Botulinum toxin type A versus 5-Fluorouracil in treatment of keloid
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ORIGINAL PAPER
Botulinum toxin type A versus 5‑Fluorouracil in treatment of keloid Sahar A. Ismail1 · Noorhan H. K. Mohammed2 · Muhammad Sotohy3 · Doaa A. E. Abou‑Taleb1 Received: 7 February 2020 / Revised: 5 July 2020 / Accepted: 26 August 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Most therapeutic approaches for keloids remain clinically unsatisfactory. In the last years, intralesional botulinum toxin-A (IL BTX-A) was proposed for treatment of keloids. Our aim of the study was to compare the clinical efficacy of IL BTX-A and IL 5-Fluorouracil (IL 5-FU) in treatment of keloids. A total of 50 patients with keloids were included in the study, 22 patients (with 26 keloids) were treated with IL BTX-A monthly for up to 6 months and other 22 patients (with 27 keloids) were treated with IL 5-FU weekly for up to 6 weeks, while the remaining 6 patients, each having multiple keloids, were treated with both IL BTX-A for some lesions (8 keloids) and IL 5-FU for their remaining lesions (8 keloids). The clinical improvement was assessed according to flattening of the lesions. Side effects were recorded. A significantly better therapeutic response of keloids was detected after IL BTX-A than IL 5-FU (P = 0.041). IL BTX-A achieved excellent and good flattening of the lesions (58.8% and 20.6%) compared to (31.4% and 17.1%) after IL 5-FU, respectively. In BTX-A treated group, there was no statistically significant difference between the clinical response in small lesions compared to medium and large ones (P = 0.476). While in 5-FU treated group, small and medium lesions showed significantly better response than larger ones (P = 0.009). IL BTX-A caused fewer side effects than IL 5-FU, less pain, itching, no hyperpigmentation and less recurrence. Both IL BTX-A and IL 5-FU showed positive results in treatment of keloids. However, IL BTX-A showed higher clinical efficacy even in large size keloids with less side effects. Keywords Keloids · Botulinum toxin · 5-Fluorouracil
Introduction Keloids are the result of excessive scar tissue formation [1, 2]. They are often considered unattractive and frustrating problems that follow injuries, although keloids of unrecognized origin can occur. They can cause functional and cosmetic deformities, itching, pain, psychological stress, patient dissatisfaction, and also, can possibly affect joint movement and decrease functional performance [1, 2]. Several therapeutic modalities for keloids are available and include topical agents, pressure dressings, IL injections [3], radiotherapy, cryosurgery, laser therapy, surgical interventions and combinations of these techniques [4]. IL injections,
* Doaa A. E. Abou‑Taleb [email protected] 1
Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Assiut University, Assiut, Egypt
2
Students Hospital, Assiut Unversity, Assiut, Egypt
3
Nahda University, Beni suef, Egypt
mainly corticosteroids and 5-FU are widely used drugs in treatment of keloids [5, 6]. 5-FU is a pyrimidine analogue w
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