Outcomes of Keloid Excision and Intralesional 5-Flurouracil Injection in Adults at the University Teaching Hospital, Lusaka, Zambia
Rafath Basith Mahsa*, Jovic Goran, Chadwick Ngwisha and Alick Bwanga
Department of Surgery, University Teaching Hospitals, Lusaka, Zambia
*Corresponding Author: Rafath Basith Mahsa, Department of Surgery, University Teaching Hospitals, Lusaka, Zambia.
September 01, 2022; Published: September 27, 2022
Introduction: Keloid scarring is an abnormal healing response characterized by excessive localized scar tissue growth in response to skin trauma, burns, or infection, for which there is no standard treatment. It is extremely difficult to treat Keloids as surgery alone usually results in recurrence, however the use of Keloid excisions and intralesional injections of 5-fluorouracil has been proven effective worldwide; however, due to paucity of data in the African setting when it comes to the management of keloids and anecdotally, lots of recurrences have been observed. As a result, the purpose of this study was to determine the outcome of Keloid treatment with surgery followed by intralesional 5-FU with a 6-month follow-up at University Teaching Hospitals.
Methods: This was an observational Cohort study on 150 patients simple randomly sampled from the adult hospital at the University Teaching Hospitals. Once the patient had consented the clinician went ahead and performed the excision of smaller lesions of Keloid, under local anaesthesia. There after 5-FU was injected around the lesion 0.5-2ml of 50mg/ml and repeat dose of 5-FU was given weekly until 4 doses of 5-FU were administered. Patients were followed-up monthly using observer scale for 6 months. Ethical approval was granted from the University of Zambia Research Ethics Committee. To test the association and correlations, the chi-square test or Fischer’s exact test was carried out for categorical variables and for continuous variables, a t-test was used. Multiple regression was used when considering predictive effects of variables. A p-value of <0.05 at 95% CI was considered significant.
Results: The mean age in this study was 27.5 (6.2) years ranging from 18 to 46 years with nearly half (45.3%) of the study subjects falling between 26 to 35 years age group and 134 (89.3%) of the them were female. The study found that there was a 26.7% incidence rate of keloid recurrence at 6 months while the study identified itchiness (AOR = 2.949, 95% CI: 1.27 - 6.84, p = 0.012), steroid use (AOR = 2.52, 95% CI: 1.11 - 5.74, p = 0.028) and low platelet count (B = 0.001, t = 2.063, p = 0.041) as predictive of keloid recurrence.
Conclusion: The results of this study suggest that treatment of keloids with 5-FU following surgical excision improves the treatment outcomes by 73.3%. The study found that itching with subsequent pain as adverse effect of 5-FU injections, among patients especially in the female population and low platelet count increases the reoccurrence rate of keloids.
Keywords: Keloids; Recurrence; Treatment outcome; 5-Flourouracil; Excision
- Seifert O and Mrowietz U. “Keloid scarring: bench and bedside”. Archives of Dermatological Research4 (2009): 259-272.
- Betarbet U and Blalock TW. “Keloids: A Review of Etiology, Prevention, and Treatment”. The Journal of Clinical and Aesthetic Dermatology 2 (2020): 33-43.
- Saha AK and Mukhopadhyay M. “A comparative clinical study on role of 5-flurouracil versus triamcinolone in the treatment of keloids”. Indian Journal of Surgery4 (2012): 326-329.
- Griffith BH., et al. “A follow-up study on the treatment of keloids with triamicinolone acetonide”. Plastic and Reconstructive Surgery2 (1970): 145-150.
- Joseph A., et al. “Recurrence of keloids after application of epidermal growth factor”. International Surgery Journal 6 (2019): 3341-3346.
- Olabanji JK and Oladele AO. “Clinical pattern and management of keloids in black population”. East African Medical Journal 4 (2011): 125-130.
- Kontochristopoulos G., et al. “Intralesional 5-fluorouracil in the treatment of keloids: an open clinical and histopathologic study”. Journal of the American Academy of Dermatology 52 (2005): 474-479.
- Narakula GK., et al. “A prospective clinical review of "multi model" approach for treating ear keloids. Indian Journal of Plastic Surgery1 (2008): 2-7.
- Juckett G and Hartman-Adams H. “Management of keloids and hypertrophic scars”. American Family Physician3 (2009): 253-260.
- Gupta S and Kalra A. “Efficacy and safety of intralesional 5-fluorouracil in the treatment of keloids”. Dermatology 2 (2002): 130-132.
- Haurani MJ., et al. “5-Fluorouracil treatment of problematic scars”. Plastic and Reconstructive Surgery1 (2009): 139-148.
- Wilson AM. “Eradication of keloids: Surgical excision followed by a single injection of intralesional 5-fluorouracil and botulinum toxin”. Canadian Journal of Plastic Surgery2 (2013): 87-91.
- Sharquie KE and Al-Dhalimi MA. “Keloid in Iraqi patients: a clinicohistopathologic study”. Dermatology Surgery8 (2003): 847-851.
- Ramakrishnan KM., et al. “Study of 1,000 patients with keloids in South India”. Plastic and Reconstructive Surgery3 (1974): 276-280.
- Chike-Obi CJ., et al. “Keloids: pathogenesis, clinical features, and management”. Seminar on Plastic Surgery 3 (2009): 178-184.
- Maemoto H., et al. “Risk factors of recurrence after postoperative electron beam radiation therapy for keloid: Comparison of long-term local control rate”. Reports of Practical Oncology and Radiotherapy 4 (2020): 606-611.
- Shen J., et al. “Hypofractionated electron-beam radiation therapy for keloids: retrospective study of 568 cases with 834 lesions”. Journal of Radiation Research5 (2015): 811-817.
- Kovalic JJ and Perez CA. “Radiation therapy following keloidectomy: a 20-year experience”. International Journal of Radiation Oncology*Biology*Physics 1 (1989): 77-80.
- Bijlard E., et al. “Intralesional 5-fluorouracil in keloid treatment: a systematic review”. Acta Dermato-Venereologica 7 (2015): 778-782.
- Kouwenberg CA., et al. “Emotional quality of life is severely affected by keloid disease: pain and itch are the main determinants of burden”. Plastic and Reconstructive Surgery4S (2015): 150-151.
- Goldstein BG and Goldstein AO. “Keloids and hypertrophic scars”. Dellavalle RP, Levy ML, Corona R, editors. Post TW. Waltham, MA: UpToDate (2019).
- Brown BC., et al. “The hidden cost of skin scars: quality of life after skin scarring”. Journal of Plastic, Reconstructive and Aesthetic Surgery 9 (2008): 1049-1058.
- Prabhu A., et al. “A randomized controlled trial comparing the efficacy of intralesional 5-fluorouracil versus triamcinolone acetonide in the treatment of keloids”. Journal of the Scientific Society 39 (2012): 19-25.
- Nanda S and Reddy BS. “Intralesional 5-fluorouracil as a treatment modality of keloids”. Dermatologic Surgery1 (2004): 54-57.
- Fitzpatrick RE. “Treatment of inflamed hypertrophic scars using intralesional 5-FU”. Dermatologic Surgery3 (1999): 224-232.
- Asilian A., et al. “New combination of triamcinolone, 5-Fluorouracil, and pulsed-dye laser for treatment of keloid and hypertrophic scars”. Dermatologic Surgery7 (2006): 907-915.
- Apikian M and Goodman G. “Intralesional 5-fluorouracil in the treatment of keloid scars”. Australas Journal of Dermatology2 (2004): 140-143.
- Mustoe TA., et al. “International clinical recommendations on scar management”. Plastic and Reconstructive Surgery2 (2002): 560-571.
- Uppal RS., et al. “The effects of a single dose of 5-fluorouracil on keloid scars: a clinical trial of timed wound irrigation after extralesional excision”. Plastic and Reconstructive Surgery5 (2001): 1218-1224.