Comparative Efficacy and Safety of Common Therapies in Keloids and Hypertrophic Scars: A Systematic Review and Meta-analysis

Bao, Yawei; Xu, Shanshan; Pan, Zhipeng; Deng, Jixiang; Li, Xinyi; Pan, Faming; Li, Xiaojing

doi:10.1007/s00266-019-01518-y

Cited by 51 publications

(40 citation statements)

References 41 publications

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“…Compared to monotherapy, a combination of TAC and 5‐FU, having been recommended by international guidelines and Asian guidlines, seems to offer the balanced benefit of faster and more efficacious response with lesser adverse effects and lower rate of recurrence. The latest Bayesian network meta‐analysis 9 evaluated comprehensively efficacy of TAC, 5‐FU, verapamil, and TAC + 5‐FU in keloid and hypertrophic scars and concluded that TAC + 5‐FU was ranked as the favorable therapies in terms of primary indicator (the numbers of patients with good‐to‐excellent effect) and Vancouver Scar Scale (VSS). According to the studies mentioned above, monotherapy with TAC is injected every 1 to 4 weeks and the dose of each injection does not exceed 80 mg.…”

Section: Resultsmentioning

confidence: 99%

Retrospective analysis of off‐label medication use at a plastic surgery hospital in China andevidence‐basedevaluation

Gao

Jiao

Guo

et al. 2020

Dermatologic Therapy

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To retrospectively analyze the off‐label prescriptions at a plastic surgery hospital in China and conduct a literature review. The prescriptions in outpatient department from January 1, 2018 to December 31, 2018 were collected and compared with the related drug instructions in indications, dosage, frequency and route of administration to identify the off‐label prescriptions. According to related literatures, guidelines, and MICROMEDEX, the rationality of off‐label drug uses was evaluated. A total of 39 836 prescriptions were screened and 3395 (8.52%) off‐label prescriptions were identified. It involved 23 items off‐label medication uses. 20 items were off‐label used in indication and three items were in indication and administration route. These off‐label prescriptions involved 19 medicines and 12 indications and the dermatology related drug usage accounted for the largest proportion (91.3%). Additionally, five items (21.7%) were Chinese patent medicine related. Of the 23 items, seven (30.4%) have been recommended by guidelines and two (8.7%) by Thomson Grading System of Micromedex. All of them have been proved by literature evidence of level 1 to 4, in which 19 (82.6%) by Level 1 evidence, 21 (91.3%) by Level 1 to 2 evidence and 2 (8.7%) only by level 3 to 4 evidence. This can provide a theoretical basis to clinicians in prescribing. Our next work is to perfect some details about evidence assessment to improve the reliability.

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Section: Resultsmentioning

confidence: 99%

Retrospective analysis of off‐label medication use at a plastic surgery hospital in China andevidence‐basedevaluation

Gao

Jiao

Guo

et al. 2020

Dermatologic Therapy

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“…Results showed that the incidence of skin atrophy and telangiectasia after verapamil injections was statistically significantly lower than that after TAC injection. The study by Bao et al 34 also suggested that the use of verapamil might be a better therapeutic strategy due to safety considerations. However, few studies have used quantitative methods to summarize the results from multiple studies as performed in the present study.…”

Section: Discussionmentioning

confidence: 99%

“…15,16,28,29 Results showed that the incidence of skin atrophy and telangiectasia after verapamil injections was statistically significantly lower than that after TAC injection. The study by Bao et al 34 In the subgroup analyses, no significant difference in the efficacy of verapamil and TAC in the studies that had eight or more treatment sessions. On the other hand, in the study that had less than eight treatment sessions, TAC was found to be more effective than verapamil.…”

Section: Summary Of Evidencementioning

confidence: 93%

Efficacy and safety of verapamil vs triamcinolone acetonide for keloids and hypertrophic scars: A systematic review and meta‐analysis

Liu

Yang

Deng

et al. 2020

Dermatologic Therapy

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The treatment of keloids and hypertrophic scars remains a challenge. Although triamcinolone acetonide (TAC) is one of the most common and effective treatments for keloids and hypertrophic scars, TAC is not effective in some patients, and some may even experience adverse outcomes. Verapamil might be considered a safe alternative to TAC. The aim of this study was to compare the efficacy and safety of verapamil and TAC for the treatment of keloids and hypertrophic scars. Three databases (Medline, EMBASE, and CENTRAL database) were electronically searched from 1997 to December 2019. Article selection was limited to randomized controlled trials (RCTs) and controlled clinical trials (CCTs). Two authors independently assessed the selection of studies, risk of bias, and extracted the data. Mean differences (MDs) were computed for continuous variables, risk ratios (RRs) were computed for dichotomous variables, and 95% confidence intervals (CIs) were calculated for both assessments. Five RCTs were included, comprising a total of 215 patients (273 scars). Vancouver Scar Scale (VSS) parameters (such as height, vascularity, pliability, and pigmentation) were reported as the outcome measures and provided detailed values in four studies. No significant differences were observed between verapamil and TAC in the reduction of height (MD 0.57, 95% CI −0.94 to 2.08, P = .46), vascularity (MD 0.30, 95% CI −0.42 to 1.02, P = .41), pliability (MD 0.67, 95% CI −1.12 to 2.47, P = .46), and degree of pigmentation (MD 0.14, 95% CI −0.41 to 0.69, P = .61). Adverse outcomes were reported in four studies. The results showed that the incidence of telangiectasia and skin atrophy that used verapamil was significantly lower than that for TAC. Concerning the treatment of keloids and hypertrophic scars, even though verapamil was safer than TAC, TAC worked faster than verapamil. Furthermore, we did not find any clear evidence that verapamil was more or less effective than TAC. Considering the high degree of safety of verapamil, we suggest that verapamil might be used as an alternative treatment when TAC results in adverse outcomes.

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“…5 Systematic reviews and meta-analyses discuss positive effects for some monotherapies, combined therapies and non-invasive scar treatments, however the certainty of evidence for these is currently low or unclear, indicating the need for further research to determine which treatments are most pertinent for adherence. 6,7 Given that patients with skin scarring are at risk of developing long-lasting physical limitations, psychological distress, appearance-related concerns, difficulties with social functioning and poor health-related quality of life, non-adherence to scar treatments may be cause for concern. 8,9…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of interventions for optimising adherence to treatments for the prevention and management of scars: A systematic review

2020

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Objectives: To identify the adherence interventions used with people receiving treatments to prevent or manage scarring, the effectiveness of these interventions, and the theoretical frameworks on which these interventions were based. Data sources: Databases (PubMed, Embase, Web of Science, CINAHL, PsychINFO and OTseeker) were searched (09.10.2020) with no date or language restrictions. Grey literature databases, clinical trial registries and references lists of key papers were also searched. Review methods: Eligible randomised controlled trials included people using treatments for scarring following skin wounds, interventions that may improve adherence, and outcomes measuring adherence. Risk of bias (selection, performance, detection, attrition, reporting) and certainty of evidence (inconsistency, imprecision, indirectness, publication bias) were assessed. Results: Four randomised trials were included with 224 participants (17 children) with burn scars. Interventions involved educational (three trials) or technology-based components (four trials) and ranged in length from two weeks to six months. All four trials reported greater adherence rates in the intervention group compared with standard practice [standardised mean difference = 1.50 (95% confidence interval (CI) = 0.91–2.08); 2.01 (95% CI 1.05–2.98); odds ratio = 0.28 (95% CI = 0.11–0.69)]. One trial did not report original data. The certainty of evidence was very low. Conclusion: Adherence interventions using education or technology for people receiving burn scar treatment may improve adherence. Further studies are needed particularly in children, with a focus on including outcomes of importance to patients (e.g. quality of life) and identifying core components of effective adherence interventions using theoretical frameworks.

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Comparative Efficacy and Safety of Common Therapies in Keloids and Hypertrophic Scars: A Systematic Review and Meta-analysis

Cited by 51 publications

References 41 publications

Retrospective analysis of off‐label medication use at a plastic surgery hospital in China andevidence‐basedevaluation

Retrospective analysis of off‐label medication use at a plastic surgery hospital in China andevidence‐basedevaluation

Efficacy and safety of verapamil vs triamcinolone acetonide for keloids and hypertrophic scars: A systematic review and meta‐analysis

Effectiveness of interventions for optimising adherence to treatments for the prevention and management of scars: A systematic review

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