Intralesional Corticosteroids with 5-FU

Compare To Other Treatments

Raised and keloid scars are raised scars containing excessive collagen, or in other words, scars that are caused by an overgrowth of collagen. 

Intralesional corticosteroid with intralesional 5-Fluorouracil (5-FU) treatment consists of simultaneously injecting the combination of these two drugs directly into the scar (“intralesionally”).1,2 

The treatment can be painful and often requires multiple (4-8) sessions. 

These drugs carry a lower risk of side effects compared to some other raised scar treatments such as radiotherapy.1-4

Corticosteroids are synthetic (made in a laboratory) drugs that work similarly to natural human hormones. When they are injected into raised scars, they may help reduce scar size by:

  • Stimulating collagen breakdown
  • Decreasing collagen production
  • Decreasing fibroblasts (cells that produce collagen)
  • Reducing inflammation (which is what led to scar formation in the first place)5

The addition of 5-FU, which is a type of drug called a cytotoxic drug (“toxic to cells”), contributes further to the reduction of raised and keloid scars. Raised scars are somewhat similar to benign (non-cancerous) tumors. In cancer treatment, cytotoxic drugs are used to kill tumor cells. When it comes to raised scars, the cytotoxic agent 5-FU works by killing or slowing the production of fibroblasts (cells that make collagen) in scarred skin. Fewer fibroblasts should lead to less collagen production and a smaller and flatter scar.6

Because this combination is relatively safe and inexpensive, intralesional corticosteroids with 5-FU is often used for raised and keloid scars.

As with all scar revision treatments, the combination of intralesional corticosteroids with 5-FU is sometimes combined with other scar revision procedures to achieve the desired results.

Before agreeing to undergo intralesional corticosteroids with 5-FU treatment, discuss your options, expected outcomes, and prices with multiple doctors.

Procedure details:

Before administering the corticosteroid with 5-FU, the doctor will clean (disinfect) the scar. 

The most commonly used intralesional corticosteroid for raised and keloid scar treatment is triamcinolone. Triamcinolone is combined with 5-FU and injected into the middle of the dermis, the deeper skin layer that is still intact underneath the raised scar.1-4 Injecting the drug into the middle of the dermis also reduces the chances of skin thinning (atrophy), which can be a side effect of intralesional corticosteroids with 5-FU treatment.1-4,8

Corticosteroid_Injection

Depending on the extent of the scarring, the doctor may adjust several factors in intralesional corticosteroid with 5-FU treatment:

  • Number of treatment sessions: Larger scars require more sessions than smaller scars. In general, multiple sessions (up to 8) are necessary. If there is no improvement at all after 4 treatment sessions, treatment is normally stopped.
  • Time between treatment sessions: This varies from 1 to 6 weeks, but is usually 1 week.
  • Dose: Typical doses of corticosteroids are 10-20 mg/ml, but can be as high as 40 mg/ml for very thick scars. The doctor must weigh the efficacy of the treatment, which tends to increase with a higher dose, against the risk of side effects, which also increases with a higher dose. When it comes to 5-FU, most doctors administer 25-150 mg of 5-FU per session, once again depending on the size and thickness of the scar.1-4

Anesthesia:

Before the treatment, the doctor may numb the scar by:

  • Mixing the corticosteroid and 5-FU with an anesthetic in the same syringe
  • Injecting a local anesthetic prior to the procedure
  • Applying a topical numbing cream 30 to 60 minutes prior to the procedure

Before-and-after:

Intralesional-Corticosteroids-with-Intralesional-5-Fluorouracil-1

A keloid scar before and 18 months after 8 treatments with intralesional corticosteroids and 5-FU.

References
  1. Khalid FA, Mehrose MY, Saleem M, Yousaf MA, Mujahid AM, Rehman SU, Ahmad S, Tarar MN. Comparison of efficacy and safety of intralesional triamcinolone and combination of triamcinolone with 5-fluorouracil in the treatment of keloids and hypertrophic scars: Randomised control trial. Burns. 45(1), 69-75 (2019).
  2. Hietanen KE, Järvinen TA, Huhtala H, Tolonen TT, Kuokkanen HO, Kaartinen IS. Treatment of keloid scars with intralesional triamcinolone and 5-fluorouracil injections – a randomized controlled trial. J Plast Reconstr Aesthet Surg. 72(1), 4-11 (2019).
  3. Alamdari, H. A., Davarnia, G., Ghadim, H. H., & Sadri, A. Intralesional Cryotherapy Versus Intralesional Corticosteroid and 5-Fluorouracil in the Treatment of Hypertrophic Scars and Keloids: A Clinical Trial. Crescent Journal of Medical & Biological Sciences, 5(3) (2018).
  4. Srivastava, S., Patil, A. N., Prakash, C., & Kumari, H. Comparison of intralesional triamcinolone acetonide, 5-fluorouracil, and their combination for the treatment of keloids. Advances in Wound Care, 6(11), 393-400 (2017).
  5. Darzi MA, Chowdri NA, Kaul SK, and Khan M. Evaluation of various methods of treating keloids and hypertrophic scars: a 10-year follow-up study. Br J Plast Surg. 45(5), 374-9 (1992).
  6. Khan MA, Bashir MM, Khan FA. Intralesional triamcinolone alone and in combination with 5-fluorouracil for the treatment of keloid and hypertrophic scars. J Pak Med Assoc. 64(9), 1003-7 (2014).
  7. Ledon JA, Savas J, Franca K, Chacon A, and Nouri K. Intralesional treatment for keloids and hypertrophic scars: a review. Dermatol Surg. 39(12), 1745-57 (2013).
  8. Levy LL, and Zeichner JA. Management of acne scarring, part II. A comparative review of non-laser-based, minimally invasive approaches. Am J Clin Dermatol. 13(5), 331-340 (2012).
  9. A. Darougheh, A. Asilian, F. Shariati, Intralesional triamcinolone alone or in combination with 5‐fluorouracil for the treatment of keloid and hypertrophic scars, Clinical and Experimental Dermatology, 34 (2), 219–23 (2020).

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