New combination of triamcinolone, 5-fluorouracil, and pulsed-dye laser for treatment of keloid and hypertrophic scars

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 weekly intervals for a total of 8 weeks. In Group 2 [TAC+5-fluorouracil (5-FU)], 0.1 mL of 40 mg/mL TAC was added to 0.9 mL of 5-FU (50 mg/mL). This combination was injected weekly for 8 weeks. In Group 3, in addition to weekly TAC+5-FU injection for 8 weeks, lesions were irradiated by 585-nm flashlamp-pumped pulsed-dye laser (PDL, 5-7.5 J/cm(2)) at the 1st, 4th, and 8th weeks. Lesions were assessed for erythema, pruritus, pliability, height, length, and width. Results Sixty patients completed the study. At the 8- and 12-week follow-up visits, all groups showed an acceptable improvement in nearly all measures, but in comparison between groups, these were statistically more significant in the TAC+5-FU and TAC+5-FU+PDL groups (p <.05 for all). At the end of the study, the erythema score was significantly lower, and itch reduction was statistically higher in the TAC+5-FU+PDL group (p <.05 for both). Good to excellent improvements (> 50% improvement) were reported by the patients as follows: 20% in Group 1, 55% in Group 2, and 75% in Group 3, all of which were significantly different (p <.05). Good to excellent responses were reported by the blinded observer as follows: 15% in Group 1, 40% in Group 2, and 70% in Group 3. Their differences were statistically significant (p <.05). Atrophy and telangiectasia were seen in 37% of patients in TAC group. Conclusion Overall efficacy of TAC+5-FU was comparable with TAC+5-FU+PDL, but the TAC+5-FU+PDL combination was more acceptable by the patients and produced better results. Its effect on lightening of the lesion was promising. The TAC+5-FU+PDL combination seems to be the best approach for treatment of keloid and hypertrophic scars.