Intralesional Cytotoxic Drugs

Immediately after treatment:

  • Most patients experience mild to moderate pain at the injection site after treatment. Sometimes, this pain can last up to 7 days.
  • No special dressings are necessary after intralesional treatment with cytotoxic drugs.

Days and weeks after treatment:

  • Some patients develop purple/red discolored spots on the skin (also known as purpura or “blood spots”) after treatment. These spots are due to mild bleeding under the skin and will gradually disappear over a few days or weeks.
  • Additionally, some patients develop shallow open sores at the treatment site, sometimes with crusting. These sores which may appear in the first few days after treatment and may last up to 2-3 weeks. Your doctor may prescribe a topical antibiotic to treat these sores.

Longer term:

  • Some patients experience skin darkening (hyperpigmentation) after intralesional treatment with cytotoxic drugs. This side effect will gradually disappear within 2 months to one year.
  • Skin thinning (atrophy) is another potential long-term side effect and may take longer (1 year or more) to disappear, and in some cases may even be permanent. Dan: The outline said “up to 1 year.” However, in the studies that saw atrophy, it did not resolve within 2 years, and according to this NIH website, atrophy that is visible to the naked eye is often permanent.
  • Unfortunately, hypertrophic and keloid scars are known to recur (come back) after treatment. Keloid scars are particularly likely to recur. Most studies on intralesional cytotoxic drugs only followed the patients for up to one year after treatment, and in that time, the scars did not recur. However, it is possible that hypertrophic and keloid scars might recur at some later point after intralesional treatment with cytotoxic drugs.
References
  1. Bijlard E, Steltenpool S, and Niessen FB. Intralesional 5-fluorouracil in keloid treatment: a systematic review. Acta dermato-venereologica. 95(7), 778-82 (2015).
  2. 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).
  3. Ledon JA, Savas J, Franca K, Chacon A, and Nouri K. Intralesional treatment for keloids and hypertrophic scars: a review. Dermatologic Surgery. 39(12), 1745-57 (2013).
  4. Kontochristopoulos G, et al. Intralesional 5-fluorouracil in the treatment of keloids: an open clinical and histopathologic study. J Am Acad Dermatol. 52(3 Pt 1):474-9 (2005).
  5. Manuskiatti W, and Fitzpatrick RE. 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(9), 1149-55 (2002).
  6. Nanda S, and Reddy BS. Intralesional 5-fluorouracil as a treatment modality of keloids. Dermatol Surg. 30(1), 54-6; discussion 56-7 (2004).
  7. Saha AK, and Mukhopadhyay M. A comparative clinical study on role of 5-flurouracil versus triamcinolone in the treatment of keloids. Indian Journal of Surgery. 74(4), 326-9 (2012).
  8. Sharma S, Bassi R, and Gupta A. Treatment of small keloids with intralesional 5-fluorouracil alone vs. intralesional triamcinolone acetonide with 5-fluorouracil. Journal of Pakistan Association of Dermatology. 22(1), 35-40 (2017).
  9. Prabhu A, Sreekar H, Powar R, and Uppin VM. 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(1), 19 (2012).
  10. España A, Solano T, and Quintanilla E. Bleomycin in the treatment of keloids and hypertrophic scars by multiple needle punctures. Dermatol Surg. 27(1), 23-7 (2001).
  11. Naeini FF, Najafian J, and Ahmadpour K. Bleomycin tattooing as a promising therapeutic modality in large keloids and hypertrophic scars. Dermatol Surg. 32(8), 1023-9; discussion 1029-30 (2006).
  12. Aggarwal H, Saxena A, Lubana PS, Mathur RK, and Jain DK. Treatment of keloids and hypertrophic scars using bleom. J Cosmet Dermatol. 7(1), 43-9 (2008).
  13. Gupta S, and Kalra A. Efficacy and safety of intralesional 5-fluorouracil in the treatment of keloids. Dermatology. 204(2), 130-2 (2002).
  14. Saray Y, and Güleç AT. Treatment of keloids and hypertrophic scars with dermojet injections of bleomycin: a preliminary study. Int J Dermatol. 44(9), 777-84 (2005).
  15. Uptodate.com. Keloids and hypertrophic scars. Available from: https://www-uptodate-com.eresources.mssm.edu/contents/keloids-and-hypertrophic-scars?source=see_link&sectionName=MANAGEMENT&anchor=H151854186#H151854186. Last retrieved on 7 November 2017.