Treatment of keloids using 5-fluorouracil in combination with crystalline triamcinolone acetonide suspension: evaluating therapeutic effects by using non-invasive objective measures.

BACKGROUND: Intralesional 5-fluorouracil (5-FU) in combination with triamcinolone acetonide (TAC) has been recommended as a promising alternative for keloids not responding to silicone-based products, cryotherapy or intralesional corticosteroids alone. Although numerous studies support the efficacy of this regime, there is a lack of objective data. OBJECTIVES: In this study, we evaluate the therapeutic effect of four courses of intralesional 5-FU in combination with TAC (3 : 1) utilizing 3D analysis (PRIMOS®pico ), ultrasound and scar scales such as the Patient and Observer Scar Assessment Scales (POSAS) and the Dermatology Life Quality Index (DLQI). METHODS: Twenty-five patients with keloids were treated using 5-FU and TAC every 4 weeks. Objective assessments were performed and the scar scales administered at baseline, as well as during consecutive visits at 1- and 12-month follow-up (FU). Routine laboratory tests were performed at baseline and at 1-month FU. RESULTS: 3D PRIMOS and ultrasound measurements revealed highly significant and stable reductions in height (baseline mean score: 4.0 ± 1.7 mm, 1-month FU mean score: 1.5 ± 0.8 mm, 12-month FU mean score: 1.8 ± 0.9 mm, P = <0.0001), volume (baseline mean score: 1,105 ± 911.5 mm3 , 1-month FU mean score: 416.1 ± 218.1 mm3 , 12-month FU mean sore: 431.2 ± 253.6 mm3 , P = <0.0001, respectively) and penetration depth of keloids (relative reduction between baseline and 12-month FU of 74.4%, P = <0.0001). The POSAS and DLQI scales confirmed significant objective and subjective improvements in scar appearance in all categories. The life quality associated with keloid appearance improved from a 'moderate effect' to a 'small effect' throughout the course of the study. CONCLUSIONS: Results of this study confirm the efficacy and safety of the combination of 5-FU and TAC in keloids. Treatments were well tolerated and demonstrated stable results at 12-month FU.

[Management and prevention of adverse events in esthetic interventions]. / Nebenwirkungen von ästhetischen Behandlungen und deren Vorbeugung.

BACKGROUND: Esthetic interventions are an integral part of today's dermatology. A plethora of novel agents and techniques is currently being launched on the market accompanied by a variety of side effects. METHOD: We summarize the most common adverse events of fillers, laser treatments, and injection of botulinum toxin and present feasible means of prevention and management. RESULTS: The profile of adverse events is more favorable in temporary fillers such as hyaluronic acid than in permanent ones. The most common filler-related adverse events include changes of skin color and unspecific swelling. Neural and vascular dysfunctions are observed less frequently, but may result in severe tissue necrosis or loss of vision. Undesirable events of laser treatments largely depend on the applied modality, localization, and indication. Local effects comprise erythema, swelling, crusting, blister formation, and weeping in extreme cases. The formation of laser-induced scarring is more likely to occur in lasers with high energies. Most adverse events of botulinum toxin are mild and transient. Pain and redness around the sites of injection are common. However, a poor injection technique and injection of too many units can trigger major motoric impairment with ptosis and dysarthria. CONCLUSION: Excellent results can be achieved with esthetic interventions. To guarantee a maximum amount of safety and to minimize risks it is of paramount importance to work with clear indications and respect contraindications. It is important to recognize early adverse events to achieve satisfactory results and avoid severe complications.

[Fillers and associated side effects]. / Filler und ihre Nebenwirkungen.

BACKGROUND: A variety of fillers is commonly used for tissue augmentation as well as skin rejuvenation, and consist of a large heterogeneous group of biomaterials. The objective was to provide an overview and classification of the most commonly injected filler materials and filler-related complications including therapy. METHOD: A summary of the current literature and common associated side effects is provided from a personal clinical perspective. RESULTS: According to degradability, filler materials can be classified as temporary (degradable), semi-permanent, and permanent (nondegradable). Temporary fillers such as hyaluronic acid and collagen are completely degraded by the surrounding tissue within several months. Semi-permanent fillers are degradable, but may induce longer-lasting secondary effects. Permanent fillers such as silicone and mineral oil derivatives are not biodegradable and have been increasingly abandoned because of severe and irreversible side effects. The most common filler-related adverse events include pigmentation changes, edema and post-injection deformations. Visible or palpable nodules can be due to filler accumulation, formation of granuloma, or infection. CONCLUSIONS: Substantial knowledge of the chemical and clinical features of the injected materials is indispensable for safe and efficient application. Early recognition of filler-related adverse effects is important to avoid severe complications and to achieve optimal results.

[Recommendations for the prevention and therapy of hypertrophic scars and keloids]. / Empfehlungen zur Prävention und Therapie hypertropher Narben und Keloide.

Hypertrophic scars and keloids form due to aberrations in the physiologic wound healing cascade characterized by greater and more sustained ECM deposition. Both entities are frequently associated with pain, pruritus and contractures, and are thus significantly affecting the patient's quality of life. Genetic susceptibility, specific anatomic locations, prolonged inflammation and delayed epithelialization significantly contribute to excessive scar formation. However, despite intensive scientific work in this field the complex mechanisms underlying the processes of scarring and wound contraction remain poorly understood and most therapeutic approaches are clinically unsatisfactory. Nevertheless, based on a rising number of clinical studies next to well-known therapeutic concepts including cryotherapy and intralesional triamcinolone, recent techniques extend the spectrum for treating excessive scars. Nonetheless, prevention of pathologic scarring is undoubtedly more effective than to later attempts to treat it.