title: The treatment of keloids and hypertrophic scars with intralesional bleomycin in skin of color.
abstract: Intralesional injection with corticosteroid remains the mainstay of therapy for hypertrophic scars and keloids, however some lesions are unresponsive or may result in skin atrophy. Intralesional bleomycin injection is an alternative therapy that has been widely reported. In order to compare the effectiveness and safety of bleomycin for the treatment of keloids and hypertrophic scars in skin of color population, Fitzpatrick skin type III to V patients with keloids or hypertrophic scars were randomized into two groups. Group A was treated monthly with intralesional triamcinolone acetonide (10 mg/mL), while group B with intralesional bleomycin (1 mg/mL) for three consecutive months. Evaluation of the treatment was performed using "Patient and Observer Scar Assessment Scale" (POSAS), self-rated patient satisfaction score, photography, and ultrasonography. Two patients had their bleomycin blood levels monitored. Twenty-six patients with keloids or hypertrophic scars were recruited. The clinical improvement as assessed by the POSAS was not statistically significant. In terms of patients satisfaction score, one half of both groups reported a very good improvement. Photographic as well as ultrasonographic evaluation showed no difference between the two groups. Bleomycin was found to enter the blood circulation in a very small amount. The major side effect was hyperpigmentation. There was no skin atrophy detected in this study. Intralesional bleomycin is a safe and effective treatment for keloids and hypertrophic scars. The treatment is comparable to intralesional triamcinolone. Unfortunately, hyperpigmentation was the major side effect in darker skin type.
authors: Division of Dermatology, Department of Medicine, Phramongkutklao Hospital, Bangkok, Thailand.
authors: Kittisak
authors: K
authors: Payapvipapong
authors: Nucha
authors: N
authors: Niumpradit
authors: Chotinand
authors: C
authors: Piriyanand
authors: Sawanya
authors: S
authors: Buranaphalin
authors: Artit
authors: A
authors: Nakakes
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055815:Young Adult; D001761:Bleomycin / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use; D017439:Cicatrix, Hypertrophic / Q000188:drug therapy; D003879:Dermatologic Agents / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use; D015552:Injections, Intralesional; D007627:Keloid / Q000188:drug therapy; D011446:Prospective Studies; D016037:Single-Blind Method; D012869:Skin Absorption; D000091762:Ethnic and Racial Minorities
chemical_list: D001761:Bleomycin; D003879:Dermatologic Agents
keywords: bleomycin; keloid; scar