Comparative efficacy of intralesional verapamil hydrochloride, triamcinolone acetonide and combination of both drug in hypertrophic scars and keloids at tertiary care center
Keywords:Keloid, Hypertrophic scars, Verapamil, Triamcinolone, VSS
Background: Keloids and hypertrophic scars are still a therapeutic problem. Despite numerous proposed therapies reported in the literature, the management of keloid and hypertrophic scars is still challenging as there is no universally accepted treatment regimen. Compare the efficacy intralesional verapamil hydrochloride and triamcinolone acetonide separately as well as combination of both drug in treatment of hypertrophic scars and keloids.
Methods: A retrospective study was carried out at the general surgery department (plastic surgery unit) at the JNUIMSRC Jaipur, Rajasthan. Total of 150 patients (60 males and 90 females) between 18 to 60 years of age were enrolled fulfilling the inclusion criteria. They were randomly categorized in to three groups (group A, B and C), based on treatment they received viz. verapamil alone, triamcinolone alone and combination of both drugs respectively. Assessment of the scars were done prior to or on the day of the first injection and at 24 weeks after the end of injection scheme by Vancouver scar scale (VSS). The decreasing values reflected clinical improvement of the scar.
Results: Better improvement observed in all four parameters: height, vascularity, pliability and pigmentation among patients receiving combination of both triamcinolone-verapamil drugs as compare to those patients receiving drugs separately either verapamil or triamcinolone alone. For parameters height, pliability and pigmentation, the improvement was found to be statistically significant (p<0.05)
Conclusions: Study highlights that the combined verapamil and triamcinolone therapy scheme causes remarkable scar improvement in keloid and hypertrophic scars in comparison to single drug scheme.
Meenakshi J, Jayaraman V, Ramakrishnan KM, Babu M. Keloid and hypertrophic scars: A review. Indian J Plastic Surg. 2005; 38:175-9.
English RS, Shenefelt PD. Keloids and hypertropic scars. Dermatol Surg. 1999; 25:631-8.
Robles DT, Berg D. Abnormal wound healing: keloids. Clin Dermatol. 2007;25:26-32.
Juckett G, Hartman-Adams H. Management of keloids and hypertrophic scars. 2009;80:253-60.
Bloemen MC, Van der Veer WM, Ulrich MM, Van Zuijlen PP, Niessen FB, Middelkoop E. Prevention and curative management of hypertrophic scar formation. Burns. 2009;35:463-75.
Leventhal D, Furr M, Reiter D. Treatment of keloids and hypertrophic scars. Arch Facial Plast Surg. 2006;8:362-8.
Mofikoya BO, Adeyemo WL, Abdus-salam AA. Keloid and hypertrophic scars: a review of recent developments in pathogenesis and management. Nig Q J Hosp Med. 2007;17:134-9.
Klumpar DI, Murray JC, Anscher M. Keloids treated with excision followed by radiation therapy. J Am Acad Dermatol. 1994;31:225-31.
Connell PG, Harland CC. Treatment of keloid scars with pulsed dye lasers and intralesional steroid. J Cutan Laser Ther. 2000;2:147-50.
Darzi MA, Chowdri NA, Kaul SK, Khan M. Evaluation of various methods of treating keloids and hypertrophic scars: A 10-year follow-up study. Br J Plast Surg. 1992;45:374-9.
Sherris DA, LarrabeeWF Jr, Murakami CS. Management of scar contractures, hypertrophic scars, and keloids. Otolaryngol Clin N Am. 1995;28:1057-68.
Gauglitz GG. Management of keloids and hypertrophic scars: current and emerging options. Clin Cosmet Investig Dermatol. 2013;6:103-14.
Ahuja RB, Chatterjee P. Comparative efficacy of intralesional verapamil hydrochloride and triamcinolone acetonide in hyper¬trophic scars and keloids. Burns. 2014;40(4):583-8.
D’Andrea F, Brongo S, Ferraro G, Baroni A. Prevention and treatment of keloids with intralesional verapamil. Dermatology. 2002;204(1):60-62.
Sullivan Ta, Smith J, Kermode J, Mclver E, Courtemanche D. Rat¬ing the burn scar. J Burn Care Rehabil. 1990;11(3):256-60.
Kant SB, Van den Kerckhove E, Colla C, Tuinder S, Van der Hulst RRWJ, Piatkowski de Grzymala AA. A new treatment of hypertrophic and keloid scars with combined triamcinolone and verapamil: a retrospective study. Eur J Plast Surg. 2018;41(1):69-80.
Saki N, Mokhtari R, Nozari F. Comparing the efficacy of intralesional triamcinolone acetonide with verapamil in treatment of keloids: A randomized controlled trial. Dermatol Pract Concept. 2019;9(1):4-9.
Margaret Shanthi FX, Ernest K, Dhanraj P. Comparison of intralesional verapamil with intralesional triamcinolone in the treatment of hypertrophic scars and keloids. Indian J Dermatol Venereol Leprol. 2008;74:343-8.
Shanti MKE, Dhanraj P. Comparison of intralesional verapamil with intralesional triamcinolone in the treatment of hypertrophic scars and keloids. Indian J Dermatol Venereol Leprol. 2007;74:343-8.
Wang R, Mao Y, Zhang Z, Li Z, Chen J, Cen Y. Role of verapamil in preventing and treating hypertrophic scars and keloids. Int Wound J. 2015;13(4):461-8.
Yang JY, Huang CY. The effect of combined steroid and calcium channel blocker injection on human hypertrophic scars in animal model: a new strategy for the treatment of hypertrophic scars. Dermatol Surg. 2010;36:1942-9.