Intralesional Chemotherapy / Cytotoxic Drugs

Compare To Other Treatments

What Is It?

This treatment consists of injecting a chemotherapeutic drug directly into a raised scar, which helps reduce the size of the scar.

The two most commonly used chemotherapeutic agents are 5-fluorouracil (5-FU) and bleomycin.

This procedure is normally repeated multiple times (4-16) in 2-week intervals. You should see gradual results with each session. After your last session, the treatment continues working. The appearance of the scar normally continues to improve over the coming year or longer. However, in some cases, scars may grow back after treatment.

Good or Excellent Response

Strength of Evidence
1
2
3
4
5
64% of patients achieved a good (>50%) or excellent (>75%) improvement in scarring

Scar Height Reduction

Strength of Evidence
1
2
3
4
5
Average 57% reduction in scarring

Scar Volume Reduction

Strength of Evidence
1
2
3
4
5
Average 57% reduction in scarring

Success Rate

Strength of Evidence
1
2
3
4
5
Average 66% reduction in scarring

Mean improvement in VSS total score

Strength of Evidence
1
2
3
4
5
Average 69% reduction in scarring

Mean improvement in VSS pigmentation score

Strength of Evidence
1
2
3
4
5
Average 66% reduction in scarring

Mean improvement in VSS height score

Strength of Evidence
1
2
3
4
5
Average 87% reduction in scarring

Mean improvement in VSS pliability score

Strength of Evidence
1
2
3
4
5
Average 86% reduction in scarring

Mean improvement in VSS vascularity score

Strength of Evidence
1
2
3
4
5
Average 70% reduction in scarring
▸ Based on These Clinical Studies & Trials
▾ Based on These Clinical Studies & Trials
  1. Mishra, B. & Arora, C. Role of intralesional bleomycin in recurrent or residual keloids and hypertrophic scars. Int Surg J 8, 575 (2021).
  2. Ismail, S. A., Mohammed, N. H. K., Sotohy, M. & Abou-Taleb, D. A. E. Botulinum toxin type A versus 5-Fluorouracil in treatment of keloid. Arch Dermatol Res 313, 549–556 (2021).
  3. Manzoor, H., Tahir, K., Nasir, A., Mufti, S. & Shehzad, A. Comparison of efficacy of intralesional 5-fluorouracil alone, intralesional triamcinolone acetonide alone and intralesional triamcinolone acetonide with 5-fluorouracil in management of keloids. Journal of Pakistan Association of Dermatologists 30, 282–285 (2020).
  4. Ismail, S. A., Mohammed, N. H. K., Sotohy, M. & Abou-Taleb, D. A. E. Botulinum toxin type A versus 5-fluorouracil in treatment of keloid. Arch Dermatol Res (2020) doi:10.1007/s00403-020-02132-8.
  5. Teplyi, V. & Grebchenko, K. The usage of radiofrequency ablation for treatment of keloids and hypertrophic scars. Probl Radiac Med Radiobiol 24, 561–573 (2019).
  6. Khan, H. A., Sahibzada, M. N. & Paracha, M. M. Comparison of the efficacy of intralesional bleomycin versus intralesional triamcinolone acetonide in the treatment of keloids. Dermatol Ther 32, e13036 (2019).
  7. Huu, N. D. et al. Successful treatment of intralesional bleomycin in keloids of Vietnamese population. Open Access Maced J Med Sci 7, 298–299 (2019).
  8. Hietanen, K. E. et al. Treatment of keloid scars with intralesional triamcinolone and 5-fluorouracil injections - a randomized controlled trial. J Plast Reconstr Aesthet Surg 72, 4–11 (2019).
  9. Srivastava, S., Patil, A., Prakash, C. & Kumari, H. intralesional triamcinolone acetonide, 5-fluorouracil, and their combination in treatment of keloids. World J Plast Surg 7, 212–219 (2018).
  10. Azimi Alamdari, H., Davarnia, G., Herizchi Ghadim, H. & Asal, S. Intralesional cryotherapy versus intralesional corticosteroid and 5-fluorouracil in the treatment of hypertrophic scars and keloids: a clinical trial. Crescent Journal of Medical and Biological Sciences 5, 215–221 (2018).
  11. Sagheer, A., Shehzad, A. & Hussain, I. Comparison of efficacy of intralesional 5-fluorouracil alone versus intralesional triamcinolone acetonide with 5-fluorouracil in small keloids. J Pak Assoc Dermatol 26, 361–365 (2016).
  12. Kabel, A. M., Sabry, H. H., Sorour, N. E. & Moharm, F. M. Comparative study between intralesional injection of bleomycin and 5-fluorouracil in the treatment of keloids and hypertrophic scars. Journal of Dermatology & Dermatologic Surgery 20, 32–38 (2016).
  13. Sudulagunta, S., Kumar, B., Khorram, H., Babu, S. & Sepehrar, M. Comparison of combined intralesional triamcinolone and 5-fluorouracil versus bleomycin in keloids. International Journal of Advances in Health Sciences (IJHS) 285–289 (2015).
  14. Payapvipapong, K., Niumpradit, N., Piriyanand, C., Buranaphalin, S. & Nakakes, A. The treatment of keloids and hypertrophic scars with intralesional bleomycin in skin of color. J Cosmet Dermatol 14, 83–90 (2015).
  15. Sharma, S., Bassi, R. & Gupta, A. Treatment of small keloids with intralesional 5-fluorouracil alone vs. intralesional triamcinolone acetonide with 5-fluorouracil. J Pak Assoc Dermatol 22, 35–40 (2012).
  16. Saha, A. K. & Mukhopadhyay, M. A comparative clinical study on role of 5-flurouracil versus triamcinolone in the treatment of keloids. Indian J Surg 74, 326–329 (2012).
  17. Sadeghinia, A. & Sadeghinia, S. Comparison of the efficacy of intralesional triamcinolone acetonide and 5-fluorouracil tattooing for the treatment of keloids. Dermatol Surg 38, 104–109 (2012).
  18. Prabhu, A., Sreekar, H., Powar, R. & Uppin, V. M. A randomized controlled trial comparing the efficacy of intralesional 5-fluorouracil versus triamcinolone acetonide in the treatment of keloids. Journal of the Scientific Society 39, 19 (2012).
  19. Haurani, M. J., Foreman, K., Yang, J. J. & Siddiqui, A. 5-Fluorouracil treatment of problematic scars. Plast Reconstr Surg 123, 139–148 (2009).
  20. Aggarwal, H., Saxena, A., Lubana, P. S., Mathur, R. K. & Jain, D. K. Treatment of keloids and hypertrophic scars using bleomycin. J Cosmet Dermatol 7, 43–49 (2008).
  21. Saray, Y. & Güleç, A. T. Treatment of keloids and hypertrophic scars with dermojet injections of bleomycin: a preliminary study. Int J Dermatol 44, 777–784 (2005).
  22. Kontochristopoulos, G. et al. Intralesional 5-fluorouracil in the treatment of keloids: an open clinical and histopathologic study. J Am Acad Dermatol 52, 474–479 (2005).
  23. Manuskiatti, W. & Fitzpatrick, R. E. Treatment response of keloidal and hypertrophic sternotomy scars: comparison among intralesional corticosteroid, 5-fluorouracil, and 585-nm flashlamp-pumped pulsed-dye laser treatments. Arch Dermatol 138, 1149–1155 (2002).
  24. Gupta, S. & Kalra, A. Efficacy and safety of intralesional 5-fluorouracil in the treatment of keloids. Dermatology 204, 130–132 (2002).
  25. España, A., Solano, T. & Quintanilla, E. Bleomycin in the treatment of keloids and hypertrophic scars by multiple needle punctures. Dermatol Surg 27, 23–27 (2001).

Side Effects

Medium-High
Medium-high side effects and adverse reactions

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