Successful Treatment of Keloid with Weekly Intralesional Triamcinolone Acetonide (40%) And 5-Fluorouracil Combination: A Case Report
Keywords:
Combined Modality Therapy, fluorouracil, keloid scar, triamcinolone acetonideAbstract
Keloids often cause significant physical discomfort and psychological distress, profoundly impacting patients' quality of life. Intralesional therapy combining triamcinolone acetonide (TA) and 5-fluorouracil (5-FU) has emerged as a promising treatment option, with demonstrated efficacy in clinical studies. Although most protocols advocate injection intervals of 2–3 weeks, weekly administration has been explored in some studies. However, data on the efficacy and safety of this combination therapy particularly in Asian populations remain limited. This case report describes the successful use of intralesional 5-FU combined with 40% TA for keloid treatment, demonstrating efficacy with minimal adverse effects. A 42-year-old woman with a history of surgical excision presented with a solitary, irregularly shaped, well-defined, hyperpigmented, and pruritic tumor in the pubic region. Following an initial cryotherapy session, the patient underwent weekly intralesional injections of 40% TA and 5-FU in a 1:9 ratio for six weeks. The patient experienced mild to moderate procedural pain, with a Visual Analog Scale (VAS) score of 3–5, and developed ulceration at the injection site after the sixth session. Despite the absence of a standardized protocol for this combination therapy, significant clinical improvement was observed, with the keloid size reducing from 6 × 3.5 × 0.8 cm to 4.9 × 2.4 × 0.1 cm . This case highlights the weekly intralesional combination of 40% TA and 5-FU as an effective treatment for keloid reduction, offering tolerable side effects and favorable patient outcomes
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References
Ogawa R. Keloid and hypertrophic scars are the result of chronic inflammation in the reticular dermis. Int J Mol Sci. 2017;18(3).
Ogawa R. The most current algorithms for the treatment and prevention of hypertrophic scars and keloids: a 2020 update of the algorithms published 10 years ago. Plast Reconstr Surg. 2022;149(1):79E-94E.
Hao Y-H, Xing X-J, Zhao Z-G, Xie F, Hao T, Yang Y, et al. A multimodal therapeutic approach improves the clinical outcome of auricular keloid patients. Int J Dermatol. 2019;58(6):745–9.
Zhuang ZH, Li YT, Wei XJ. The safety and efficacy of intralesional triamcinolone acetonide for keloids and hypertrophic scars: a systematic review and meta-analysis. Burns. 2021;47(5):987–98.
Lee HJ, Jang YJ. Recent understandings of biology, prophylaxis and treatment strategies for hypertrophic scars and keloids. Int J Mol Sci. 2018;19(3).
Huang C, Wu Z, Du Y, Ogawa R. The epidemiology of keloids. In: Téot L, Mustoe TA, Middelkoop E, Gauglitz GG, editors. Textbook on Scar Management. Switzerland: Springer; 2020. p. 29–35.
Chiang RS, Borovikova AA, King K, Banyard DA, Lalezari S, Toranto JD, et al. Current concepts related to hypertrophic scarring in burn injuries. Wound Repair Regen. 2016;24(3):466–77.
Reinholz M, Guertler A, Schwaiger H, Poetschke J, Gauglitz GG. Treatment of keloids using 5-fluorouracil in combination with crystalline triamcinolone acetonide suspension: evaluating therapeutic effects by using non-invasive objective measures. J Eur Acad Dermatology Venereol. 2020;34(10):2436–44.
Elsaie ML. Update on management of keloid and hypertrophic scars: a systemic review. J Cosmet Dermatol. 2021;20(9):2729–38.
Sharma S, Bassi R, Gupta A. Treatment of small keloids with intralesional 5-fluorouracil alone vs. intralesional triamcinolone acetonide with 5-fluorouracil. J Pakistan Assoc Dermatologists. 2012;22(1):35–40.
Wolfram D, Tzankov A, Pülzl P, Piza-Katzer H. Hypertrophic scars and keloids - a review of their pathophysiology, risk factors, and therapeutic management. Dermatologic Surg. 2009;35(2):171–81.
Nanda S, Reddy BSN, Fitzpatrick RE. Intralesional 5-fluorouracil as a treatment modality of keloids. Dermatologic Surg. 2004;30(1):54–7.
Walsh LA, Wu E, Pontes D, Kwan KR, Poondru S, Miller CH, et al. Keloid treatments: an evidence-based systematic review of recent advances. Syst Rev. 2023;12(1).
Saleem F, Rani Z, Bashir B, Alta F, Khurshid K, Pal SS. Comparison of efficacy of intralesional 5-fluorouracil plus triamcinolone versus triamcinolone alone in the treatment of keloids. Med Forum Mon. 2022;33(5):62–6.
Khalid FA, Mehrose MY, Saleem M, Yousaf MA, Mujahid AM, Rehman SU, et al. Comparison of efficacy and safety of intralesional triamcinolone and combination of triamcinolone with 5-fluorouracil in the treatment of keloids and hypertrophic scars: randomised control trial. Burns. 2019;45(1):69–75.
Berman B, Sadegh Amini, Hilary Baldwin. Keloid management. In: June K Robinson, C William Hanke, Daniel M Siegel, Alina Fratila, editors. Surgery of the skin. third. Elsevier Inc; 2015. p. 674–87.
Smith N, Kelly B. Cha, Christopher Bichakjian. Perioperative considerations in dermatologic surgery. In: Kang S, Amagai M, Bruckner AL, Enk AH, Margolis DJ, McMichael AJ, et al., editors. Fitzpatrick’s Dermatology. Edisi ke-9th New York: Mc Graw-Hill; 2019. p. 3706–24.
Lee CC, Tsai CH, Chen CH, Yeh YC, Chung WH, Chen CB. An updated review of the immunological mechanisms of keloid scars. Front Immunol. 2023;14(March):1–15.
Manoharan A, Rao SM. Analysis of risk factors behind keloid. 2020;6(2):138–41.
Udayan Betarbet, Travis W. Blalock. Keloids: a review of etiology, prevention, and treatment. J Clin Aesthet Dermatol. 2020;13(2):33–43.
Magda M.W.Ulrich. Fetal wound healing. In: Téot L, Mustoe TA, Middelkoop E, Gauglitz GG, editors. Textbook on Scar Management. Switzerland: Springer; 2020. p. 4–9.
Wang PH, Huang BS, Horng HC, Yeh CC, Chen YJ. Wound healing. J Chinese Med Assoc. 2018;81(2):94–101.
Elazhary E, Abd Al-Salam F, Abd El-Hafiz H, Maghraby H. Updates on keloid scar pathogenesis, assessment and treatment modalities. J Recent Adv Med. 2022;3(1):75–86.
Vivas AC, Tang JC, Maderal AD, Viera MH. Hypertrophic scars and keloids, part 1: conventional treatments. Cosmet Dermatology. 2012;25(7):309–16.
Coppola MM, Salzillo R, Segreto F, Persichetti P. Triamcinolone acetonide intralesional injection for the treatment of keloid scars : patient selection and perspectives. Clin Cosmet Investig Dermatol. 2018;24(11):387–96.
Lee J, Kim J. Minimal-invasive technologies for treatment of hts and keloids: corticosteroids. In: Téot L, Mustoe TA, Middelkoop E, Gauglitz GG, editors. Textbook on Scar Management. Switzerland: Springer; 2020. p. 244–9.
Rabey NG, Goldie SJ, Price RD. 5-fluorouracil for keloid scars ( protocol ). Cochrane Database Syst Rev. 2017;(9).
Agusni JH, Sutedja EK, Chandra F. Triamcinolone acetonide and 5-fluorouracil intralesional combination injection in keloid treatment. Int J Integr Heal Sci. 2017;5(1):36–41.
Khan MA, Bashir MM, Khan FA. Intralesional triamcinolone alone and in combination with 5-fluorouracil for the treatment of keloid and hypertrophic scars. J Pak Med Assoc. 2014;64(9):1003–7.
Gauglitz GG, Korting HC, Pavicic T, Ruzicka T, Jeschke MG. Hypertrophic scarring and keloids: pathomechanisms and current and emerging treatment strategies. Mol Med. 2011;17(1–2):113–25.
Limandjaja GC, Niessen FB, Scheper RJ, Gibbs S. The keloid disorder: heterogeneity, histopathology, mechanisms and models. Front Cell Dev Biol. 2020;8(5).
Ekstein SF, Wyles SP, Moran SL, Meves A. Keloids: a review of therapeutic management. Int J Dermatol. 2021;60(6):661–71.
Limmer EE, Glass DA. A review of current keloid management: mainstay monotherapies and emerging approaches. Dermatol Ther (Heidelb). 2020;10(5):931–48.
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