# Combination Therapy of 5-Fluorouracil and Triamcinolone Acetonide with Compression Therapy after Surgical Excision in the Management of Keloids in Ears

## TL;DR

Combining 5-fluorouracil and triamcinolone acetonide with compression therapy after surgery reduces keloid recurrence in ears compared to using triamcinolone alone.

## Contribution

A novel multimodal therapy combining 5-FU, TCA, and compression therapy is shown to lower keloid recurrence rates in ears.

## Key findings

- Combination therapy (5-FU + TCA + compression) had a 21.7% recurrence rate, lower than TCA + compression alone (38.3%).
- Recurrence was more common in males than females across both groups.
- Combination therapy showed better long-term results despite mild localized side effects.

## Abstract

Background
 Any deviation from the normal process of wound healing leads to excessive scar formation in the form of keloid or hypertrophic scar.

Materials and Methods
 The study included 120 candidates with keloids divided equally into two groups, A and B, of 60 patients each. After surgical excision, group A received combination therapy of intramarginal 5-fluorouracil (5-FU) and triamcinolone acetonide (TCA), while group B received only TCA, followed by compression therapy in both.

Results
 Eighty-seven patients had keloids on ear lobules, 25 (20.8%) on helix, and 8 (6.7%) over multiple locations on ear. Ninety-two (76.7%) had keloids over bilateral, 18 (15%) on left, and 10 (8.3%) on right ear. Sixty-three (52.5%) belonged to third, 65 (54.2%) to fourth, and 8 (6.7%) to fifth decade of life. Overall recurrence rate was 21.7 and 38.3% in group A and B, respectively. Recurrence was seen in 2 from group A (male:female 2:0) and 4 from group B (male:female 3:1) at 3 months, in 7 from group A (male:female 5:2) and 13 in group B (male:female 8:5) at 6 months, and in 4 from group A (male:female 3:1) and 6 from group B (male:female 5:1) at 1 year. Overall, pain was reported by 9 and 7 from group A and B, respectively, and burning sensation by 3 and 1 from group A and B, respectively. Ulceration was noted in 2, wound dehiscence in 1 and transient hyperpigmentation in 2 from group A. Based on the Vancouver Scar Scale, outcome on follow-up had an average of 3.5 at 3 months, 4.2 at 6 months, and 4.8 at 1 year in group A, and 3.8 at 3 months, 4.7 at 6 months, and 5.4 at 1 year in group B.

Conclusion
 Multimodal approach of combination therapy of intramarginal 5-FU and TCA with compression therapy after surgical excision of keloids in ears yields lower recurrence rate when compared with TCA alone. Chances of recurrence are more common in males than females. Though intramarginal 5-FU in combination with TCA has more localized side effects than TCA alone yet lower recurrence rate and better results in the long term can overcome the mild severity of these side effects.