Efficacy and Safety of Intralesional 5-Fluorouracil in the Treatment of Keloids

Abstract

Background: The treatment of keloids remains challenging. Cryosurgery and intralesional corticosteroids have been considered as the mainstream of therapy; however, the long-term use of corticosteroids has been found to be associated with serious side effects. Intralesional 5-fluorouracil (5-FU) has only been used in one study for the treatment of hypertrophic scars and keloids, mostly in combination with other treatments. The efficacy of 5-FU as an individual therapeutic agent is unknown. Objective: To evaluate the efficacy and safety of intralesional injections of 5-FU in the treatment of small keloid lesions. Methods: Twenty-four (12 male, 12 female) consecutive patients with keloids of 6 cm or less in their maximum dimension were treated with intralesional injections of 50–150 mg 5-FU per week for a maximum of 16 injections. Results: One third (8/24, 33.3%) of the patients showed more than 75% flattening of the keloid. Three out of 8 patients (with >75% flattening) required less than 16 (13, 13 and 15) injections for achieving the desired response. Overall, about half of the patients showed more than 50% flattening of the treated keloid. A correlation with the duration of keloid was found. Six (54.5%) out of 11 patients with keloids of ≤5 years duration, in contrast to only 2 (15.4%) out of 13 patients with keloids of >5 years duration showed more than 75% flattening (p < 0.05). Side effects included pain (all patients), hyperpigmentation (all patients) and ulceration (1 patient). No difference in peripheral blood count was noted before, during and after the therapy. Conclusion: Intralesional 5-FU can be safely used for the management of small keloids of shorter duration.

A Comparative Clinical Study on Role of 5-Flurouracil Versus Triamcinolone in the Treatment of Keloids

“…Ulceration and tissue sloughing were seen in 65% of the patients, which took a few weeks to heal. This has been observed in other studies also [1,[4][5][6]. None of these side effects were seen with triamcinolone acetonide injection, so the patient compliance was much more in the latter group.…”

“…Several studies evaluating intralesional steroids have reported roughly a 50% recurrence rate [2,3]. In the recent past, intralesional 5-FU has been tried in hypertrophic scars and keloids in combination or as an individual therapeutic agent [1,[4][5][6]. A paucity of literature is available regarding the usefulness and safety profile of 5-FU as an individual therapeutic agent [1].…”

“…A paucity of literature is available regarding the usefulness and safety profile of 5-FU as an individual therapeutic agent [1]. However, several studies suggest that the overall efficacy is not better than other modalities and significant side effects such as ulceration and hyperpigmentation make topical 5-FU less appealing [1][2][3][4][5]. Hence, we conducted a prospective trial to compare the efficacy of 5-FU versus triamcinolone as a therapeutic agent for the treatment of keloids.…”

Narbe und Keloid – und nun?

“…Es wird einmal wöchentlich mit einer Dosis von 50 mg/ ml über 12 bis maximal 16 Wochen intraläsional appliziert, wo− bei eine Gesamtdosis von 50 ± 150 mg pro Sitzung nicht über− schritten werden soll. Durch eine Inhibition der Fibroblastenpro− liferation kommt es zur einer signifikanten Abflachung der Ke− loide, bei bis zu 50 % der Patienten, wie Gupta und Kalra berich− ten [23]. Mögliche Nebenwirkungen sind Hautirritationen, Schmerzen während der Injektion, Ulzerationen und Purpura.…”

A comparative study between intralesional 5-fluorouracil combined with triamcinolone acetonide and triamcinolone acetonide alone in the treatment of keloids

“…The symptoms disappeared in 17 (70.8%) patients and improved in 3 (12.5%) patients. 27 Kontochristopoulos et al in his study found that out of 20 patients, 17 (85%) patients showed more than 50% improvement. 28 Darougheh et al in his study patient's self-assessment at end of study showed > 50% improvement in 55% patients among Group 1.…”