Comparison of Ultrasound‐Assisted Low‐Dose Versus Medium‐Dose 5‐Fluorouracil and Triamcinolone Acetonide in the Treatment of Hypertrophic Scar

Abstract

Intralesional 5‐fluorouracil (5‐FU) and triamcinolone acetonide (TAC) injection is effective for the treatment of hypertrophic scar. The side effects of current that recommended 45 mg/ml (high‐dose) 5‐FU have been reported. However, no previous study has investigated the efficacy and safety of low‐dose (2.5 mg/ml) 5‐FU with 4 mg/ml TAC or medium‐dose (10 mg/ml) 5‐FU with 4 mg/ml TAC for treatment of hypertrophic scar. Herein, a retrospective comparative study was conducted. The records of 70 patients, treated with low‐dose (2.5 mg/ml) 5‐FU and 4 mg/ml TAC every 4 weeks (Group 1) or medium‐dose (10 mg/ml) 5‐FU and 4 mg/ml TAC every 4 weeks (Group 2), were analyzed. The Vancouver Scar Scale (VSS), vascularity, and thickness of hypertrophic scar at baseline and at 7th‐treatment (each group received 6 treatment sessions) were compared. The ultrasound showed the large vascular distribution in scar margins. Both groups gained clinical improvement in VSS, vascularity, and thickness. Group 2 (medium‐dose) exhibited significantly better improvement than Group 1 (low‐dose). However, the overall side effects rate was 11.4% in Group 1, significantly lower than 31.4% in Group 2. Scar margins were suggested to be target sites for injection. Medium‐dose (10 mg/ml) 5‐FU + 4 mg/ml TAC could effectively reduce the thickness of hypertrophic scar; however, the side effects rate was also higher in medium‐dose group than in low‐dose group.