Comparison of Efficacy of Intralesional Triamcinolone and Combination of Triamcinolone With 5-Fluorouracil in The Treatment of Keloid

Shah Faisal; Shahid Hameed; Abdul Majid; Afia Ayub; Siyab Ahmad; Muhammad Ali Nasir

doi:10.51253/pafmj.v74iSUPPL-2.7273

Authors

Shah Faisal Department of Plastic Surgery, Combined Military Hospital Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Shahid Hameed Department of Plastic Surgery, Combined Military Hospital Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Abdul Majid Department of Plastic Surgery, Combined Military Hospital Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Afia Ayub Department of Plastic Surgery, Combined Military Hospital Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Siyab Ahmad Department of Histopathology, Armed Forces Institute of Pathology / National University of Medical Sciences (NUMS) Rawalpindi Pakistan
Muhammad Ali Nasir Department of Plastic Surgery, Combined Military Hospital Rawalpindi/National University of Medical Sciences (NUMS) Pakistan

DOI:

https://doi.org/10.51253/pafmj.v74iSUPPL-2.7273

Keywords:

5-Fluorouracil, Keloid, Triamcinolone

Abstract

Objectives: To study the efficacy of intralesional Triamcinolone and combination of Triamcinolone with 5-Fluorouracil in the treatment of keloid in terms or reduction in height of lesion.

Study Design: Cross-sectional analytical study.

Place and Duration Of Study: Department of Plastic Surgery, Combined Military Hospital, Rawalpindi, Jul 2020 to Mar 2021.

Methodology: A total of 56 patients suffering from keloid formation were included in our study. Patients who had received previous treatment for keloids were excluded. All patients were assessed for volume of keloid before and after 8 weeks of intervention. Group A patients received therapy with intralesional Triamcinolone 4 mg with 5-Fluorouracil 45 mg once weekly while Group B patients received intralesional Triamcinolone 10 mg alone once weekly. Patients were followed up after 8 weeks to ascertain mean reduction in volume of keloid post-intervention. Data was analyzed by SPSS 26.0.

Results: The difference in total volume post-treatment between the two groups was significant, (p=0.001), however the difference in total volume reduction across both groups with treatment was not significant, (p=0.382). Treatment was effective in 23(82.1%) of with the combination of Triamcinolone and 5-Fluorouracil, while this figure was only 16(57.1%) with Triamcinolone alone, (p=0.042).

Conclusion: The combination of intralesional Triamcinolone and 5-Fluorouracil is superior to intralesional Triamcinolone alone in the treatment of keloids, and may be considered for therapy in patients who do not respond to treatment with single agents.

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References

Ojeh N, Bharatha A, Gaur U, Forde AL. Keloids: Current and emerging therapies. Scars Burn Heal. 2020 Aug 10;6:2059513120940499.

Betarbet U, Blalock TW. Keloids: A Review of Etiology, Prevention, and Treatment. J Clin Aesthet Dermatol. 2020 Feb; 13(2): 33-43.

Limandjaja GC, Niessen FB, Scheper RJ, Gibbs S. The Keloid Disorder: Heterogeneity, Histopathology, Mechanisms and Models. Front Cell Dev Biol. 2020 May 26(8)360.

Li K, Nicoli F, Cui C, Xi WJ, Al-Mousawi A, Zhang Z, et al. Treatment of hypertrophic scars and keloids using an intralesional 1470 nm bare-fibre diode laser: a novel efficient minimally-invasive technique. Sci Rep. 2020; 10(1): 21694.

Ekstein SF, Wyles SP, Moran SL, Meves A. Keloids: a review of therapeutic management. Int J Dermatol. 2021 Jun;60(6):661-671.

Thornton NJ, Garcia BA, Hoyer P, Wilkerson MG. Keloid Scars: An Updated Review of Combination Therapies. Cureus. 2021 Jan 30; 13(1): e12999.

McGinty S, Siddiqui WJ. Keloid. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-.

Hewedy ES, Sabaa BEI, Mohamed WS, Hegab DS. Combined intralesional triamcinolone acetonide and platelet rich plasma versus intralesional triamcinolone acetonide alone in treatment of keloids. J Dermatolog Treat. 2020 Mar 4: 1-7. Online ahead of print.

Limmer EE, Glass DA 2nd. A Review of Current Keloid Management: Mainstay Monotherapies and Emerging Approaches. Dermatol Ther (Heidelb). 2020 Oct; 10(5): 931-948.

Jiang ZY, Liao XC, Liu MZ, Fu ZH, Min DH, Yu XT, et al. Efficacy and Safety of Intralesional Triamcinolone Versus Combination of Triamcinolone with 5-Fluorouracil in the Treatment of Keloids and Hypertrophic Scars: A Systematic Review and Meta-analysis. Aesthetic Plast Surg. 2020 Oct; 44(5): 1859-1868.

Khalid FA, Mehrose MY, Saleem M, Yousaf MA, Mujahid AM, Rehman SU, et al. Comparison of efficacy and safety of intralesional triamcinolone and combination of triamcinolone with 5-fluorouracil in the treatment of keloids and hypertrophic scars: Randomised control trial. Burns. 2019 Feb; 45(1): 69-75.

Darougheh A, Asilian A, Shariati F. Intralesional triamcinolone alone or in combination with 5-fluorouracil for the treatment of keloid and hypertrophic scars. Clin Exp Dermatol. 2009; 34(2): 219–223.

Khan MA, Bashir MM, Khan FA. Intralesional triamcinolone alone and in combination with 5‐fluorouracil for the treatment of keloid and hypertrophic scars. J Pak Med Assoc 2014; 64: 1003–7.

Asilian A, Darougheh A, Shariati F. New combination of triamcinolone, 5‐fluorouracil, and pulsed‐dye laser for treatment of keloid and hypertrophic scars. Dermatol Surg 2006; 32: 907–15.

Manuskiatti W, Fitzpatrick RE. Treatment response of keloidal and hypertrophic sternotomy scars: comparison among intralesional corticosteroid, 5-fluorouracil, and 585-nm flashlamp-pumped pulsed-dye laser treatments. Arch Dermatol. 2002 Sep; 138(9): 1149-55.

Noishiki C, Hayasaka Y, Ogawa R. Sex Differences in Keloidogenesis: An Analysis of 1659 Keloid Patients in Japan. Dermatol Ther (Heidelb). 2019 Dec; 9(4): 747-754.

Tripathi S, Soni K, Agrawal P, Gour V, Mondal R, Soni V. Hypertrophic scars and keloids: a review and current treatment modalities. Biomed Dermatol. 2020; 4: 11.

Hietanen KE, Järvinen TA, Huhtala H, Tolonen TT, Kuokkanen HO, Kaartinen IS. Treatment of keloid scars with intralesional triamcinolone and 5-fluorouracil injections - a randomized controlled trial. J Plast Reconstr Aesthet Surg. 2019 Jan; 72(1): 4-11.

Wong TS, Li JZ, Chen S, Chan JY, Gao W. The Efficacy of Triamcinolone Acetonide in Keloid Treatment: A Systematic Review and Meta-analysis. Front Med (Lausanne). 2016 Dec 27; 3: 71.

Ren Y, Zhou X, Wei Z, Lin W, Fan B, Feng S. Efficacy and safety of triamcinolone acetonide alone and in combination with 5-fluorouracil for treating hypertrophic scars and keloids: a systematic review and meta-analysis. Int Wound J. 2017 Jun; 14(3): 480-487.

Shah VV, Aldahan AS, Mlacker S, Alsaidan M, Samarkandy S, Nouri K. 5-Fluorouracil in the Treatment of Keloids and Hypertrophic Scars: A Comprehensive Review of the Literature. Dermatol Ther (Heidelb). 2016 Jun; 6(2): 169-83.

Huang L, Cai YJ, Lung I, Leung BC, Burd A. A study of the combination of triamcinolone and 5-fluorouracil in modulating keloid fibroblasts in vitro. J Plast Reconstr Aesthet Surg. 2013 Sep; 66(9): e251-9.

Davison SP, Dayan JH, Clemens MW, Sonni S, Wang A, Crane A. Efficacy of intralesional 5-fluorouracil and triamcinolone in the treatment of keloids. Aesthet Surg J. 2009 Jan-Feb; 29(1): 40-46.

Srivastava S, Patil A, Prakash C, Kumari H. Comparison of Intralesional Triamcinolone Acetonide, 5-Fluorouracil, and Their Combination in Treatment of Keloids. World J Plast Surg. 2018 May; 7(2): 212-219.

Kontochristopoulos G, Stefanaki C, Panagiotopoulos A, Stefanaki K, Argyrakos T, Petridis A, et al. Intralesional 5-fluorouracil in the treatment of keloids: an open clinical and histopathologic study. J Am Acad Dermatol. 2005; 52(3.1): 474–479