Comparison of efficacy and safety of Intralesional Verapamil hydrochloride & Intralesional triamcinolone acetonide in the treatment of keloids

Authors

  • Abdullah Adil Department of Dermatology Unit II, KEMU/ Mayo Hospital, Lahore
  • Saima Ilyas
  • Rutaba Kiran Department of Dermatology Unit II, KEMU/ Mayo Hospital, Lahore
  • Wajieha Saeed Department of Dermatology Unit II, KEMU/ Mayo Hospital, Lahore
  • Shahbaz Aman Department of Dermatology Unit II, KEMU/ Mayo Hospital, Lahore
  • Tahir Jamil Department of Dermatology Unit II, KEMU/ Mayo Hospital, Lahore

Keywords:

Efficacy, Safety, Verapamil, Keloids, Triamcinolone acetonide

Abstract

Background: A keloid is a benign dermal fibro-proliferative tumor with no malignant potential. It is an aberrant proliferation of dense fibrous tissue that develops beyond the borders of the initial lesion, generally following cutaneous injury. Environmental and genetic factors both have a role in keloid formation. The rates are highest among people of African, Asian, and Hispanic heritage because of their darker complexion. A wide variety of approaches have been used to treat keloids. Incomplete knowledge of disease etiology and focused therapeutics has prevented the identification of the most successful of these treatments. 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. Material & Method: The present interventional study was carried out in the outpatient clinic of the Dermatology Department Unit-2 KEMU ∕ Mayo Hospital, Lahore. The duration of study was twelve months after approval of synopsis. Total 88 (44 in each group) patients were enrolled. Informed consent and demographic detail were taken. Randomization into two groups was done by lottery method. Group A (44 patients) was treated with intralesional verapamil hydrochloride (2.5mg/ml) through an insulin syringe. Group B (44 patients) was treated with intralesional triamcinolone acetonide (20mg/ml) and 0.1ml/cm2 of the respective drug was given. 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, whichever was earlier. 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 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 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 compare to Intralesional verapamil hydrochloride for the treatment of keloids; however Intralesional verapamil hydrochloride is safer.  

References

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Published

2024-05-06

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Adil A, Saima Ilyas, Kiran R, Saeed W, Aman S, Jamil T. Comparison of efficacy and safety of Intralesional Verapamil hydrochloride &amp; Intralesional triamcinolone acetonide in the treatment of keloids. J Pak Assoc Dermatol [Internet]. 2024May6 [cited 2024May19];34(1):31-9. Available from: https://jpad.com.pk/index.php/jpad/article/view/2574

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