Comparing Combination Triamcinolone Acetonide and 5-Fluorouracil with Monotherapy Triamcinolone Acetonide or 5-Fluorouracil in the Treatment of Hypertrophic Scars: A Systematic Review and Meta-Analysis

Abstract

Scarring presents a significant global burden, with an estimated 100 million patients developing scarring after surgery annually. 1 Keloid Background: Keloids and hypertrophic scars cause physical and psychosocial problems. A combination of 5-fluorouracil (5-FU) and triamcinolone acetonide (TAC) may enhance the treatment of pathologic scars, although the evidence base is limited. The authors compared the efficacy and complication rates of combination intralesional TAC and 5-FU with those of monotherapy intralesional TAC or 5-FU for the treatment of keloids and hypertrophic scars. Methods: Embase, MEDLINE, and CENTRAL were searched by two independent reviewers. The primary outcome was treatment efficacy (51% to 100% improvement). Study quality and risk of bias were assessed using the Cochrane risk of bias tool. Results: Of 277 articles screened, 13 studies were included, comprising 12 randomized control trials and one nonrandomized study. Six studies compared combination intralesional therapy versus monotherapy 5-FU, and nine studies compared combination intralesional therapy versus monotherapy TAC. The combined group demonstrated superior objective treatment efficacy compared with the monotherapy TAC group (OR, 3.45; 95% CI, 2.22 to 5.35; I 2 = 0%; P < 0.00001) and monotherapy 5-FU group (OR, 4.17; 95% CI, 2.21 to 7.87; I 2 = 0%; P < 0.0001). Telangiectasia was less frequent in combination therapy (OR, 0.24; 95% CI, 0.11 to 0.52; I 2 = 0%; P = 0.0003) compared with monotherapy TAC. Conclusions: Combined intralesional TAC and 5-FU administration demonstrated superior treatment efficacy outcomes compared with monotherapy TAC or 5-FU. Patient-reported outcome measures should be incorporated in the design of future research to justify clinical recommendations.

Pharmacotherapy for Keloids and Hypertrophic Scars

“…The clinical efficacy was compared between 5-FU alone and a combination of 5-FU + TAC in treating KD. 5-FU, both as a single agent and in combination with TAC, was equally efficacious in reducing the KD size, and the combination group reduced the side effects [424]. The efficacy and safety of a combination of TAC and 5-FU were compared with those of TAC alone and 5-FU alone in treating HTSs and KDs.…”

Discussion: Comparing Combination Triamcinolone Acetonide and 5-Fluorouracil with Monotherapy Triamcinolone Acetonide or 5-Fluorouracil in the Treatment of Hypertrophic Scars: A Systematic Review and Meta-Analysis

“…Discussion: Comparing Combination Triamcinolone Acetonide and 5-Fluorouracil with Monotherapy Triamcinolone Acetonide or 5-Fluorouracil in the Treatment of Hypertrophic Scars: A Systematic Review and Meta-Analysis Rei Ogawa, MD, PhD Tokyo, Japan I congratulate the authors on this valuable and thorough systematic review and meta-analysis, 1 which I believe will help guide decision-making when treating keloids and hypertrophic scars. In their study, the authors compared the efficacy and complication rates of combination therapy using intralesional 5-fluorouracil (5-FU) and triamcinolone acetonide (TAC) injections with those of monotherapy using either agent, in the treatment of keloids and hypertrophic scars.…”

Application of high-precision 3D scanner in keloids evaluation to improve patients’ compliance: a questionnaire-based study

“…Each year in the developed world, approximately 100 million people suffer from scar-related issues [ 1 ]. Current guidelines recommend that the combination of 5-fluorouracil (5-FU) and triamcinolone acetonide (TA) injections, administered in 3–5 treatment sessions (6–10 weeks), effectively reduces the elevation and redness of keloids [ 2 , 3 ]. Consistently, the effectiveness of treating keloids, whatever evaluated by naked-eye observations or Vancouver Scar Scale (VSS), is observed after at least three treatment sessions in previous observational studies [ 4 ].…”