Assessment of the Effectiveness of Steroid Injection versus 5-Fluorouracil Injection Following Fractional Ablative Erbium Yttrium Aluminum Garnet Laser in Hypertrophic Scars

Background: Hypertrophic scar (HTS) is a significant dermatological pathology resulting from disrupted healing and has multiple cosmetic and psychological impact. Still there is no gold standard therapy. Aim: The current study aimed to compare between two treatment options: intralesional steroids versus intralesional 5-fluorouracil injections following Erbium YAG fractional laser therapy. Patients and Methods: A total of 30 patients with HTS of any size lasting from 6 months to 1 year have been included into the study during the period from March 2020 to August 2021. Scar severity was done using the Vancouver scar scale (VSS). All patients were first treated with fractional ablative 2,940 nm Erbium YAG laser. After Laser session the lesion was divided into two halves. First half was injected with intralesional triamcinolone acitonide (TAC) (Epirelefan vial, Eipico, Egypt) (40 mg/1ml). The other side was injected with intralesional 5-fluorouracil (Utoral 250 mg/5ml ampules, EMIC United Pharmaceuticals) (0.1ml/2.5 cm). Patients were evaluated for change in VSS, patient satisfaction and recurrence rate. Results: Patients treated with 5-FU have lower VSS at post treatment assessment (3.37 ± 2.72) versus patients treated with steroid (5.03 ± 1.16). Recurrence rate was significantly higher among steroid-treated patients (46.7%) versus 16.7% among 5-FU treated patients (p-value = 0.01. Conclusion: Both intralesional 5-FU and steroid are effective when administered following treatment with fractional ablative 2,940 nm Erbium YAG laser. However, 5-FU revealed higher efficacy compared to intralesional steroid injection with lower significantly lower rate of recurrence.