20251117012)

Place and Duration of Study: Departments of Dermatology, Pakistan Emirates Military Hospital (PEMH), and Combined Military Hospital (CMH), Rawalpindi, Pakistan, from Feb to Aug 2025.

Methodology: This study included 60 patients, 30 in each group, with diagnosis of keloid and hypertrophic scars where Group-A received combined injection of triamcinolone acetonide (TAC) (20mg/ml) and verapamil (1.25mg/ml), while Group-B received only injection of TAC 20 mg/ml, at three weeks interval for maximum five sessions. After five sessions, keloid scars were assessed by VSS.

Results: The study participants had an mean age of 32.58 ± 8.09 years with an mean duration of symptoms lasting 8.27 ± 2.50 months and mean baseline VSS score of 8.48 ± 2.39. Demographic distribution showed 51.70% male and 48.30% female participation. There were no remarkable differences between the groups regarding age distribution, gender, duration of keloids or baseline VSS score. After treatment, the VSS scores were significantly reduced in Group-A (3.37 ± 1.96) compared to Group-B (5.77 ± 2.40) where p<0.001.

Conclusion: Intralesional verapamil combined with TAC is significantly more effective than TAC alone in reducing keloid severity, as demonstrated by a greater reduction in VSS scores.

Downloads

Download data is not yet available.

References

1. Klomparens K, Simman R. Treatment of Keloids: A Meta-analysis of Intralesional Triamcinolone, Verapamil, and Their Combination. Plast Reconstr Surg Glob Open 2022; 10(1): e4075. https://doi.org/10.1097/GOX.0000000000004075

2. Bao Y, Xu S, Pan Z, Deng J, Li X, Pan F, et al. Comparative Efficacy and Safety of Common Therapies in Keloids and Hypertrophic Scars: A Systematic Review and Meta-analysis. Aesthetic Plast Surg 2020; 44(1): 207-218. https://doi.org/10.1007/s00266-019-01518-y

3. Adil A, Ilyas S, Kiran R, Saeed W, Aman S, Jamil T. Comparison of efficacy and safety of Intralesional Verapamil hydrochloride & Intralesional triamcinolone acetonide in the treatment of keloids. J Pak Assoc Dermatol 2024; 34(1): 31-39.

4. Belie O, Ugburo AO, Mofikoya BO, OA TO, Belie MF. A comparison of intralesional verapamil and triamcinolone monotherapy in the treatment of keloids in an African population. Niger J Clin Pract 2021; 24(7): 986-992. https://doi.org/10.4103/njcp.njcp_474_20

5. Haghani-Dogahe Z, Hadadi R, Esmailzadeh M, Mobayen M. Comparing intralesional triamcinolone and verapamil-triamcinolone injections in keloids: A single-blinded randomised clinical trial. Int Wound J 2023; 20(10): 4166-4174. https://doi.org/10.1111/iwj.14314

6. Mohanty S, Gupta J, Rohatgi G, Saigal S. Comparative efficacy of intralesional verapamil hydrochloride, triamcinolone acetonide and combination of both drug in hypertrophic scars and keloids at tertiary care center. Int Surg J 2021; 8(10): 2940-2945.

7. Liu R, Yang B, Deng Z, Liu L, Zhao X. Efficacy and safety of verapamil vs triamcinolone acetonide for keloids and hypertrophic scars: A systematic review and meta-analysis. Dermatol Ther 2020; 33(4): e13564. https://doi.org/10.1111/dth.13564

8. Ahuja RB, Chatterjee P. Comparative efficacy of intralesional verapamil hydrochloride and triamcinolone acetonide in hypertrophic scars and keloids. Burns 2014; 40(4): 583-588. https://doi.org/10.1016/j.burns.2013.09.029

9. Kuang J, An P, Li W. Comparative efficacy and safety of verapamil and triamcinolone in keloid and hypertrophic scar treatment: a meta-analysis. J Cosmet Laser Ther 2021; 23(1-2): 26-34. https://doi.org/10.1080/14764172.2021.1950765

10. Danielsen PL, Rea SM, Wood FM, Fear MW, Viola HM, Hool LC, et al. Verapamil is Less Effective than Triamcinolone for Prevention of Keloid Scar Recurrence After Excision in a Randomized Controlled Trial. Acta Derm Venereol 2016; 96(6): 774-778. https://doi.org/10.2340/00015555-2384

11. Jiang ZY, Liao XC, Liu MZ, Fu ZH, Min DH, Guo GH. The Safety and Efficacy of Intralesional Verapamil Versus Intralesional Triamcinolone Acetonide for Keloids and Hypertrophic Scars: A Systematic Review and Meta-analysis. Adv Skin Wound Care 2020; 33(4): 1-7.

https://doi.org/10.1097/01.ASW.0000655476.10403.d6

12. Kant SB, van den Kerckhove E, Colla C, Tuinder S, van der Hulst R, Piatkowski de Grzymala AA. A new treatment of hypertrophic and keloid scars with combined triamcinolone and verapamil: a retrospective study. Eur J Plast Surg 2018; 41(1): 69-80.

https://doi.org/10.1007/s00238-017-1322-y

13. Kaur A, Garg R, Mittal RK, Shah S, Patial T, Addiwal R. Comparative Efficacy of Intralesional Triamcinolone Acetonide and 5-Fluorouracil for Keloid Scars. Plast Aesthet Nurs (Phila) 2022; 42(4): 184-189.

https://doi.org/10.1097/PSN.0000000000000465

14. Sun P, Lu X, Zhang H, Hu Z. The Efficacy of Drug Injection in the Treatment of Pathological Scar: A Network Meta-analysis. Aesthetic Plast Surg 2021; 45(2): 791-805.

https://doi.org/10.1007/s00266-019-01570-8

15. Wang P, Gu L, Bi H, Wang Q, Qin Z. Comparing the Efficacy and Safety of Intralesional Verapamil With Intralesional Triamcinolone Acetonide in Treatment of Hypertrophic Scars and Keloids: A Meta-Analysis of Randomized Controlled Trials. Aesthet Surg J 2021; 41(6): NP567-NP575. https://doi.org/10.1093/asj/sjaa357

16. Zhang W, Li X, Li X. Efficacy and Safety of Verapamil Versus Triamcinolone Acetonide in Treating Keloids and Hypertrophic Scars: A Systematic Review and Meta-Analysis. Aesthetic Plast Surg 2023; 47(1): 473-482. https://doi.org/10.1007/s00266-022-03229-3

17. Serag-Eldin YMA, Mahmoud WH, Gamea MM, Hegab DS. Intralesional pentoxifylline, triamcinolone acetonide, and their combination for treatment of keloid scars. J Cosmet Dermatol 2021; 20(10): 3330-3340.

https://doi.org/10.1111/jocd.14305

18. Mane BS, Gavali RM. Our Experience at Tertiary Medical College-Intralesional Injection of Triamcinolone Acetonide Versus Injection Verapamil Following Keloidectomy with Fillet Flap in Auricular Keloids. Indian J Otolaryngol Head Neck Surg 2024; 76(1): 237-244.

https://doi.org/10.1007/s12070-023-04132-2

19. Leszczynski R, da Silva CA, Pinto A, Kuczynski U, da Silva EM. Laser therapy for treating hypertrophic and keloid scars. Cochrane Database Syst Rev 2022; 9(9): CD011642.

https://doi.org/10.1002/14651858.CD011642.pub2

20. Srivastava S, Kumari H, Singh A. Comparison of Fractional CO(2) Laser, Verapamil, and Triamcinolone for the Treatment of Keloid. Adv Wound Care (New Rochelle) 2019; 8(1): 7-13.

https://doi.org/10.1089/wound.2018.0798