Intralesional Cryotherapy Versus Intralesional Corticosteroid and 5-Fluorouracil in the Treatment of Hypertrophic Scars and Keloids: A Clinical Trial

Objectives: Keloids are raised fibrous scars that extend beyond the boundaries of the original wound and usually reappear after surgical excision. Hypertrophic scars are similar lesions but are limited to wound edges and may regress over time. The aim of the present study was to provide a comparative assessment of intralesional cryotherapy with 2 methods of intralesional injection of triamcinolone and 5-fluorouracil. Materials and Methods: The study was conducted on Iranian Azeri patients with hypertrophic and keloid scars in Sina hospital (Tabriz-Iran) from August 2016 to May 2017. Twenty-one scars were assigned to each group. The first group received intralesional cryotherapy and the second and third groups were treated with intralesional triamcinolone acetonide (40 mg/mL) 0.2 mL/cm(2) and 5-fluorouracil (50 mg/mL) 0.2 mL/cm(2), respectively. Dimensions of the scars (including surface area, height and volume) were measured before and after the study. Therapies were repeated every 4 weeks and would be reapplied for 6 sessions depending on the presence of scar tissue. Results: A significant decline was found in surface area, height and volume of the scars with cryotherapy after the first session compared to other 2 methods. The decline in surface area, height and volume after the sixth session was 52.9%, 61.37%, and 78.06% respectively with steroid injection and 32.16%, 58.07%, and 60.67% with 5-FU injection. Results also showed that in terms of surface area, height and volume of the disease, there was a significant difference between steroid and 5-FU groups in the sixth session, with the results being more favorable in the former group. Side effects were permanent hypopigmentation, telangiectasia and atrophy in the steroid group; surface wound, hyperpigmentation and increased pain in the 5-FU group; and temporary hypopigmentation in the cryotherapy group. Conclusions: Results showed that intralesional cryotherapy accelerates keloid healing and has fewer side effects than other treatments.