Combination of Triamcinolone, 5-Fluorouracil, and Pulsed-Dye Laser for Treatment of Keloid and Hypertrophic Scars

Keloids and hypertrophic scars are benign growths of dermal collagenthat usually cause major physical, psychological, and cosmetic problems. In this 12-week single-blinded clinical trial, 69 patients were randomly assignedinto 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 [TAC15-fluorouracil (5-FU)], 0.1mL of 40mg/mL TAC was added to 0.9 mL of 5-FU (50mg/mL). Thiscombination was injected weekly for 8 weeks. In Group 3, in addition to weekly TAC15-FUinjection for 8 weeks, lesions were irradiated by 585-nm flashlamp-pumped pulsed-dyelaser (PDL, 5–7.5 J/cm2) at the 1st, 4th, and 8th weeks. Lesions were assessed for erythema, pruritus, pliability, height, length, and width. Sixty patients completed the study. At the 8- and 12-week follow-up visits, allgroups showed an acceptable improvement in nearly all measures, but in comparisonbetween groups, these were statistically more significant in the TAC15-FU and TAC15-FU1PDL groups (po.05 for all). At the end of the study, the erythema score was significantlylower, and itch reduction was statistically higher in the TAC15-FU1PDL group(po.05 for both). Good to excellent improvements (450% improvement) were reported bythe patients as follows: 20% in Group 1, 55% in Group 2, and 75% in Group 3, all of whichwere significantly different (po.05). Good to excellent responses were reported by theblinded observer as follows: 15% in Group 1, 40% in Group 2, and 70% in Group 3. Theirdifferences were statistically significant (po.05). Atrophy and telangiectasia were seen in37% of patients in TAC group. Overall efficacy of TAC15-FU was comparable with TAC15-FU1PDL, butthe TAC15-FU1PDL combination was more acceptable by the patients and producedbetter results. Its effect on lightening of the lesion was promising. The TAC15-FU1PDLcombination seems to be the best approach for treatment of keloid and hypertrophic scars.