Comparison of Intralesional Triamcinolone Acetonide, 5-Fluorouracil and Their Combination in the Management of Keloids in a Tertiary Care Centre (PMCH)

Background: Keloids are benign fibro proliferative disorders characterized by excessive collagen deposition extending beyond the original wound margins. Their management remains challenging due to high recurrence rates and suboptimal response to single-modality treatments. Intralesional triamcinolone acetonide (TAC) and 5fluorouracil (5-FU), alone or in combination, are widely used therapeutic options. Aim: To compare the efficacy and safety of intralesional TAC, 5-FU, and their combination in the management of keloids. Methods: A prospective randomized comparative study was conducted in the Department of Plastic Surgery, Patna Medical College and Hospital (PMCH), including 60 patients with clinically diagnosed keloids. Patients were randomly allocated into three groups: Group A (TAC), Group B (5-FU), and Group C (TAC + 5-FU), with 20 patients in each group. Intralesional injections were administered at 4-week intervals for a maximum duration of 16 weeks (total of 4 doses). Outcomes were assessed using the Vancouver Scar Scale (VSS), symptom relief (pain and pruritus), and recurrence rates. Recurrence was evaluated based on clinical assessment of scar size and VSS score during follow-up. Patients were followed for 6 months after completion of therapy. Statistical analysis was performed using ANOVA and Chi-square tests, with p < 0.05 considered statistically significant Results: All groups demonstrated statistically significant improvement in VSS scores (p < 0.001). The combination group showed the greatest reduction in scar height (64.7%) and total VSS score (63.4%), along with superior improvement in vascularity, pigmentation, and pliability. Symptomatic relief was highest in the combination group, with 90% reduction in pain and 85% reduction in pruritus. Adverse effects such as skin atrophy were more common with TAC, while ulceration and injection site pain were more frequent with 5-FU. The combination group exhibited fewer severe complications and the lowest recurrence rate (10%). Conclusion: Intralesional combination therapy with TAC and 5-FU is more effective and safer than monotherapy in the treatment of keloids. It provides superior clinical improvement, better symptomatic relief, and lower recurrence rates, and may be considered a preferred treatment modality in clinical practice.