From the Research
For keloid injections, a combination of intralesional triamcinolone acetonide and 5-fluorouracil is the most effective treatment, offering a balanced benefit of faster and more efficacious response with lesser adverse effects compared to individual drugs. This treatment approach is supported by a study published in 2017 1, which compared the efficacy of triamcinolone acetonide, 5-fluorouracil, and their combination in the treatment of keloids. The results showed that the combination of triamcinolone acetonide and 5-fluorouracil resulted in faster and more significant improvement in keloid height, vascularity, and pliability, with fewer adverse effects.
The typical concentration of triamcinolone acetonide used in keloid injections ranges from 10-40 mg/mL, with injections administered directly into the keloid every 3-4 weeks until adequate response is achieved, usually requiring 3-5 sessions. The medication should be injected into the body of the keloid until blanching occurs, using a 27-30 gauge needle. This treatment works by suppressing inflammation, reducing collagen synthesis, and increasing collagen breakdown within the keloid tissue.
Some key points to consider when using this treatment approach include:
- The combination of triamcinolone acetonide and 5-fluorouracil may be more effective than individual drugs, but it also increases the risk of adverse effects such as skin atrophy, hypopigmentation, and telangiectasia.
- The efficacy of this treatment approach may vary depending on the size, location, and age of the keloid, with older and larger keloids typically requiring more aggressive treatment.
- Pain during injection can be managed with topical anesthetics applied 30-60 minutes before the procedure.
- Treatment success can be assessed using the patient and observer scar assessment scale (POSAS) or the Vancouver Scar Scale (VSS).
Other studies have also investigated the efficacy of different intralesional injections in the treatment of keloids, including verapamil 2, platelet-rich plasma 3, and botulinum toxin type A 4. However, the combination of triamcinolone acetonide and 5-fluorouracil remains the most effective treatment approach, with the most recent and highest quality study supporting its use 1.