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. 2019 Mar 14:12:173-180.
doi: 10.2147/CCID.S191137. eCollection 2019.

Topical 5 fluorouracil cream vs combined 5 fluorouracil and fractional erbium YAG laser for treatment of severe hypertrophic scars

Abeer Attia Tawfik  1 , Maha Fathy  2 , Ashraf Badawi  1   3 , Noha Abdallah  1 , Hisham Shokeir  1
Affiliations

Topical 5 fluorouracil cream vs combined 5 fluorouracil and fractional erbium YAG laser for treatment of severe hypertrophic scars

Abeer Attia Tawfik et al. Clin Cosmet Investig Dermatol. .

Abstract

Background: Topical 5 fluorouracil (5-FU) has been reported as one of the standard treatments for hypertrophic scars (HTS). Ablative fractional laser was found to have promising results in the delivery of topical drugs into the skin by creating vertical channels through which the drugs can penetrate the skin. So far there have been no comparative studies performed to compare both modalities in the same patient and same anatomical region, especially in severe HTS.

Objective: The aim of this study was to compare the effectiveness of topical 5-FU and combined topical 5-FU and laser in treating severe HTS.

Patients and methods: Twenty-four severe HTS lesions were treated by 5-FU monotherapy and 5-FU combined with ablative fractional erbium YAG laser. Each lesion was divided into two parts. One part was treated with topical 5-FU twice weekly for 8 months. The other part was treated with combined topical 5-FU and ablative fractional erbium YAG laser once per month for 8 months. The scars' improvement was evaluated by Vancouver scar scale (VSS) and skin analysis camera.

Results: The assessment by VSS showed a significant reduction in the mean height, pliability, and vascularity of the lesions which were treated with combined approaches compared to 5-FU monotherapy. Pain and ulceration occurred at a higher rate in the combination therapy group.

Conclusion: Treatment of severe HTS with combined 5-FU and ablative fractional erbium YAG laser is more effective than 5-FU alone.

Keywords: 5-FU; fractional erbium YAG laser; fractional lasers; hypertrophic scars; scar management; skin ablation; transcutaneous drug delivery; wound healing.

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Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Comparison between 5-FU alone and laser + 5-FU according to percentage of improvement in vascularity, pigmentation, pliability, and height. Abbreviation: 5-FU, 5 fluorouracil.
Figure 2
Figure 2
This male patient presented with a post-traumatic scar. Note: The upper part was treated with 5-FU monotherapy and lower part with combined approach. Abbreviation: 5-FU, 5 fluorouracil.
Figure 3
Figure 3
This male patient presented with a post-traumatic scar. Note: The upper part was treated with combined approach and lower part with 5-FU monotherapy. Abbreviation: 5-FU, 5 fluorouracil.
Figure 4
Figure 4
Comparison photos: the upper part was treated with 5-FU monotherapy and the lower part was treated with the combined approach Note: The combined approach showed better improvement, as seen in the middle and lower photos. Abbreviation: 5-FU, 5 fluorouracil.
Figure 5
Figure 5
A photo taken by the Antera skin analysis camera of a hypertrophic scar on the face of a child before treatment (A), and after treatment (B). The upper part appears slightly elevated after treatment with 5-FU monotherapy while the lower part appears flattened after combined the approach. Abbreviation: 5-FU, 5 fluorouracil.
See this image and copyright information in PMC

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