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. 2018;41(1):69-80.
doi: 10.1007/s00238-017-1322-y. Epub 2017 Jun 8.

A new treatment of hypertrophic and keloid scars with combined triamcinolone and verapamil: a retrospective study

S B Kant  1 , E van den Kerckhove  1   2   3 , C Colla  1 , S Tuinder  1 , R R W J van der Hulst  1 , A A Piatkowski de Grzymala  1
Affiliations

A new treatment of hypertrophic and keloid scars with combined triamcinolone and verapamil: a retrospective study

S B Kant et al. Eur J Plast Surg. 2018.

Abstract

Background: Since the management of keloid and hypertrophic scars still remains a difficult clinical problem, there is need for adequate, effective therapy. In this study, we explored for the first time the efficacy and the potential synergetic effect of combined triamcinolone and verapamil for the treatment of hypertrophic and keloid scars. The objective was to assess the efficacy of combined intralesional triamcinolone and verapamil therapy for hypertrophic and keloid scars.

Methods: Fifty-eight patients with hypertrophic scars (n = 31) and keloid scars (n = 27) were included. A specific injection therapy scheme was applied. Five follow-up moments were chosen, with a maximum follow-up of nearly 2 years. The effects of combination therapy on scar pliability, thickness, relief, vascularization, surface area, pain, and pruritus were examined by means of the Patient and Observer Scar Assessment Scale (POSAS).

Results: Our results reveal a fast and abiding improvement of both keloid and hypertrophic scars after treatment with the combination therapy. All POSAS components showed a reduction in scar score, while scar relief, pain, itchiness, and surface area improved significantly (P < 0.05) in keloids. Significant improvement in hypertrophic scars was found in scar pigmentation, vascularization, pliability, thickness, pain, and surface area. Overall POSAS scores revealed statistically significant decreases between baseline and 3-4 months, 4-6 months, and >12 months after start of therapy in both keloids and hypertrophic scars.

Conclusions: This study reveals that combined therapy of triamcinolone and verapamil results in overall significant scar improvement with a long-term stable result.Level of evidence: Level IV, therapeutic study.

Keywords: Hypertrophic scars; Keloids; Kenacort; Verapamil.

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Conflict of interest statement

Compliance with ethical standardsAuthors Kant, van den Kerckhove, Colla, Tuinder, van der Hulst, and Piatkowski de Grzymala declare that they have no conflict of interest.For this kind of retrospective study formal consent from a local ethics committee is not requiredFor this type of study formal consent is not required.None.

Figures

Fig. 1
Fig. 1
Mean Patient, Observer, and total POSAS scores are shown at baseline and four subgroup visits (early, medium, long, and late term) for keloid scars. A single asterisk indicates a statistical significant (P < 0.05) difference compared to baseline
Fig. 2
Fig. 2
Mean Patient, Observer, and total POSAS scores are shown at baseline and four subgroup visits (early, medium, long, and late term) for hypertrophic scars. A single asterisk indicates a statistical significant (P < 0.05) difference compared to baseline
Fig. 3
Fig. 3
a Patient scar scores as part of the total POSAS score are displayed for keloid scars at baseline and five follow-up moments: 1–3 months, 3–4 months, 4–6 months, 6–12 months, and >12 months. Scars were rated on a ten-step scale. Braces indicate a statistical significant (P < 0.05) difference between follow-up moments. b Patient scar scores as part of the total POSAS score are displayed for keloid scars at baseline and five follow-up moments: 1–3 months, 3–4 months, 4–6 months, 6–12 months, and >12 months. Scars were rated on a ten-step scale. Braces indicate a statistical significant (P < 0.05) difference between follow-up moments
Fig. 4
Fig. 4
a Patient scar scores as part of the total POSAS score are displayed for hypertrophic scars at baseline and five follow-up moments: 1–3 months, 3–4 months, 4–6 months, 6–12 months, and >12 months. Scars were rated on a ten-step scale. Braces indicate a statistical significant (P < 0.05) difference between follow-up moments. b. Patient scar scores as part of the total POSAS score are displayed for hypertrophic scars at baseline and five follow-up moments: 1–3 months, 3–4 months, 4–6 months, 6–12 months, and >12 months. Scars were rated on a ten-step scale. Braces indicate a statistical significant (P < 0.05) difference between follow-up moments
Fig. 5
Fig. 5
a Observer scar scores as part of the total POSAS score are displayed for keloid scars at baseline and five follow-up moments: 1–3 months, 3–4 months, 4–6 months, 6–12 months, and >12 months. Scars were rated on a ten-step scale. Braces indicate a statistical significant (P < 0.05) difference between follow-up moments. b Observer scar scores as part of the total POSAS score are displayed for keloid scars at baseline and five follow-up moments: 1–3 months, 3–4 months, 4–6 months, 6–12 months, and >12 months. Scars were rated on a ten-step scale. Braces indicate a statistical significant (P < 0.05) difference between follow-up moments
Fig. 6
Fig. 6
a Observer scar scores as part of the total POSAS score are displayed for hypertrophic scars at baseline and five follow-up moments: 1–3 months, 3–4 months, 4–6 months, 6–12 months, and >12 months. Scars were rated on a ten-step scale. Braces indicate a statistical significant (P < 0.05) difference between follow-up moments. b. Observer scar scores as part of the total POSAS score are displayed for hypertrophic scars at baseline and five follow-up moments: 1–3 months, 3–4 months, 4–6 months, 6–12 months, and >12 months. Scars were rated on a ten-step scale. Braces indicate a statistical significant (P < 0.05) difference between follow-up moments
Fig. 7
Fig. 7
A 42-year-old male patient with multiple keloids at the start of the injection scheme
Fig. 8
Fig. 8
The same 42-year-old male patient after patient completing the full injection scheme 7 weeks later
See this image and copyright information in PMC

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