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Cytotoxic agents
Cytotoxic agents
Intralesional administration of cytotoxic agents, such as fluorouracil (5-FU) and bleomycin, serves as an alternative treatment option for hypertrophic scars and keloids.55 5-FU prevents proliferation of fibroblasts in dermal wounds, and some evidence suggests its efficacy for facial acne scars.55,90 Augmenting 5-FU with intralesional corticosteroids and a 585-nm PDL can also yield satisfactory results. A randomized control trial compared the response rate to intralesional corticosteroids alone or combined with 5-FU and 585-nm PDL. While no significant difference was apparent between the groups, all groups showed high success rates. In addition, intralesional injections reduced the treatment duration, and showed more rapid improvement compared to treatment with the PDL alone.91
Disadvantages of 5-FU administration are pain and purpura, although it has been
proposed that combining 5-FU with either a corticosteroid or lidocaine can alleviate these side effects. The dose of 5-FU used in several studies falls between 50 and 150 mg per session. In order to increase the efficacy of this method, the recommended dose can be administered more than once a week.92