The treatment of keloids and hypertrophic scars with intralesional bleomycin in skin of color.

Abstract

Intralesional injection with corticosteroid remains the mainstay of therapy for hypertrophic scars and keloids, however some lesions are unresponsive or may result in skin atrophy. Intralesional bleomycin injection is an alternative therapy that has been widely reported. In order to compare the effectiveness and safety of bleomycin for the treatment of keloids and hypertrophic scars in skin of color population, Fitzpatrick skin type III to V patients with keloids or hypertrophic scars were randomized into two groups. Group A was treated monthly with intralesional triamcinolone acetonide (10 mg/mL), while group B with intralesional bleomycin (1 mg/mL) for three consecutive months. Evaluation of the treatment was performed using "Patient and Observer Scar Assessment Scale" (POSAS), self-rated patient satisfaction score, photography, and ultrasonography. Two patients had their bleomycin blood levels monitored. Twenty-six patients with keloids or hypertrophic scars were recruited. The clinical improvement as assessed by the POSAS was not statistically significant. In terms of patients satisfaction score, one half of both groups reported a very good improvement. Photographic as well as ultrasonographic evaluation showed no difference between the two groups. Bleomycin was found to enter the blood circulation in a very small amount. The major side effect was hyperpigmentation. There was no skin atrophy detected in this study. Intralesional bleomycin is a safe and effective treatment for keloids and hypertrophic scars. The treatment is comparable to intralesional triamcinolone. Unfortunately, hyperpigmentation was the major side effect in darker skin type.

• Authors: Kittisak Payapvipapong, Nucha Niumpradit, Chotinand Piriyanand, Sawanya Buranaphalin, Artit Nakakes
• Journal: Journal of cosmetic dermatology (J Cosmet Dermatol) Vol. 14 Issue 1 Pg. 83-90 (Mar 2015) ISSN: 1473-2165 [Electronic] England
• PMID: 25626920 (Publication Type: Journal Article, Randomized Controlled Trial)
• Copyright: © 2015 Wiley Periodicals, Inc.

Chemical References

• Dermatologic Agents
• Bleomycin

Topics

• Adolescent
• Adult
• Bleomycin (adverse effects, pharmacokinetics, therapeutic use)
• Cicatrix, Hypertrophic (drug therapy)
• Dermatologic Agents (adverse effects, pharmacokinetics, therapeutic use)
• Female
• Humans
• Injections, Intralesional
• Keloid (drug therapy)
• Male
• Middle Aged
• Prospective Studies
• Single-Blind Method
• Skin Absorption
• Skin Pigmentation
• Young Adult