Document Detail

Treatment response of keloidal and hypertrophic sternotomy scars: comparison among intralesional corticosteroid, 5-fluorouracil, and 585-nm flashlamp-pumped pulsed-dye laser treatments.
MedLine Citation:
PMID:  12224975     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To compare the clinical response of keloidal and hypertrophic scars after treatment with intralesional corticosteroid alone or combined with 5-fluorouracil (5-FU), 5-FU alone, and the 585-nm flashlamp-pumped pulsed-dye laser (PDL). DESIGN: Prospective, paired-comparison, randomized controlled trial. SETTING: A private ambulatory laser facility. PATIENTS: Ten patients with previously untreated keloidal or hypertrophic median sternotomy scars at least 6 months after surgery that were considered problematic by the patients. INTERVENTIONS: Five segments were randomly treated with 4 different regimens: (1) laser radiation with a 585-nm PDL (5 J/cm(2)); (2) intralesional triamcinolone acetonide (TAC) (20 mg/mL); (3) intralesional 5-FU (50 mg/mL); and (4) intralesional TAC (1 mg/mL) mixed with 5-FU (45 mg/mL). One segment of each scar received no treatment and served as a control. MAIN OUTCOME MEASURES: Scar height, erythema, and pliability were evaluated before and every 8 weeks after treatment. Patients' subjective evaluations were tabulated. Histologic sections of segments were examined in 1 biopsy sample per segment at week 32. RESULTS: There was a statistically significant clinical improvement in all treated segments. No significant difference in treatment outcome vs method of treatment was noted. However, intralesional formulas resulted in faster resolution than the PDL: scar induration responded better to intralesional formulas, scar texture responded better to the PDL, and scar erythema responded the same as the control with all treatments. Adverse sequelae, including hypopigmentation, telangiectasia, and skin atrophy, were observed in 50% (5/10) of the segments that received corticosteroid intralesionally alone. No long-term adverse sequelae were demonstrated in the segments treated with other modalities. CONCLUSIONS: Clinical improvement of keloidal and hypertrophic scars after treatment with intralesional corticosteroid alone or combined with 5-FU, 5-FU alone, and PDL seemed comparable, with the exceptions of the incidence of adverse reactions, which were most common with intralesional corticosteroid. Intralesional 5-FU is comparable to the other therapies.
Woraphong Manuskiatti; Richard E Fitzpatrick
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Archives of dermatology     Volume:  138     ISSN:  0003-987X     ISO Abbreviation:  Arch Dermatol     Publication Date:  2002 Sep 
Date Detail:
Created Date:  2002-09-12     Completed Date:  2002-10-16     Revised Date:  2008-03-17    
Medline Journal Info:
Nlm Unique ID:  0372433     Medline TA:  Arch Dermatol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1149-55     Citation Subset:  AIM; IM    
Dermatology Associates and Cosmetic Laser Associates of San Diego County Inc, 9850 Genesee Ave, Suite 480, La Jolla, CA 92037, USA.
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MeSH Terms
Adrenal Cortex Hormones / administration & dosage*
Biopsy, Needle
Cicatrix, Hypertrophic / drug therapy*,  pathology,  radiotherapy*
Drug Therapy, Combination
Fluorouracil / administration & dosage*
Follow-Up Studies
Injections, Intralesional
Keloid / drug therapy*,  etiology,  pathology,  radiotherapy*
Laser Therapy, Low-Level / methods*
Middle Aged
Prospective Studies
Reference Values
Sensitivity and Specificity
Statistics, Nonparametric
Sternum / surgery
Thoracotomy / adverse effects,  methods
Treatment Outcome
Wound Healing / physiology
Reg. No./Substance:
0/Adrenal Cortex Hormones; 51-21-8/Fluorouracil

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