Keloides tratados con 5FU mas triamcinolona.
Treatment of Keloids Using 5-Fluorouracil in Combination With Crystalline Triamcinolone Acetonide Suspension
TAKE-HOME MESSAGE
In this study, 25 patients with keloids were treated with a combination of intralesional 5-fluorouracil (5-FU) (50 mg/mL) and triamcinolone (40 mg/mL) in a ratio of 3:1 for a total of 4 treatments at monthly intervals. Between baseline and 12-month follow-up, keloid height and volume were reduced by approximately 59% and 53%, respectively. Penetration depth was decreased by around 74% from baseline to 12-month follow-up. Regular laboratory results showed no systemic side effects, and the most common side effects were hyperpigmentation (9/25) and telangiectasias (6/25).
- Although the study was limited by lack of a control group, the results suggest that a combination of intralesional 5-FU and triamcinolone may be effective in decreasing the size of keloids and is well tolerated. Further studies are warranted to confirm these findings and compare the results with other existing treatments of keloids.
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Employing non-invasive, physical measurement tools (digital photography, PRIMOS 3D, ultrasound), and importantly, validated clinical assessment scales (POSAS, DLQI), the authors of this study quantified the significant, sustained, beneficial effects of injecting keloids monthly with the combination of 5-fluorouracil (50 mg/mL) and triamcinolone acetonide (40 mg/mL) at a ratio of 3:1. The absence of an untreated or placebo-treated control group is appropriate based upon ethical considerations, but as intralesional injection of triamcinolone acetonide alone is the standard treatment of keloids, the study would have greatly benefitted by the inclusion of a triamcinolone acetonide treated group for comparison. The major limitations to the use of these intralesional injections are the development of ulcerations (32%), and the contraindication in pregnancy, as the majority of keloids occur in women of child-bearing potential.
BACKGROUND
Intralesional 5-fluorouracil (5-FU) in combination with triamcinolone acetonide (TAC) has been recommended as a promising alternative for keloids not responding to silicone-based products, cryotherapy or intralesional corticosteroids alone. Although numerous studies support the efficacy of this regime, there is a lack of objective data.
OBJECTIVES
In this study, we evaluate the therapeutic effect of four courses of intralesional 5-FU in combination with TAC (3 : 1) utilizing 3D analysis (PRIMOS®pico ), ultrasound and scar scales such as the Patient and Observer Scar Assessment Scales (POSAS) and the Dermatology Life Quality Index (DLQI).
METHODS
Twenty-five patients with keloids were treated using 5-FU and TAC every 4 weeks. Objective assessments were performed and the scar scales administered at baseline, as well as during consecutive visits at 1- and 12-month follow-up (FU). Routine laboratory tests were performed at baseline and at 1-month FU.
RESULTS
3D PRIMOS and ultrasound measurements revealed highly significant and stable reductions in height (baseline mean score: 4.0 ± 1.7 mm, 1-month FU mean score: 1.5 ± 0.8 mm, 12-month FU mean score: 1.8 ± 0.9 mm, P = <0.0001), volume (baseline mean score: 1,105 ± 911.5 mm3 , 1-month FU mean score: 416.1 ± 218.1 mm3 , 12-month FU mean sore: 431.2 ± 253.6 mm3 , P = <0.0001, respectively) and penetration depth of keloids (relative reduction between baseline and 12-month FU of 74.4%, P = <0.0001). The POSAS and DLQI scales confirmed significant objective and subjective improvements in scar appearance in all categories. The life quality associated with keloid appearance improved from a 'moderate effect' to a 'small effect' throughout the course of the study.
CONCLUSIONS
Results of this study confirm the efficacy and safety of the combination of 5-FU and TAC in keloids. Treatments were well tolerated and demonstrated stable results at 12-month FU.
Treatment of Keloids Using 5-Fluorouracil in Combination With Crystalline Triamcinolone Acetonide Suspension: Evaluating Therapeutic Effects by Using Non-Invasive Objective Measures
J Eur Acad Dermatol Venereol 2020 Mar 14;[EPub Ahead of Print], M Reinholz, A Guertler, H Schwaiger, J Poetschke, GG Gauglitzposted by dermatica at
August 24, 2020
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