COMPARISON OF INTRALESIONAL METHOTREXATE WITH TRIAMCINOLONE ACETONIDE IN TREATMENT OF HYPERTROPHIC SCARS

While treatment of keloids and hypertrophic scars normally shows modest results, we found that treatment with bleomycin was more promising. The present study was divided into two parts. In the first part the aim was to show the results using a combination of bleomycin and triamcinolone acetonide per cm2 (BTA). In the second part the objective was to determine the response to both drugs in large keloids that were divided into 1 cm2 squares, treating each square with the dose previously used. In the first part of the study, the clinical response of 37 keloids ranging from 0.3 to 1.8 cm2 treated with BTA were followed up over a period of 1- 2 years. 0.375 IU bleomycin and 4 mg triamcinolone acetonide were injected every 3 months. In the second part of the study we reviewed the clinical response in six patients with large keloids. The monthly dose administered never exceeded 3 IU of bleomycin. The first study showed 36 keloids (97.29%) softening after the first dose. In the second study, 5 showed different responses (the response was complete in the four smaller keloids). The largest keloid needed 9 doses to achieve an improvement of 70%. In conclusion, combined treatment with 0.375 IU of bleomycin and 4mg of triamcinolone acetonide to 1 cm2 was considered to be an acceptable procedure for the treatment of keloids. The best results were obtained in keloids over 1 cm2 or when divided into 1 cm2 square areas. Larger series need to be performed in order to confirm these results..

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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

Aesthetic Surgery Journal ◽

10.1093/asj/sjaa357 ◽

2020 ◽

Author(s):

Pu Wang ◽

Luosha Gu ◽

Hongsen Bi ◽

Qifei Wang ◽

Zelian Qin

Keyword(s):

Adverse Effects ◽

Randomized Controlled Trials ◽

Triamcinolone Acetonide ◽

Meta Analysis ◽

Controlled Trials ◽

Hypertrophic Scars ◽

Efficacy And Safety ◽

Skin Atrophy ◽

Randomized Controlled ◽

First Session

Abstract Background Clinical treatment of hypertrophic scars (HS) and keloids is often unsatisfactory. Intralesional injections of triamcinolone acetonide (TAC) and verapamil are widely used to treat HS and keloids, but their efficacy and safety are controversial. Objectives: To conduct a meta-analysis of the effectiveness and safety of verapamil and TAC in the treatment of HS and keloids. Methods Embase, Google Scholar, and PubMed were searched for randomized controlled trials (RCTs) from inception to February 2020. RCTs that evaluated treatment effects with the Vancouver Scar Scale or reported adverse effects were included. The continuous data and the dichotomous variables were analyzed as mean difference (MD) and relative risk (RR), respectively. Results Seven RCTs (461 patients) were included. Compared to baseline, TAC rapidly changed the △height (MD=0.07; P<0.05) and △pliability (MD=0.23; P<0.05) after the first session, with no significant differences in the △height (after last session: MD=0.50; P=0.42), △pigmentation (after first session: MD=0.07; P=0.51, after last session: MD=-0.10; P=0.14), △vascularity(after first session: MD=-0.25; P=0.57, after last session: MD=-0.02; P=0.79) and △pliability (after last session MD=0.52; P=0.48). Although total adverse effects (RR=0.42; P=0.1) were not significantly different, in the subgroup analysis, the incidence of telangiectasia (RR=0.04; P<0.05) and skin atrophy (RR=0.10; P<0.05) but not pain (RR=1.27; P=0.77) was significantly lower with verapamil than with TAC. Conclusions Verapamil may be an effective substitute for TAC. Although total adverse effects did not change, the incidence of telangiectasia and skin atrophy was lower with verapamil than with TAC.

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