Intralesional Corticosteroids with 5-FU

Compare To Other Treatments

The charts below show the chances of developing various side effects from intralesional corticosteroids with 5-FU.1-4 It should be noted that the side effects are dose-dependent. In other words, the risk of side effects increases with the dose of corticosteroids and 5-FU.

Certain/Likely Side Effects (% = Incidence)

SHORT TERM Mild to moderate pain during injectionup to 100%
LONG TERM Spider veins (telangiectasia)up to 50%
SHORT TERM or LONG TERM Thinning of the skin (skin atrophy)*up to 44%
SHORT TERM Shallow open sore (superficial ulceration) at the injection siteup to 20%

*Thinning of the skin (atrophy): Thinning of the skin after intralesional corticosteroid with 5-FU therapy makes the skin look sunken in, and usually resolves between 6 months to 1 year after treatment. However, in some cases, it may take longer to resolve.

Possible Side Effects

SHORT TERM or LONG TERM Skin darkening (hyperpigmentation)up to 5.3%

Studies:   

Four studies have looked at the side effects of intralesional corticosteroid with 5-FU treatment.

  • Study 1:

    • Authors: Hietanen et al.1
    • Total # of patients: 25
    • # of female patients: 14
    • # of male patients: 11
    • Age of patients: 18-77, Average: 41
    • Dose: 20 mg/ml of triamcinolone mixed with 50 mg/ml of 5-FU per session
    • Duration of treatment and follow-up: 3 treatments, follow-up for 6 months
    • Side effects:
      • Spider veins (telangiectasia): 50%
      • Thinning of the skin (skin atrophy): 44%
  • Study 2:

    • Authors: Srivastava et al.2
    • Total # of patients: 20
    • # of female patients: 12
    • # of male patients: 8
    • Age of patients: Average: 27
    • Dose: 40 mg/ml of triamcinolone with 50 mg/ml of 5-FU per session
    • Duration of treatment and follow-up: 8 treatments, follow-up for 30 weeks
    • Side effects:
      • Mild to moderate pain during injection: 34%
      • Shallow open sore (superficial ulceration) at injection site: 20%
      • Skin atrophy (thinning of the skin): 10%
      • Telangiectasia (spider veins): 5%
  • Study 3:

    • Authors: Khalid et al.3
    • Total # of patients: 57
    • # of female patients: (not reported)
    • # of male patients: (not reported)
    • Age of patients: Average: 26
    • Dose: 4 mg of triamcinolone with 45 mg of 5-FU per session
    • Duration of treatment and follow-up: 8 treatments, follow-up for 22 months
    • Side effects:
      • Recurrence: 17.5%
      • Shallow open sore (superficial ulceration) at injection site: 8.8%
      • Hyperpigmentation (skin darkening): 5.3%
      • Telangiectasia (spider veins): 3.5%
  • Study 4:

    • Authors: Darougheh et al.4
    • Total # of patients: 17
    • # of female patients: (not reported)
    • # of male patients: (not reported)
    • Age of patients: 5-70
    • Dose: 4 mg of triamcinolone with 45 mg of 5-FU per session
    • Duration of treatment and follow-up: 8 treatments, follow-up for 12 weeks
    • Side effects:
      • Pain: 100%

Study 1: In a study published in 2019 in the Journal of Plastic, Reconstructive & Aesthetic Surgery, Hietanen and colleagues treated 25 patients with keloids and hypertrophic scars with intralesional triamcinolone and 5-FU. The patients received 8 injections at 1-week intervals. All patients received 20 mg/ml of triamcinolone mixed with 50 mg/ml of 5-FU. The researchers regularly followed the patients for 6 months. Spider veins were reported in half of the patients, while skin atrophy (thinning) was a side effect in 44% of the treated patients.1

Study 2: In a study published in 2017 in the journal Advances in Wound Care, Srivastava and colleagues treated 20 patients with keloid scars with intralesional triamcinolone and 5-FU. The patients received 40 mg/ml of triamcinolone with 50 mg/ml of 5-FU every 3 weeks for 8 sessions and were followed for an additional 6 weeks. Side effects were rare and included mild-to-moderate pain during the injection (34%), shallow open sore (superficial ulceration) at the injection site (20%), thinning of the skin (10%), and spider veins (5%).2

Study 3: In a study published in 2018 in the journal Burns, Khalid and colleagues treated 57 patients with keloids and hypertrophic scars with intralesional triamcinolone and 5-FU. The patients received 4 mg of triamcinolone and 45 mg of 5-FU every week for 8 sessions and were followed for an additional 22 months. Darkening of the skin, spider veins, and shallow open sore (superficial ulceration) at the injection site were rare side effects. However, 17.5% of patients reported recurrence of scars. The mean time of scar recurrence was 10 months, but they could recur as soon as after 2 months, or 18 months after the end of the treatment.3

Study 4: In a study published in 2009 in the journal Clinical and Experimental Dermatology, Darougheh and colleagues treated 17 patients with keloids and hypertrophic scars with the intralesional combination of triamcinolone and 5-FU and compared the efficacy and safety of this combination treatment with intralesional triamcinolone alone. The patients received 4 mg of triamcinolone and 45 mg of 5-FU every week for 8 sessions. While all patients reported pain at the injection site as a side effect of the combination treatment, no other textural or pigmentary changes were observed in the group treated with the intralesional combination of triamcinolone and 5-FU.4

References
  1. 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).
  2. 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).
  3. 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).
  4. 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 (2009).