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

Karunasree Nagarur, Narasimha Rao Raja


Background: Many modalities of keloid treatment have been advocated which have a variable and transient success. There is no universally accepted treatment resulting in permanent cure. Hence there is need for evaluation of better modalities to achieve good cosmetic acceptability. Current study compares the efficacy and safety of intralesional 5-fluorouracil combined with triamcinolone acetonide and triamcinolone acetonide alone in the treatment of keloids.

Methods: Cases of clinically diagnosed keloids from South Central Railway Hospital were included in the study. These patients were randomly allocated alternately between group 1 and 2. An interventional and comparative study, comparing the percentage reduction in volume of keloid between both groups after treatment was done. For group 1 intralesional injection 5-fluorouracil 0.9 ml (50 mg/ml) combined with 0.1 ml of triamcinolone acetonide (40 mg/ml) i.e., 45 mg of 5 Fluorouracil was combined with 4 mg of triamcinolone, weekly once for 8 weeks. For group 2 intralesional triamcinolone acetonide 10 mg/ml alone weekly for 8 weeks. Volume of keloid (i.e., (length x breadth x height measured by vernier calipers) before starting treatment and one week after the last injection was compared. percentage reduction in the volume was calculated.

Results: The overall therapeutic response in volume reduction in group 1 was found to be better and statistically significant (p value<0.01) compared to group 2.

Conclusions: The present study has shown that intralesional 5-FU+TAC is more effective compared to TAC intralesional injection alone.


Keloid, Intralesional 5-flourouracil, Intralesional triamcinolone acetonide

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Nedelec B, Shankowsky A, Tredgett EE. Rating the resolving hypertrophic scar: comparison of the Vancouver Scar Scale and scar volume. J Burn Care Rehabil. 2000;21:205-12.

Sullivan T, Smith J, Kermode J, Mclver J, Courtemanche DJ. Rating the burn scar. J Burn Care Rehabil. 1990;11:256-60.

Lye I, Edgar DW, Wood FM, Carroll S. Tissue tonometry is a simple, objective measure for pliability of burn scar: is it reliable? J Burn Care Res 2006;27:82-5.

Kelly AP. Keloids. Dermatol Clin. 1988;6:413-24.

Griffith BH. The treatment of keloids with triamcinolone acetonide. Plast Reconstr Surg. 1966;38:202-8.

Ketchum LD, Smith J, Robinson DW, Masters FW. The treatment of hypertrophic scar, keloid and scar contracture by triamcinolone acetonide. Plast Reconstr Surg. 1966;38:209-18.

Ketchum LD, Robinson DW, Masters FW. Follow-up on treatment of hypertrophic scars and keloids with triamcinolone. Plast Reconstr Surg. 1971;48:256-9.

Ritota PC, Lo AK. Cushing’s syndrome in postburn children following intralesional triamcinolone injection. Ann Plast Surg. 1996;36:508-11.

Savant S. Hypertrophic scars and keloids. In: Textbook of dermatosurgery and cosmetology. 2nd ed. Mumbai: ASCAD; 2008:316-30.

DeBeurmann R, Gougerot GH. Cheloids des musquescies. Ann Dermatol Syphilol. 1906;7:151.

Borok TL, Bray M, Sinclair I. Role of ionizing irradiation for 393 keloids. Int J Radiat Oncol Biol Phys. 1988;15:865-70.

Cosman B, Crikelair GF, Ju DM. The surgical treatment of keloids. Plast Reconstr Surg. 1961;27:335-58.

Van den Brenk HA, Minty CC. Radiation in the management of keloids and hypertrophic scars. Br J Surg. 1960;47:595-605.

Malaker K, Vijayraghavan K, Hodson I, Al Yafi T. Retrospective analysis of treatment of unresectable keloids with primary radiation over 25 years. Clin Oncol. 2004;16:290-8.

Al-Attar A, Mess S, Thomassen JM, Kauffman CL, Davison SP. Keloid pathogenesis and treatment. Plast Reconstr Surg. 2006;117:286-300.

Uppal RS, Khan U, Kakar S, Talas G, Chapman P, Mc Grouther AD. The effects of a single dose of 5-fluorouracil on keloid scars: A clinical trial of timed wound irrigation after extralesional excision. Plast Reconstr Surg. 2001;108:1218-24.

Fitzpatrick RE. Treatment of inflamed hypertrophic scars using intralesional 5 -FU. Dermatol Surg. 1999;25:224-32.

Manuskiatti W, Fitzpatrick RE. Treatment response of keloidal and hypertrophic sternotomy scars: Comparison among intralesional corticosteroid, 5-fluorouracil, and 585-nm flashlamp-pumped pulsed-dye laser treatments. Arch Dermatol. 2002;138:114-55.

Espana A, Solano T, Quintanilla E. Bleomycin in the treatment of keloids and hypertrophic scars. Dermatol Surg. 2001;27:23-7.

Bodokh I, Brun P. The treatment of keloids with intralesional Bleomycin. Ann Dermatol Venereol. 1996;123:791-4.

Gupta S, Kumar B. Intralesional cryosurgery using lumbar puncture and or hypodermic needles for large, bulky, recalcitrant keloids. Int J Dermatol. 2001;40:349-53.

Malakar S, Malakar R. Intralesional cryosurgery: Consequences, cautions and precautions. Indian J Dermatol. 2000;45:100-1.

Zurada JM, Kriegel D. Topical treatments for hypertrophic scars. J Am Acad Dermatol. 2006;55:1024-31.

Kelly AP: Update on the management of Keloids. Semin Cutan Med Surg. 2009;28:71-6

Murray JC. Scars and keloids. Dermatol Clin. 1993;11:697-708.

Nanda S, Reddy BS. Intralesional 5-fluorouracil as a treatment modality of keloids. Dermatol Surg. 2004;30:56-7.

Gupta S, Kalra A. Efficacy and safety of intralesional 5-fluorouracil in the treatment of keloids. Dermatology. 2002;204:130-2.

Kontochristopoulos G, Stefanaki C, Panagiotopoulos A, Stefanaki K, Argyrakos T, Petridis A, et al. Intralesional 5-fluorouracil in the treatment of keloids: an open clinical and histopathologic study. J Am Acad Dermatol. 2005;52:474-9.

Darougheh A, Asilian A, Shariati F. Intralesional triamcinolone acetonide alone or in combination with 5-flourouracil for the treat ment of keloid and hypertrophic scars. Clin Exp Dermatol. 2009;34:219-23.

Darougheh A, Asilian A, Shariati F. New combination of triamcinolone, 5-flourouracil and pulsed dye laser for treatment of keloid and hypertrophic scars. Dermatol Surg. 2006;32:907-15.

Berman B, Bieley HC. Keloids. J Am Acad Dermatol. 1995;33:117-23.