5-Fluorouracil in the Treatment of Keloids and Hypertrophic Scars: A Comprehensive Review of the Literature

Abstract

Hypertrophic (HTSs) and keloid scars are common dermatological complaints produced by disruption of the normal wound-healing process. Despite a wide array of therapeutic options available to treat these lesions, HTSs and keloids continue to pose a significant challenge to clinicians in everyday practice. The chemotherapeutic drug 5-fluorouracil (5-FU) is a well-known treatment option reserved for recalcitrant HTSs and keloid lesions. We present clinicians with a comprehensive review of the published data concerning the use of 5-FU in the treatment of HTSs and keloids. The current evidence suggests that 5-FU is a safe and practical alternative for the treatment of HTSs and keloids as it may substantially improve the appearance of proliferative scars and reduce the chance of recurrence. This therapeutic option is most effective in conjunction with adjuvant therapy such as corticosteroids. Additional randomized controlled clinical trials with large sample sizes should be conducted to corroborate the existing efficacy and safety data in patients with HTSs and keloids.Electronic supplementary materialThe online version of this article (doi:10.1007/s13555-016-0118-5) contains supplementary material, which is available to authorized users.

Management of Facial Scars

“…5 A recent review by Shah et al found that 5-FU injection into hypertrophic scars can rarely cause wound dehiscence, scar widening, or tissue necrosis, but it commonly does not have negative side effects. 23 Bleomycin is another injectable medication that can be used to treat hypertrophic scars and keloids. 4 There is little research on bleomycin and scar management.…”

The Scar Bane, Without the Pain: A New Approach in the Treatment of Elevated Scars: Thermomechanical Delivery of Topical Triamcinolone Acetonide and 5-Fluorouracil

“…Keloid scars are an uncommon but troubling complication of dermal injury, with a predilection for younger patients and higher Fitzpatrick skin types, particularly patients of African, Asian, or Hispanic origin with an associated family history [ 1 – 3 ]. Intralesional corticosteroid injections are considered the first-line treatment for keloids [ 3 , 4 ].…”

“…Keloid scars are an uncommon but troubling complication of dermal injury, with a predilection for younger patients and higher Fitzpatrick skin types, particularly patients of African, Asian, or Hispanic origin with an associated family history [ 1 – 3 ]. Intralesional corticosteroid injections are considered the first-line treatment for keloids [ 3 , 4 ]. Corticosteroids can be used alone or in combination with other scar-modulating treatments such as intralesional 5-fluorouracil injection, cryotherapy, surgical excision, radiation therapy, compression therapy, and silicone-based dressings [ 5 – 7 ].…”

“…Keloid scars may develop after acne vulgaris, trauma, surgical incisions, burn injuries, or without an obvious trigger [ 1 , 2 ]. Intralesional corticosteroid injection is considered the first-line treatment for keloid scars [ 3 , 4 ]. Combination therapies with other adjuvant therapeutic modalities, such as pressure garments, silicone gel, radiation, or cryotherapy, seem to further increase treatment efficacy [ 5 – 7 ].…”

The Efficacy of Triamcinolone Acetonide in Keloid Treatment: A Systematic Review and Meta-analysis

“…In the study of Shah et al, 5-FU in conjunction with TAC displayed the highest efficiency in improving the symptoms of scars and decreasing recurrence (30). Our subgroup analysis revealed that TAC in combination with 5-FU was more effective than TAC alone only when TAC was used at a low concentration (10 mg/ml).…”