The Scar Bane, Without the Pain: A New Approach in the Treatment of Elevated Scars: Thermomechanical Delivery of Topical Triamcinolone Acetonide and 5-Fluorouracil

Abstract

Introduction Keloids are challenging to treat due to their inadequate response to treatment and high recurrence rate. Intralesional triamcinolone acetonide (TAC) injection with or without 5-fluorouracil (5FU) is considered the first-line treatment for keloids. Three significant disadvantages of intralesional injections are the pain associated with the procedure, the uneven topography, and epidermal atrophy. Fractionated ablative carbon dioxide (CO 2 ) laser-assisted drug delivery (LADD) of the topical solution can help facilitate transdermal drug delivery and shows promise in scar remodeling. This study examined the use of a thermomechanical device (Tixel, Novoxel) to facilitate the transdermal delivery of TAC and 5-FU in the treatment of keloid scars. Methods Seven patients each received eight topical thermal ablations, with one ablation performed every 2–3 weeks. TAC and 5FU were applied after each ablation. Outcomes were evaluated using the Vancouver Scar Scale (VSS), and pain was assessed using the Visual Analog Scale (VAS). Results Mean keloid VSS reduced from 8.6 ± 1.2 to 5 ± 2.7 after the eight treatments. Mean treatment pain VAS score was 2.4 ± 0.7. Patients rated their satisfaction level as moderate–high. No severe adverse reactions were noted. Conclusion Thermomechanical drug delivery of TAC and 5-FU is safe and effective. This is a promising option for the treatment of keloid scars, particularly in the pediatric population.

Wound Healing Process After Thermomechanical Skin Ablation

“…Pain during treatment was also milder in comparison with CO 2 laser, where local or forced cold air anesthesia was required to achieve similar VAS scores during treatment 18. Even when comparing with intralesional treatment of keloids with the combination of triamcinolone and 5‐fluorouracil (5FU), a lower pain score was reported using TMA 19. Thus, TMA could be suitable for sensible populations.…”

Thermo‐Mechanical Fractional Injury Enhances Skin Surface‐ and Epidermis‐ Protoporphyrin IX Fluorescence: Comparison of 5‐Aminolevulinic Acid in Cream and Gel Vehicles

“…TMFI-mediated thermal disruption of the skin barrier has been explored in vitro and in vivo for hydrophilic drugs that poorly penetrate the intact skin. Evaluated drugs include verapamil hydrochloride, diclofenac sodium, botulinum toxin A, and ALA [10][11][12][13]18]. A recent study by Shavit and Dierickx determined skin surface PpIX fluorescence in normal skin after TMFI, combined with commercially available photosensitizers in different concentrations and vehicle formulations [13].…”

“…Thermo-mechanical fractional injury (TMFI) is a relatively new technique that by the protrusion of pyramidshaped, titanium covered micro-tips, conducts heat to the skin, generating an array of fractional microscopic vertical columns of thermal injury [10,11]. TMFI has previously been explored for cutaneous uptake of hydrophilic drugs, such as verapamil, diclofenac sodium, 5-fluorouracil, and magnesium ascorbyl phosphate, after TMFI exposure [12][13][14]. In a recent study, TMFI pretreatment enhanced PpIX fluorescence at the skin surface following incubation with 20% ALA gel [14].…”

Skin Resurfacing

“…Agents such as 5fluorouracil, calcium hydroxylapatite, or steroids are applied to the affected area after the fractional ablative treatment. This allows the medication to penetrate scar tissue in a widespread, more uniform fashion than can be achieved with repeated manual intralesional injection using a needle [42][43][44][45][46][47]. Even without drug delivery, ablative fractional treatment alone has been shown to increase quality of life in patients with significant hypertrophic scarring and contractures through improving function and appearance of the lesions [48][49][50].…”