COMPARISON OF EFFICACY OF INTRALESIONAL 5- FLUOROURACIL PLUS TRIAMCINOLONE ACETONIDE VERSUS INTRALESIONAL TRIAMCINOLONE ACETONIDE IN THE TREATMENT OF KELOID

Abstract

Background: Keloids represent a therapeutic challenge due to their aberrant fibroproliferative scars and high recurrence rates even after standard intralesional triamcinolone acetonide monotherapy.

Objective: The efficacy and safety of intralesional TAC plus 5-FU was compared to TAC alone for symptomatic keloid lesions.

Methods: This prospective, single-center comparative cohort study enrolled 200 patients (aged 20-50 years) with keloids (1-5 cm, >3 months duration) at the Department of Dermatology, Combined Military Hospital Abbottabad, Pakistan. Patients received TAC monotherapy (40 mg/mL; Group A, n=100) or TAC (40 mg/mL) + 5-FU (50 mg/mL; 1:1 ratio; Group B, n=100) every 3 weeks for up to 6 sessions. Primary outcomes were changes in Vancouver Scar Scale (VSS) scores and keloid volume at 12 and 24 weeks; secondary outcomes included visual analog scale (VAS) symptom scores, response rates (≥50% reduction), recurrence (>25% regrowth), and adverse events.

Results: Baseline characteristics were comparable except keloid duration (longer in Group A). At 24 weeks, Group B showed superior VSS reduction (5.1 vs. 3.5 points; p<0.001), volume decrease (73.9% vs. 55.8%; p<0.001), and VAS resolution (0 vs. 2.2; p<0.001), with higher response rates (89% vs. 69%; p=0.001) and lower recurrence (12% vs. 24%; p=0.042). Adverse events were mild and similar (23% vs. 20%; p=0.731).

Conclusion: TAC + 5-FU intralesional injection is more effective and long-lasting than intralesional injections of TAC alone for keloids, with no diminished safety. This regimen deserves application as first-line management in resource-constrained settings pending multicenter validation.