Beyond the litany of treatment options, another obstacle in the scar literature is a lack of uniformity in reporting clinical results. This makes extrapolating from or comparing studies difficult. Many authors quantify treatment outcome using a visual appearance rating scale. Other outcome measurement options include symptom relief and direct scar size measurement. Qualitative descriptive scales are available for scars but are far from being widely accepted
A recent meta-analysis of 39 studies, representing 27 different treatments, reported a 70 percent chance of clinical improvement with any type of treatment.Therefore, it is possible that current treatments may not have any significant effect on clinical improvement. Based on emerging information on keloid pathophysiology, there is a need for further studies in order to develop better therapies for pathologic scarring.
Keloid patients underwent excision followed by a series of treatments with intralesional 5-fluorouracil into the healing scar to prevent recurrence (n = 32).The hypertrophic scar patients were treated with the same series of injections without scar excision to both control symptoms and improve scar appearance (n = 21).The primary outcome measures were scar volume and a symptom questionnaire.Patients were followed for 1 year after completing the injection treatments.
Because of the off-label use of 5-fluorouracil for the treatment of scars, time was spent explaining the indications, techniques, alternatives, benefits, and risks of the therapy. This was reinforced to the patients at each of the 10 injections in the treatment series.Results
Each treatment involved intralesional injection of 50 mg of 5-fluorouracil (50 mg/ml; American Pharmaceutical Partners, Inc., Schaumburg, Ill.) and 10 mg of lidocaine 1% (Hospira Worldwide, Schaumburg, Ill.).
For most of the scars, the medication was distributed evenly throughout the scar or the healing incision for the keloid group.
For large hypertrophic scars, the medication was injected into the most symptomatic part of the scar at that particular visit.
Treatments were continued until the maximum dose of 500 mg (10 injections) was reached.
Their definition of recurrence was any visible evidence of scar growth. “It did not mean the scar returned to preexcision size or that the patient was dissatisfied with the result.”
In the keloid group, there were no recurrences during the course of the treatment, but there were six (6 / 32) at 1 year follow-up. This represents a success rate of greater than 80% at one year. The literature reports a success rate of 75 – 95 % for radiation combined with excision.
Of the hypertrophic scar patients, 86 percent had symptom improvement which was maintained for 1 year after treatment. More than one-third had complete resolution of the symptoms. Median scar volume reduction was 40 percent in this group.
I find this article interesting, but am not ready to begin using 5-fluorouracil prior to the tradition treatment courses. As the authors point out,
One weakness of the study is the length of follow-up. Although most studies do not report results longer than 1 year after treatment, it is clear that keloid recurrence can occur years later.REFERENCE