Combination of Surgery and Intralesional Verapamil Injection in the Treatment of the Keloid

Abstract

Keloid scars are one of the most challenging problems for physicians and surgeons. These scars have been treated in many ways, with varying success. Verapamil is a widely used calcium channel antagonist, and it has been shown that calcium channel blockers inhibit the synthesis/secretion of extracellular matrix molecules, including collagen, glycosaminoglycans, and fibronectin, and increase collagenase. In this study, we performed total keloid excision in combination with reconstruction with W-plasty or skin grafting and injection of verapamil hydrochloride into the lesions of 21 patients with keloids. Patients were followed for minimum of 2 years, and the treatment outcome was evaluated based on the cosmetic appearances, symptomatic improvements, and the results of microscopic examinations. Also, patient satisfaction was scored with a visual analog scale. Two years after the operations, two patients had keloid in lesser diameter than the original lesions, two patients had lesions that were hypertrophic scars in appearance, and four patients had pruritus. One patient had keloid on the donor site. The rate of patient satisfaction was 6.4 on a scale of 1 to 10. We reviewed the treatment of keloid in this study and obtained one of the lower rates of complication in the literature. We believe that surgical excision with W-plasty or skin grafting and intralesional verapamil injection may be a good alternative in the treatment of keloid.

A study of verapamil in treatment of keloid

“…9 Verapamil inhibits the synthesis and secretion of extracellular matrix molecules, including collagen, glycosaminoglycans, fibronectin and increases collagenase by inducing procollagenase expression. 18 This study was done to evaluate efficacy of VPL in treatment of the keloid, in skin phototype IV and V. The drug VPL was used in the concentration of 2.5 mg/ml intralesionally, and VSS was used for assessment of the improvement.…”

Strategic management of keloid disease in ethnic skin: a structured approach supported by the emerging literature

“…Historically, a number of treatment modalities such as cryotherapy, 23 interferon 24 and veramapril 25 have been utilized for treating KD, with inconsistent levels of success. However, more recent treatments such as lasers, 26 intralesional steroid injections, 27 silicone gel, 28 5-fluorouracil (FU), 29 radiotherapy, 30 bleomycin, 31 imiquimod, 32 photodynamic therapy (PDT), 33 electrical stimulation (ES) 34 and surgery 35 have also been used in the management of KD, but not all have shown efficacy in ethnic pigmented skin.…”

Verapamil as Alternative Treatment in Hypertrophic and Keloid Scars

“…Patients were evaluated for 2 years. They reported long-term improvement of symptoms, decrease in thickness of the keloid, and increased satisfaction [15]. In the last few years, many other studies have further supported the effectiveness of verapamil as an alternative treatment for pathological scars showing results similar to the ones achieved with steroids therapy.…”

“…There are no significant adverse events of intralesional verapamil reported in these trials. The inhibition of calcium-dependent reactions involved in the production of extracellular matrix leads to improved degradation of the extracellular matrix [14][15][16][17][18].…”