This Viewpoint discusses the treatment of keloids and hypertrophic scars, reviewing the evidence that multimodality therapy that includes fluorouracil seems to be most effective.
Hypertrophic scars and keloids can occur as a result of abnormal healing of planned surgical incisions or trauma. By definition, hypertrophic scars do not extend beyond the original wound edges, unlike keloids. Whereas keloids almost never resolve spontaneously, hypertrophic scars may resolve partially without treatment, although intervention is usually required if improvement is desired. Intralesional steroid, namely, triamcinolone acetonide, has been the predominant therapy for decades. However, adverse effects including telangiectasias, hypopigmentation, and tissue atrophy occur in one-third of patients, and recurrence is common.1 In response, many alternative treatments have arisen including surgical excision, silicone, antitumor agents (fluorouracil, bleomycin sulfate, mitomycin, retinoic acid, colchicine), imiquimod, interferon alfa-2b, cryotherapy, radiotherapy, laser therapy, pressure therapy, verapamil hydrochloride, and onion extract, among others. A full review of all therapies is beyond the scope of this article; however, fluorouracil has become increasingly popular to augment wound healing. Knowledge of the current evidence for steroid and fluorouracil use is essential for the facial plastic surgeon treating hypertrophic scars and keloids. The purpose of this review is to examine the evidence for triamcinolone and fluorouracil, either alone or in combination, in the treatment of hypertrophic scars and keloids.