Comparison of efficacy and safety of intralesional verapamil hydrochloride and intralesional triamcinolone acetonide in the treatment of keloids
Keywords:
Efficacy, Safety, Verapamil, Keloids, Triamcinolone acetonideAbstract
Objective The purpose of this study was to evaluate the effectiveness and safety of intralesional verapamil hydrochloride versus intralesional triamcinolone acetonide for the treatment of keloids. Methods Total 88 (44 in each group) patients were enrolled. Group A (44 patients) was treated with intralesional verapamil hydrochloride (2.5mg/ml) through an insulin syringe. Group B (44 patients) was treated with 0.1ml/cm2 intralesional triamcinolone acetonide (20mg/ml). In both groups, site of lesion was draped with alcohol solution. The patients were treated every two weeks for 10 sessions or until the resolution of keloid. Response to treatment was assessed by VSS score by two blinded qualified dermatologists at 2-weeks follow up visit and inter-observer agreement was calculated. Follow up was done one month after the last treatment session and percentage reduction in VSS score from baseline was calculated and efficacy was assessed. Results In intralesional verapamil group, the mean age of the patients was 34.93±12.42 years and in intralesional triamcinolone group, the mean age of the patients was 34.45±11.80 years. In intralesional verapamil group 25(56.8%) patients were male and in intralesional triamcinolone group, 24(54.5%) patients were male. At baseline; the mean VSS was 8.98±1.66 with intralesional verapamil, and 9.52±1.21 with intralesional triamcinolone (p-value=0.082). At the 18th week; the mean VSS was 5.68±1.58 vs. 4.91±0.83 (p-value=0.006). After 4 weeks of cessation of trial drugs, the mean VSS was 3.7±1.60 vs. 1.73±1.04, respectively (p-value=0.000). In intralesional verapamil group, the mean percentage reduction was 64.24±15.72% and in intralesional triamcinolone group it was 82.34±10.46%, p-value<0.001. In intralesional verapamil group, efficacy was noted in 10(22.7%) patients and in 28(63.6%) patients in intralesional triamcinolone group (p-value=<0.001). No side effects were observed with intralesional verapamil and with intralesional triamcinolone, side effects were absent in 26(60.5%) patients, p-value=<0.001. Conclusion Intralesional triamcinolone acetonide is significantly more efficacious as compared to Intralesional verapamil hydrochloride for the treatment of keloids; however, intralesional verapamil hydrochloride is safer.References
References
Mari W, Alsabri SG, Tabal N, Younes S, Sherif A, Simman R. Novel Insights on Understanding of Keloid Scar: Article Review. J Am Coll Clin Wound Spec. 2015;7(1-3):1-7.
Ud-Din S, Bayat A. New insights on keloids, hypertrophic scars, and striae. Dermatol Clin. 2014;32(2):193-209.
Sun LM, Wang KH, Lee YC. Keloid incidence in Asian people and its comorbidity with other fibrosis-related diseases: a nationwide population-based study. Arch Dermatol Res. 2014;306(9):803-8.
Brown JJ, Bayat A. Genetic susceptibility to raised dermal scarring. Br J Dermatol. 2009;161(1):8-18.
van de Kar AL, Houge G, Shaw AC, de Jong D, van Belzen MJ, Peters DJ, et al. Keloids in Rubinstein-Taybi syndrome: a clinical study. Br J Dermatol. 2014;171(3):615-21.
Lu WS, Zheng XD, Yao XH, Zhang LF. Clinical and epidemiological analysis of keloids in Chinese patients. Arch Dermatol Res. 2015;307(2):109-14.
Andrews JP, Marttala J, Macarak E, Rosenbloom J, Uitto J. Keloids: The paradigm of skin fibrosis - Pathomechanisms and treatment. Matrix Biol. 2016;51:37-46.
Mustoe TA, Cooter RD, Gold MH, Hobbs FD, Ramelet AA, Shakespeare PG, et al. International clinical recommendations on scar management. Plast Reconstr Surg. 2002;110(2):560-71.
Berman B, Maderal A, Raphael B. Keloids and Hypertrophic Scars: Pathophysiology, Classification, and Treatment. Dermatol Surg. 2017;43 Suppl 1:S3-s18.
Liberman AC, Budzinski ML, Sokn C, Gobbini RP, Steininger A, Arzt E. Regulatory and Mechanistic Actions of Glucocorticoids on T and Inflammatory Cells. Front Endocrinol (Lausanne). 2018;9:235.
Boggio RF, Freitas VM, Cassiola FM, Urabayashi M, Machado-Santelli GM. Effect of a calcium-channel blocker (verapamil) on the morphology, cytoskeleton and collagenase activity of human skin fibroblasts. Burns. 2011;37(4):616-25.
Margaret Shanthi FX, Ernest K, Dhanraj P. Comparison of intralesional verapamil with intralesional triamcinolone in the treatment of hypertrophic scars and keloids. Indian J Dermatol Venereol Leprol. 2008;74(4):343-8.
Fearmonti R, Bond J, Erdmann D, Levinson H. A review of scar scales and scar measuring devices. Eplasty. 2010;10:e43.
Ahuja RB, Chatterjee P. Comparative efficacy of intralesional verapamil hydrochloride and triamcinolone acetonide in hypertrophic scars and keloids. Burns. 2014;40(4):583-8.
Uzair M, Butt G, Khurshid K, Pal SS. Comparison of intralesional triamcinolone and intralesional verapamil in the treatment of keloids. Our Dermatol Online. 2015;6(3):280.
Abedini R, Sasani P, Mahmoudi HR, Nasimi M, Teymourpour A, Shadlou Z. Comparison of intralesional verapamil versus intralesional corticosteroids in treatment of keloids and hypertrophic scars: a randomized controlled trial. Burns. 2018;44(6):1482-8.
Aggarwal A, Ravikumar BC, Vinay KN, Raghukumar S, Yashovardhana D. A comparative study of various modalities in the treatment of keloids. Int J Dermatol. 2018;57(10):1192-200.
Shanthi FM, Ernest K, Dhanraj P. Comparison of intralesional verapamil with intralesional triamcinolone in the treatment of hypertrophic scars and keloids. Indian J Dermatol Venereol Leprol. 2008;74:343.
Srivastava S, Kumari H, Singh A. Comparison of fractional CO2 laser, verapamil, and triamcinolone for the treatment of keloid. Adv Wound Care. 2019;8(1):7-13.
Abou‐Taleb DA, Badary DM. Intralesional verapamil in the treatment of keloids: a clinical, histopathological, and immunohistochemical study. J Cosmet Dermatol. 2021;20(1):267-73.
Shah YM, Garg AM, Paliwal G, Ansari AS, Jain C, Rastogi R. A study of verapamil in treatment of keloid. Int J Res Dermatol. 2018;4:176.
Klomparens K, Simman R. Treatment of keloids: a meta-analysis of intralesional triamcinolone, verapamil, and their combination. Plast Reconstruct Surg Glob Open. 2022;10(1).
Wang P, Gu L, Bi H, Wang Q, Qin Z. Comparing the efficacy and safety of intralesional verapamil with intralesional triamcinolone acetonide in treatment of hypertrophic scars and keloids: a meta-analysis of randomized controlled trials. Aesth Surg J. 2021;41(6):NP567-NP75.
Ahuja RB, Chatterjee P. Comparative efficacy of intralesional verapamil hydrochloride and triamcinolone acetonide in hypertrophic scars and keloids. Burns. 2014;40(4):583-8.
Wang R, Mao Y, Zhang Z, Li Z, Chen J, Cen Y. Role of verapamil in preventing and treating hypertrophic scars and keloids. Int Wound J. 2016;13(4):461-8.
Li Z, Jin Z. Comparative effect and safety of verapamil in keloid and hypertrophic scar treatment: a meta-analysis. Therap Clin Risk Manage. 2016:1635-41.
Zamanian A, Nokandeh M, Behrangi E, Fazel Z, Azizian Z. Comparing efficacy and tolerability of triamcinolone and verapamil in treatment of hypertrophic scars and keloids. J Skin Stem Cell. 2017;4(3-4).
Kuang J, An P, Li W. Comparative efficacy and safety of verapamil and triamcinolone in keloid and hypertrophic scar treatment: a meta-analysis. J Cosmet Laser Therap. 2021;23(1-2):26-34.