Intralesional Injection of Botulinum Toxin Type A Compared with Intralesional Injection of Corticosteroid for the Treatment of Hypertrophic Scar and Keloid: A Systematic Review and Meta-Analysis

Abstract

Background The optimal treatment for hypertrophic scar and keloid remains controversial. Therefore, the aim of this systematic review and meta-analysis was to compare the effectiveness of intralesional injection of botulinum toxin type A compared with placebo and intralesional injection of corticosteroid compared with placebo in patients with hypertrophic scar and keloid. Material/Methods Six databases were searched using Medical Subject Headings (MeSH) keywords and included Web of Science, PubMed, EMBASE, the Cochrane Library, WanFang, and CNKI from their inception to March 1 2019, without language restriction. Randomized controlled trials (RCTs) and prospective controlled trials (PCTs) were identified that compared intralesional injection of botulinum toxin type A with placebo and corticosteroid with placebo in hypertrophic scar and keloid. The quality of controlled trials was assessed by the Newcastle-Ottawa Scale (NOS). Results Comparison of intralesional botulinum toxin type A and corticosteroid showed significant differences in the Visual Analog Scale (VAS) (P<0.001) (WMD, −4.30; 95% CI, −4.44 to −4.16) and effective rate (P=0.012) (RR=0.82; 95% CI, 0.70–0.96). Intralesional injection of botulinum toxin type A compared with placebo showed significant differences in the VAS (P<0.001) (WMD, 1.41; 95% CI, 1.21–1.62), the width of scar (P=0.00) (WMD, −0.15; 95% CI, −0.19 to −0.10) and Vancouver Scar Scale (VSS) (P=0.003) (WMD, −0.69; 95% CI, −1.14 to −0.23). Conclusions Systematic review and meta-analysis showed that injection of intralesional botulinum toxin type A was more effective in the treatment of hypertrophic scar and keloid than injection of intralesional corticosteroid or placebo.

The Roles of Inflammation in Keloid and Hypertrophic Scars

“…Apart from blocking acetylcholine release, BTX has antiinflammatory effects on wound healing and scar formation (57,58). A meta-analysis evaluating intralesional injection of BTX A versus corticosteroids and placebo in the treatment of hypertrophic scar and keloid showed that BTX A was more effective than the others (59). Another study conducted by An et al compared the effects of inflammation intervention in earlier phases (operationday) with that in later phase (2-week postoperative) on scar formation after thyroidectomy (60).…”

A Review of Current Keloid Management: Mainstay Monotherapies and Emerging Approaches

“…Data has been mixed, however, as to how botulinum toxin compares to steroid injections. While studies such as those by Shaarawy et al and Rasaii et al found no difference between the two treatments, Pruksapong et al found steroids to be superior, while a metanalysis performed by Bi et al showed botulinum toxin as superior [ 23 – 26 ]. Factors such as decreased adverse effects and greater improvement in symptoms offer additional benefits of botulinum toxin in comparison to triamcinolone [ 23 , 24 ].…”

Keloid Formation after Circumcision: A Case Report and Current Literature Review

“…To date, various methods including intralesional therapies (corticosteroids, 5-fluorouracil, interferon, bleomycin injection, intralesional brachytherapy, intralesional botox), surgical excision, topical corticosteroid injection, radiation therapy (external beam radiotherapy; EBRT and brachytherapy), silicone gel therapies, compression therapy, and laser therapies have been trialled for the treatment of keloids. [5][6][7][8] Of these, intralesional corticosteroid injection, topical corticosteroid injection, surgical excision, and silicone gel therapies were reported to be successful for the treatment of penile keloids.…”