Efficacy and safety of triamcinolone acetonide alone and in combination with 5-fluorouracil for treating hypertrophic scars and keloids: a systematic review and meta-analysis

Abstract

Pathological scars, such as keloids and hypertrophic scars, readily cause physical and psychological problems. Combination 5-fluorouracil (5-FU) with triamcinolone acetonide (TAC) is presumed to enhance the treatment of pathological scars, although supportive evidence is lacking. We aimed to compare the efficacy and safety of TAC alone and in combination with 5-FU for the treatment of hypertrophic scars and keloids. Five databases (PubMed, Medline, Cochrane databases, Embase and CNKI) were searched with the limitations of human subjects and English-language text. Mean differences (MDs), odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. The Cochrane Collaboration's Risk of Bias Tool was used to assess the risk of bias. The control group received intralesional TAC alone, and the experimental group received TAC combined with 5-FU injection. A pooled analysis of the effectiveness based on patient self-assessment after treatment showed that the experimental group achieved better results than the control group (OR = 2·92, 95% CI = 1·63-5·22, P = 0·0003). Similarly, a pooled analysis of the effectiveness based on observer assessment following treatment produced the same conclusion (OR = 4·03, 95% CI = 1·40-11·61, P = 0·010). A meta-analysis of scar height after treatment showed that the experimental group performed better than the control group (MD = -0·14, 95% CI = -0·23-0·05, P = 0·002). The erythema score of the experimental group after treatment was superior (MD = -0·20, 95% CI = -0·34-0·06, P = 0·004). The heterogeneity test showed no heterogeneity among the studies (P > 0·1, I² = 0%). TAC combined with 5-FU is more suitable for the treatment and prevention of hypertrophic scars and keloids, with greater improvement in scar height and patient satisfaction as well as fewer side effects.

Keywords: 5-Fluorouracil; Hypertrophic scars; Keloids; Meta-analysis; Triamcinolone acetonide.

Figure 1

Review flow diagram.

Figure 2

Risk of bias summary: this risk of bias tool incorporates the assessment of randomisation (sequence generation and allocation concealment), blinding (participants and outcome assessors), incomplete outcome data, selective outcome reporting and other risk of bias. The items were judged as ‘low risk’, ‘unclear risk’ or ‘high risk’. Green means ‘low risk’, red means ‘high risk’ and yellow means ‘unclear risk’.

Figure 3

Risk of bias graph: each risk of bias assessment was presented as the percentage across all the included studies, which indicates the proportion of different levels of risk of bias for each item.

Figure 4

Forest plot of comparison: clinical effectiveness in terms of patient self‐assessment of experimental group versus control group. Experimental group, triamcinolone acetonide combined with 5‐FU; control group, triamcinolone acetonide alone.

Figure 5

Forest plot of comparison: clinical effectiveness in terms of observer assessment of experimental group versus control group.

Figure 6

Forest plot of comparison: scar height of experimental group versus control group.

Figure 7

Forest plot of comparison: erythema scores of experimental group versus control group.

Figure 8

Funnel plot to test for publication bias. Each point represents a separate study for the indicated association. Log OR represents the natural logarithm of the OR. The vertical line represents the mean effects size. OR, odds ratio; SE, standard error.