Intralesional Cytotoxic Drugs

What Is It?

The two most commonly used intralesional chemotherapeutic agents are 5-fluorouracil (5-FU) and bleomycin. It is thought that hypertrophic (raised) scars result from an abnormal reaction in the skin after a wound or skin trauma that causes an overgrowth of collagen. Therefore, most treatments for hypertrophic scars aim to eliminate/remove this overgrowth of collagen. 5-FU works through inhibiting the proliferation of collagen-producing cells that are present in the skin. Bleomycin destroys excess collagen in the skin through cell-killing effects on these cells.

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 56% 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
  1. Alamdari, H.A., Davarnia, G., Ghadim, H.H., & Sadri, A. (2018). 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(3), 215-221.
  2. Manuskiatti, W., & Fitzpatrick, R. E. (2002). Treatment response of keloidal and hypertrophic sternotomy scars: comparison among intralesional corticosteroid, 5-fluorouracil, and 585-nm flashlamp-pumped pulsed-dye laser treatments. Archives of dermatology, 138(9), 1149–1155.
  3. Sadeghinia, A., & Sadeghinia, S. (2012). Comparison of the efficacy of intralesional triamcinolone acetonide and 5-fluorouracil tattooing for the treatment of keloids. Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.], 38(1), 104–109.
  4. 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. J Sci Soc 2012;39:19-25
  5. Saha, A. K., & Mukhopadhyay, M. (2012). A comparative clinical study on role of 5-flurouracil versus triamcinolone in the treatment of keloids. The Indian journal of surgery, 74(4), 326–329.
  6. Sharma, S., Vinay, K., & Bassi, R. (2021). Treatment of Small Keloids Using Intralesional 5-fluorouracil and Triamcinolone Acetonide versus Intralesional Bleomycin and Triamcinolone Acetonide. The Journal of clinical and aesthetic dermatology, 14(3), 17–21.
  7. Fitzpatrick R. E. (1999). Treatment of inflamed hypertrophic scars using intralesional 5-FU. Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.], 25(3), 224–232.
  8. Afshan Sagheer, Atif Shehzad, Ijaz Hussain. (2016) Comparison of efficacy of intralesional 5-fluorouracil alone versus intralesional triamcinolone acetonide with 5-fluorouracil in small keloids. Journal of Pakistan Association of Dermatologists. 2016;26 (4):361-365.
  9. Hietanen, K. E., Järvinen, T. A., Huhtala, H., Tolonen, T. T., Kuokkanen, H. O., & Kaartinen, I. S. (2019). Treatment of keloid scars with intralesional triamcinolone and 5-fluorouracil injections - a randomized controlled trial. Journal of plastic, reconstructive & aesthetic surgery : JPRAS, 72(1), 4–11.
  10. Khan, H. A., Sahibzada, M. N., & Paracha, M. M. (2019). Comparison of the efficacy of intralesional bleomycin versus intralesional triamcinolone acetonide in the treatment of keloids. Dermatologic therapy, 32(5), e13036.
  11. Payapvipapong, K., Niumpradit, N., Piriyanand, C., Buranaphalin, S., & Nakakes, A. (2015). The treatment of keloids and hypertrophic scars with intralesional bleomycin in skin of color. Journal of cosmetic dermatology, 14(1), 83–90.
  12. Srivastava, S., Patil, A., Prakash, C., & Kumari, H. (2018). Comparison of Intralesional Triamcinolone Acetonide, 5-Fluorouracil, and Their Combination in Treatment of Keloids. World journal of plastic surgery, 7(2), 212–219.
  13. Gupta, S., & Kalra, A. (2002). Efficacy and safety of intralesional 5-fluorouracil in the treatment of keloids. Dermatology (Basel, Switzerland), 204(2), 130–132.
  14. Kontochristopoulos, G., Stefanaki, C., Panagiotopoulos, A., Stefanaki, K., Argyrakos, T., Petridis, A., & Katsambas, A. (2005). Intralesional 5-fluorouracil in the treatment of keloids: an open clinical and histopathologic study. Journal of the American Academy of Dermatology, 52(3 Pt 1), 474–479.
  15. Nanda, S. and Reddy, B.S.N. (2004), Intralesional 5-Fluorouracil as a Treatment Modality of Keloids. Dermatologic Surgery, 30: 54-57.
  16. Sudulagunta, Sreenivasa & Kumar, B & Khorram, Hadi & Babu, Sodalagunta & Sepehrar, Mona. (2015). Comparison of combined intralesional Triamcinolone and 5-fluorouracil versus Bleomycin in Keloids. International Journal of Advances in Health Sciences (IJHS). 285-289.
  17. Goldan, O., Weissman, O., Regev, E., Haik, J., & Winkler, E. (2008). Treatment of postdermabrasion facial hypertrophic and keloid scars with intralesional 5-Fluorouracil injections. Aesthetic plastic surgery, 32(2), 389–392.
  18. Haurani, M. J., Foreman, K., Yang, J. J., & Siddiqui, A. (2009). 5-Fluorouracil treatment of problematic scars. Plastic and reconstructive surgery, 123(1), 139–148.
  19. Huu, N. D., Huu, S. N., Thi, X. L., Van, T. N., Minh, P., Minh, T. T., Van, T. H., Cam, V. T., Huyen, M. L., Hau, K. T., Gandolfi, M., Satolli, F., Feliciani, C., Tirant, M., Vojvodic, A., & Lotti, T. (2019). Successful Treatment of Intralesional Bleomycin in Keloids of Vietnamese Population. Open access Macedonian journal of medical sciences, 7(2), 298–299.
  20. Naeini, F. F., Najafian, J., & Ahmadpour, K. (2006). Bleomycin tattooing as a promising therapeutic modality in large keloids and hypertrophic scars. Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.], 32(8), 1023–1030.
  21. Teplyi, V., & Grebchenko, K. (2019). THE USAGE OF RADIOFREQUENCY ABLATION FOR TREATMENT OF KELOIDS AND HYPERTROPHIC SCARS. VYKORYSTANNIa RADIOChASTOTNOÏ ABLIaTsIÏ PRY LIKUVANNI KELOÏDNYKh TA GIPERTROFIChNYKh RUBTsIV. Problemy radiatsiinoi medytsyny ta radiobiolohii, 24, 561–573.
  22. Ismail, S.A., Mohammed, N.H.K., Sotohy, M. et al. Botulinum toxin type A versus 5-Fluorouracil in treatment of keloid. Arch Dermatol Res 313, 549–556 (2021).
  23. Sabry, Hanan & Kabel, Ahmed & Sabry, Hanan & Sorour, Neveen & Moharm, Fatma. (2016). Comparative study between intralesional injection of bleomycin and 5-fluorouracil in the treatment of keloids and hypertrophic scars. Journal of Dermatology & Dermatologic Surgery. 20. 10.1016/j.jdds.2015.07.003.
  24. Aggarwal, H., Saxena, A., Lubana, P. S., Mathur, R. K., & Jain, D. K. (2008). Treatment of keloids and hypertrophic scars using bleom. Journal of cosmetic dermatology, 7(1), 43–49.
  25. España, A., Solano, T., & Quintanilla, E. (2001). Bleomycin in the treatment of keloids and hypertrophic scars by multiple needle punctures. Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.], 27(1), 23–27.
  26. Saray, Y., & Güleç, A. T. (2005). Treatment of keloids and hypertrophic scars with dermojet injections of bleomycin: a preliminary study. International journal of dermatology, 44(9), 777–784.
  27. Hina Manzoor, Kehkshan Tahir, Asma Nasir, Shaiqa Mufti, Atif Shehzad (2020). Journal of Pakistan Association of Dermatologists. 2020; 30(2): 282-285.
  28. Mishra, Bharat & Arora, Chetna. (2021). Role of intralesional bleomycin in recurrent or residual keloids and hypertrophic scars. International Surgery Journal. 8. 575. 10.18203/2349-2902.isj20210366.

Side Effects

Medium-High
Medium-high side effects and adverse reactions

Reviews

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