At the annual meeting of the American Academy of Dermatology, Dr. Jonith Breadon gave an update on keloid management at the Skin of Color Symposium. Below are the highlights, in case you missed it.
Several studies were published within the last year about the use of imiquimod as a treatment for keloids, said Dr. Breadon, a dermatologist in Chicago. In one study, investigators treated nine patients with imiquimod 5% cream daily for 8 weeks after excision and primary closure of trunk keloids. The keloids recurred in eight of the nine patients, and one patient was lost to follow-up (Dermatol. Surg. 2009;35:629-33).
However, prior studies have shown some promise for imiquimod as an effective adjunctive therapy for keloids. In 2003, investigators conducted a prospective, double-blind, placebo-controlled pilot study of 20 patients treated with imiquimod daily for 2 weeks, then 3 times a week under occlusion, after shave keloid excision. At 6 months, 37.5% recurrence was noted in the imiquimod group and 75% recurrence in the placebo group, without a statistically significant difference (J. Craniofac. Surg. 2003;14:654-7).
Overall, the recently published studies for imiquimod as a treatment for keloids, post-excision, showed mixed results. A large, prospective, double-blind, placebo-controlled study is needed with enough statistical power to draw firm conclusion, noted Dr. Breadon.
Another group of investigators used topical tamoxifen therapy in hypertrophic scars or keloids in burns. Prior research has shown that transforming growth factor (TGF-β1) promotes keloid scar formation. Topical tamoxifen citrate inhibits TGF-β1. They found a reduction in erythema and size of immature hypertrophic burn scars. While larger trials are needed, the results of this study are promising (Arch. Dermatol. Res. 2010;302:1-4).
Another promising study used 5-fluorouracil as a treatment for hypertrophic and keloid scars. Two groups were studied: 24 patients with hypertrophic scars and 32 patients with keloids. The keloids were excised, whereas the hypertrophic scars were not. All patients received 10 monthly injections of 50 mg 5-fluorouracil (50mg/mL) plus 10 mg 1% lidocaine. In the keloid group, six recurrences were noted at 1 year follow-up. In the hypertrophic scar group, one-third had complete resolution at 1 year, and 86% maintained symptom improvement for 1 year (Plas. Reconstr. Surg. 2009;123:139-48).
The bottom line: Imiquimod use post-excision has not shown consistent results. Topical tamoxifen may be a promising new therapy for keloids, and 5-fluorouracil was shown to be helpful in a recent study.