Unlocking Better Keloid Treatment: Corticosteroid, 5-Fluorouracil, and Hyaluronidase vs. Corticosteroid Alone - A Randomized Comparative Study

Abstract

Background and aims: Keloids are challenging lesions to manage due to their resistance to treatment and high recurrence rates. This study evaluated the efficacy of an intralesional injection combining triamcinolone acetonide, 5-fluorouracil, and hyaluronidase compared with triamcinolone monotherapy in treating keloids.

Methods: This single-blinded clinical trial involved 16 participants, block-randomized into two groups. The intervention group received intralesional injections of triamcinolone acetonide (0.2 cc of 40 mg/cc solution), 5-fluorouracil (0.4 cc of 250 mg/5cc vial), and hyaluronidase (0.2 cc equivalent to 300 IU). The control group received triamcinolone acetonide (0.2 cc of 40 mg/cc solution) with 0.6 cc lidocaine of 2%. Keloid characteristics were assessed before treatment, after three injections at 3-4-week intervals, and 2 months posttreatment.

Results: Significant improvements were observed in both groups. However, the intervention group showed greater reductions in lesion height, pliability, and modified Vancouver scar scale scores compared to the control group. No complications resulted from our interventional injection during the study period, while telangiectasia occurred with triamcinolone monotherapy.

Conclusion: These findings suggest that triple therapy was as effective as steroid monotherapy, with better outcomes in specific aspects of scar improvement and without side effects. Hyaluronidase could be promising for further research in this area.

Keywords: 5‐fluorouracil; corticosteroids; hyaluronidase; hypertrophic scar; keloid.