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Treatment Response of Keloidal and Hypertrophic Sternotomy Scars
Comparison Among Intralesional Corticosteroid, 5-Fluorouracil, and 585-nm Flashlamp-Pumped Pulsed-Dye Laser Treatments
Woraphong Manuskiatti, MD;
Richard E. Fitzpatrick, MD
Arch Dermatol. 2002;138:1149-1155.
Objective To compare the clinical response of keloidal and hypertrophic scars
after treatment with intralesional corticosteroid alone or combined with 5-fluorouracil
(5-FU), 5-FU alone, and the 585-nm flashlamp-pumped pulsed-dye laser (PDL).
Design Prospective, paired-comparison, randomized controlled trial.
Setting A private ambulatory laser facility.
Patients Ten patients with previously untreated keloidal or hypertrophic median
sternotomy scars at least 6 months after surgery that were considered problematic
by the patients.
Interventions Five segments were randomly treated with 4 different regimens: (1) laser
radiation with a 585-nm PDL (5 J/cm2); (2) intralesional triamcinolone
acetonide (TAC) (20 mg/mL); (3) intralesional 5-FU (50 mg/mL); and (4) intralesional
TAC (1 mg/mL) mixed with 5-FU (45 mg/mL). One segment of each scar received
no treatment and served as a control.
Main Outcome Measures Scar height, erythema, and pliability were evaluated before and every
8 weeks after treatment. Patients' subjective evaluations were tabulated.
Histologic sections of segments were examined in 1 biopsy sample per segment
at week 32.
Results There was a statistically significant clinical improvement in all treated
segments. No significant difference in treatment outcome vs method of treatment
was noted. However, intralesional formulas resulted in faster resolution than
the PDL: scar induration responded better to intralesional formulas, scar
texture responded better to the PDL, and scar erythema responded the same
as the control with all treatments. Adverse sequelae, including hypopigmentation,
telangiectasia, and skin atrophy, were observed in 50% (5/10) of the segments
that received corticosteroid intralesionally alone. No long-term adverse sequelae
were demonstrated in the segments treated with other modalities.
Conclusions Clinical improvement of keloidal and hypertrophic scars after treatment
with intralesional corticosteroid alone or combined with 5-FU, 5-FU alone,
and PDL seemed comparable, with the exceptions of the incidence of adverse
reactions, which were most common with intralesional corticosteroid. Intralesional
5-FU is comparable to the other therapies.
From Dermatology Associates and Cosmetic Laser Associates of San Diego
County Inc, La Jolla, Calif. Dr Manuskiatti is now with the Department of
Dermatology, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
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