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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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