BACKGROUND: Keloids are overgrowths of fibrous tissue following cutaneous injuries. They are often symptomatic and troubling cosmetically, with significant psychosocial burden for the patient. A safe, cost-effective alternative treatment for keloids will definitely be beneficial.
OBJECTIVES: This study aims to determine the efficacy of intralesional 5-fluorouracil versus triamcinolone acetonide in the treatment of keloids as to reduction of keloid volume, improvement of symptoms and cosmetic appearance. Adverse effects and recurrences between the two treatment groups will likewise be evaluated.
METHODS: This is a single-blind, randomized, controlled trial. Fourteen patients with 2 or more keloids on the same site or symmetrically distributed, with no co-existing morbidity and with informed consent, were included in the study. Patients received both intralesional injections of 5-fluorouracil (5-FU, Utoral 50 mg/mL) and triamcinolone acetonide (TAG, Kanolone 10 mg/mL). One keloid was injected with 5-FU and one with TAG. They were submitted to 1-6 treatment sessions with an average interval of 2 weeks between each session. Measurements of keloid volume using alginate impression material and digital photographs were taken before treatment, 2 weeks and 2 months post-treatment. Occurrence of adverse effects, improvement of symptoms, as well as cosmetic outcome, was likewise recorded.
RESULTS: Both 5-fluorouracil and triamcinolone acetonide were shown to be effective in the treatment of keloid. Comparing the two, 5-FU statistically proved to be better, by having greater volume reduction, more symptom improvement, and higher scores on patient's assessment of cosmetic outcome. Adverse sequelae were pain, hyperpigmentation, and ulceration which healed in 1 - 2 weeks with topical antibiotic ointment. Corticosteroid side effects such as telangiectasia and atrophy were not appreciated with the 5-FU group. There was no recurrence during the follow-up period of 8 weeks in any of the patients.
CONCLUSION: Five-fluorouracil was shown to be effective in reducing keloid volume, improving symptoms of pain and pruritus, and cosmetic outcome, as compared to triamcinolone acetonide. Likewise, it was found to be safe. Adverse effects associated with corticosteroids were not seen. No recurrence was noted two months post-treatment.