Efficacy of Fractional Carbon Dioxide Laser (FCO(2)) with Intralesional 5-Fluorouracil (5-FU) in the Treatment of Keloids

CONTEXT: Managing keloids remains a challenge in clinical practice. Many therapeutic options are available, but none is universally accepted or without recurrence. Therefore, an effort is required to choose the treatment with maximal outcomes. AIMS: To evaluate the effectiveness of combining fractional carbon dioxide (FCO(2)) laser and intralesional 5-fluorouracil (5-FU) for the treatment of keloids. MATERIALS AND METHODS: In this prospective open-label study, 24 patients received FCO(2) laser treatment, started at baseline, for a total of six sittings. The patients also received 1 mL/cm(2)/keloid of 5-FU (50 mg/mL) intralesionally, following irradiation, at identical time points. The primary outcome evaluated was the clinical response concerning height, pliability, vascularity, and pigmentation, using the Vancouver Score Scale (VSS). Adverse reactions and recurrences were recorded as secondary outcomes. RESULTS: A significant reduction was observed in the VSS in terms of pliability and height after three treatment sessions. The mean VSS reduction was 65%, from 8.45 ± SD 0.93 at baseline to 3 ± SD 1.8 one month after the last treatment (P < 0.05). Most patients (79.1%; n = 19) showed a satisfactory response to treatment, with 57.8% (n = 11) achieving an excellent result. Adverse reactions included post-inflammatory hyperpigmentation in four patients and ulceration in two. Recurrences were reported in 21% of the patients who responded well. CONCLUSIONS: Combination therapy with FCO(2) laser and intralesional 5-FU showed a promising effect in the treatment of resistant keloids, with an acceptable safety profile and low recurrence rate.