Treatment response of keloidal and hypertrophic sternotomy scars: comparison among intralesional corticosteroid, 5-fluorouracil, and 585-nm flashlamp-pumped pulsed-dye laser treatments.
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).


METHODS
Prospective, paired-comparison, randomized controlled trial.


METHODS
A private ambulatory laser facility.


METHODS
Ten patients with previously untreated keloidal or hypertrophic median sternotomy scars at least 6 months after surgery that were considered problematic by the patients.


METHODS
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.


METHODS
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.
Manuskiatti
Woraphong
W
Dermatology Associates and Cosmetic Laser Associates of San Diego County Inc, 9850 Genesee Ave, Suite 480, La Jolla, CA 92037, USA.
Fitzpatrick
Richard E
RE
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000328:Adult; D000368:Aged; D001707:Biopsy, Needle; D017439:Cicatrix, Hypertrophic / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D004359:Drug Therapy, Combination; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage*; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D015552:Injections, Intralesional; D007627:Keloid / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology / Q000532:radiotherapy*; D028022:Low-Level Light Therapy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011336:Probability; D011446:Prospective Studies; D012016:Reference Values; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D013249:Sternum / Q000601:surgery; D013908:Thoracotomy / Q000009:adverse effects / Q000379:methods; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology
D000305:Adrenal Cortex Hormones; D005472:Fluorouracil