Efficacy of Intralesional 5-fluorouracil and Triamcinolone in the Treatment of Keloids

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Joseph H. Dayan, MD, Steven P. Davison, DDS, MD,
Smitha Sonni, MD, Amy Crane, MD

BACKGROUND: Keloids are a common problem with a reported incidence of 4.5 to

16 percent in darker-skinned individuals.^{1, 2}  Intralesional triamcinolone has traditionally been the mainstay of treatment and in conjunction with excision has yielded efficacy rates between 58% and 93%.^3-7  However there are a significant number of treatment failures and substantial inconsistencies with regard to the reproducibility of results.    Additionally, adverse effects including hypopigmentation, atrophy, and telangiectasias have been reported to be as high as 37% in the literature.⁸  The purpose of this study is to evaluate the efficacy and adverse effects of a 5-fluorouracil/steroid mixture over the past seven years and compare the results with steroid alone.

METHODS: All charts from 1999 to 2006 were reviewed. Patients were stratified into

three groups: 5-FU/steroid without surgical excision, 5-FU/steroid with excision, and

steroid with excision. The follow-up period ranged from 6 months to 6 years. Percentage

size reduction and adverse effects including telangiectasia, atrophy, hypopigmentation, and dehiscence were recorded.  A mixture of 75% 5-FU and 25% Kenolog 40 was most commonly used.  0.1 ml of solution per centimeter of lesion was injected.  Patients undergoing concurrent excision received injections intraoperatively and again at 2, 4, and 6 weeks post-op.  Non-surgical patients received injections an average of four weeks apart.

RESULTS: A total of 94 patients with 102 keloids were identified. Patients who

underwent excision with the 5-FU/steroid combination had a 92% average reduction in

lesion size compared to 73% in the group of patients who did not receive 5-FU. Patients

who received 5-FU/steroid without excision had an average size reduction of 81%. These

differences were statistically significant (p = 0.05). Adverse effects were higher in the

5-FU groups compared with the steroid only group (23% and 15%, respectively),

although these results were not statistically significant (p = 0.62).   The most common side effect was telangiectasia.

CONCLUSIONS: Although this study is limited by its retrospective nature, the results in this study, the supporting basic science data, and anecdotal reports suggest combination 5-FU/triamcinolone may be superior in efficacy compared to intralesional steroid therapy.^9-16  The successes of 5-FU in those particularly intractable keloid cases where steroids have failed is significant.  Interestingly, the side effect profile was not lower in the 5-FU group.  However, we speculate the telangiectasias and atrophy were likely caused by the steroid component.  Thus, we are prospectively studying the effects of 5-FU with a lower triamcinolone dose.  Long-term prospective trials using anti-neoplastic agents are needed to properly establish an ideal treatment regimen for this challenging problem.