From the FDA Drug Label
Triamcinolone Acetonide Ointment is indicated for the relief of the inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses. The FDA drug label does not answer the question.
From the Research
Triamcinolone acetonide in combination with 5-fluorouracil is the most effective treatment for keloid scars, as it provides a faster response rate and fewer complications compared to triamcinolone acetonide alone. The standard approach involves injecting the medication directly into the keloid at intervals of 2-6 weeks until adequate response is achieved. The dose of triamcinolone acetonide should be limited to 20-40 mg per session, and 5-fluorouracil should be used at a concentration of 25 mg/mL 1. For optimal results, the injection should be delivered into the body of the keloid rather than superficially, using a 27-30 gauge needle.
Mechanism of Action
Triamcinolone acetonide works by suppressing inflammation and inhibiting fibroblast proliferation, which reduces collagen synthesis in the keloid tissue. This leads to softening and flattening of the raised scar. 5-fluorouracil, on the other hand, inhibits thymidylate synthase, leading to a decrease in DNA synthesis and cell proliferation. The combination of both medications provides a synergistic effect, resulting in improved outcomes.
Potential Side Effects
Potential side effects of triamcinolone acetonide include skin atrophy, hypopigmentation, telangiectasia, and pain at the injection site. 5-fluorouracil can cause additional side effects such as ulceration, scarring, and hyperpigmentation. However, the combination of both medications has been shown to have fewer complications compared to triamcinolone acetonide alone 1.
Treatment Duration
Treatment should be continued until satisfactory flattening occurs or side effects become concerning. The response to treatment can be variable, with some patients experiencing significant improvement after a few sessions, while others may require multiple injections over several months. Regular follow-up appointments are necessary to monitor the response to treatment and adjust the treatment plan as needed.
Comparison with Other Treatments
Other treatments for keloid scars, such as surgical excision, cryotherapy, and laser therapy, may be considered in resistant cases or in combination with intralesional injections. However, these treatments may have higher recurrence rates and more significant side effects compared to intralesional injections of triamcinolone acetonide and 5-fluorouracil 2, 3, 4, 5.
In summary, the combination of triamcinolone acetonide and 5-fluorouracil is the most effective treatment for keloid scars, providing a faster response rate and fewer complications compared to triamcinolone acetonide alone. This treatment approach should be considered as the first-line treatment for keloid scars, with other treatments reserved for resistant cases or in combination with intralesional injections.