Efficacy of Intralesional 5-fluorouracil and Triamcinolone
in the Treatment of Keloids
Joseph H. Dayan, MD, Steven P. Davison, DDS, MD,
Smitha Sonni, MD, Amy Crane, MD
BACKGROUND: Keloids are a common problem with a reported incidence of 4.5 to
16 percent in darker-skinned individuals.1, 2 Intralesional triamcinolone has traditionally
been the mainstay of treatment and in conjunction with excision has yielded efficacy
rates between 58% and 93%.3-7 However there are a significant number of treatment
failures and substantial inconsistencies with regard to the reproducibility of results.
Additionally, adverse effects including hypopigmentation, atrophy, and telangiectasias
have been reported to be as high as 37% in the literature.8 The purpose of this study is to
evaluate the efficacy and adverse effects of a 5-fluorouracil/steroid mixture over the past
seven years and compare the results with steroid alone.
METHODS: All charts from 1999 to 2006 were reviewed. Patients were stratified into
three groups: 5-FU/steroid without surgical excision, 5-FU/steroid with excision, and
steroid with excision. The follow-up period ranged from 6 months to 6 years. Percentage
size reduction and adverse effects including telangiectasia, atrophy, hypopigmentation,
and dehiscence were recorded. A mixture of 75% 5-FU and 25% Kenolog 40 was most
commonly used. 0.1 ml of solution per centimeter of lesion was injected. Patients
undergoing concurrent excision received injections intraoperatively and again at 2, 4, and
6 weeks post-op. Non-surgical patients received injections an average of four weeks
apart.
RESULTS: A total of 94 patients with 102 keloids were identified. Patients who
underwent excision with the 5-FU/steroid combination had a 92% average reduction in
lesion size compared to 73% in the group of patients who did not receive 5-FU. Patients
who received 5-FU/steroid without excision had an average size reduction of 81%. These
differences were statistically significant (p = 0.05). Adverse effects were higher in the
5-FU groups compared with the steroid only group (23% and 15%, respectively),
although these results were not statistically significant (p = 0.62). The most common
side effect was telangiectasia.
CONCLUSIONS: Although this study is limited by its retrospective nature, the results
in this study, the supporting basic science data, and anecdotal reports suggest
combination 5-FU/triamcinolone may be superior in efficacy compared to intralesional
steroid therapy.9-16 The successes of 5-FU in those particularly intractable keloid cases
where steroids have failed is significant. Interestingly, the side effect profile was not
lower in the 5-FU group. However, we speculate the telangiectasias and atrophy were
likely caused by the steroid component. Thus, we are prospectively studying the effects
of 5-FU with a lower triamcinolone dose. Long-term prospective trials using antineoplastic agents are needed to properly establish an ideal treatment regimen for this
challenging problem.
Figure 1. A 43 year-old gentleman presenting with recurrent keloids after failed multimodal triamcinolone treatment. Results shown after intralesional 5-FU, excision and
single-dose radiation at 20 months post-op.
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