Key Points Highlighted
- Study Focus: The study explores a multimodal approach using intramarginal 5-fluorouracil (5-FU) and triamcinolone acetonide (TCA) with compression therapy post-surgical excision for ear keloids.
- Design: 120 patients were randomized into two groups—Group A (TCA + 5-FU) and Group B (TCA alone)—with compression therapy applied in both.
- Outcome: Group A showed significantly lower recurrence (21.7%) than Group B (38.3%) over a year.
- Side Effects: Mild localized effects like ulceration, transient hyperpigmentation, and pain were more common in Group A but manageable.
- Evaluation Metric: Vancouver Scar Scale (VSS) was used to assess outcomes, showing better results in Group A.
- Conclusion: Combination therapy with compression offers superior results in reducing keloid recurrence compared to monotherapy.
Title: “Combination Therapy for Keloid Scars in Ears: Reducing Recurrence with 5-FU, TCA, and Compression”
Keloid scars remain a persistent therapeutic challenge due to their high recurrence rate and complex pathophysiology. The article titled “Combination Therapy of 5-Fluorouracil and Triamcinolone Acetonide with Compression Therapy after Surgical Excision in the Management of Keloids in Ears” published in the Indian Journal of Plastic Surgery (2025) by Lamba et al., examines a combination therapy approach that shows promise in managing ear keloids post-excision.
The Burden of Keloid Scarring
Keloids, defined by their growth beyond the margins of a healed wound, particularly affect darker-skinned individuals and often arise after minor trauma such as ear piercing. Traditional therapies including surgical excision, corticosteroid injections, and silicone gel sheeting frequently suffer from high relapse rates, with surgical excision alone resulting in recurrence rates upwards of 80–100%.
Study Design and Methods
The prospective study included 120 patients with ear keloids, randomly divided into two groups:
- Group A received intramarginal injections of both 5-FU (50mg/mL) and TCA (40mg/mL) following surgical excision.
- Group B received only TCA injections.
Both groups were treated with compression therapy using customized silicone-lined metallic clips.
Patients were followed up at 3, 6, and 12 months post-operatively. Outcomes were assessed using the Vancouver Scar Scale (VSS), and recurrence, pain, and side effects were recorded.
Results in Focus
The combination therapy group (Group A) exhibited a lower recurrence rate of 21.7%, compared to 38.3% in the TCA-only group. Statistically significant differences were observed with a p-value of 0.0214. This suggests that the synergistic effect of 5-FU and TCA, combined with compression, plays a vital role in suppressing fibroblast overactivity—a hallmark in keloid pathogenesis.
The VSS scores were better in the combination group at all follow-up intervals, indicating improved aesthetic and symptomatic outcomes.
Side Effects and Management
While Group A experienced more localized side effects such as ulceration (2 cases), hyperpigmentation (2 cases), and mild burning or pain, these were self-limiting or managed effectively with conservative treatment. Importantly, no systemic side effects were reported, reinforcing the safety of the multimodal strategy.
This side effect profile aligns with previous findings by Shah et al., who noted similar mild localized complications when using intralesional 5-FU for keloids .
Interpretation and Clinical Implications
The study by Lamba et al. reinforces the need for a multifaceted strategy in keloid management. Notably, male patients experienced higher recurrence, indicating a potential role of hormonal or behavioral factors, which warrants deeper exploration.
Compression therapy remains an underutilized but powerful adjunct. The use of customized clips lined with silicone is a practical, non-invasive method that could be standardized in clinical practice. Furthermore, the results suggest that localized side effects should not deter clinicians from adopting combination therapy given its superior long-term benefits.
Scope for Future Research
Further investigation is needed to:
- Assess the effectiveness of this protocol on keloids in other anatomical regions.
- Standardize dosing regimens and injection intervals across different age and ethnic populations.
- Explore genetic and molecular markers that may predict recurrence or therapeutic response.
FAQs
- Is combination therapy with 5-FU and triamcinolone effective for ear keloids?
Yes, combining 5-FU with triamcinolone acetonide post-surgery significantly reduces the recurrence of ear keloids compared to single-drug treatment. - What is the best treatment for recurring keloids on ears after piercing?
A multimodal approach including surgical excision, followed by 5-FU and triamcinolone injections with compression therapy offers the best results. - Are intralesional injections for ear keloids painful?
Some pain or burning may occur, especially with 5-FU, but these effects are generally manageable with simple medications. - What are the chances of keloid coming back after this combination therapy?
The recurrence rate drops to around 21.7%, which is significantly lower than using steroids alone or excision without adjuvants. - Does silicone compression therapy help reduce keloid recurrence?
Yes, silicone-lined pressure devices improve scar remodeling and reduce the recurrence risk when combined with medical treatment. - Is treatment for keloid on the ear different from other body parts?
Yes, ear keloids are easier to compress and are more suitable for mechanical therapies compared to areas like the chest or shoulders. - Are there long-term side effects of using 5-FU for keloids?
No long-term systemic effects have been reported. Most side effects are local, such as mild pain or skin discoloration, and resolve over time. - Can men and women respond differently to keloid treatment?
Yes, men in the study had a higher recurrence rate than women, suggesting a possible gender difference in treatment outcomes. - How soon after surgery do I get the injections for keloid prevention?
The first injection is usually administered 15 days after surgery, followed by monthly doses for up to two months. - Is this therapy safe for all age groups?
This protocol was used safely in patients aged 18–50 years. More studies are needed for older populations and children.
“Best Combination Therapy for Keloid Scars on Ears: 5-FU, Triamcinolone & Compression Explained”
Keywords and phrases
keloid scars, combination therapy, triamcinolone acetonide, 5-fluorouracil injections, compression therapy for ear keloids
- intralesional therapy for keloid
- silicone pressure clips for keloids
- recurrence prevention in ear keloids
- keloid ear treatment without surgery
- best scar treatment after ear piercing
Learn how a combination of 5-FU, triamcinolone acetonide, and compression therapy after surgical excision can reduce keloid recurrence, especially in ear scars.
keloid scars, intralesional corticosteroids, triamcinolone acetonide, 5-fluorouracil (5-FU), compression therapy, ear keloids, recurrence rate, surgical excision, silicone gel sheets, Vancouver Scar Scale, hypertrophic scars
Lamba RS, Pargal P, Salwan A, Junaise PM, Nigam P, Bansal N. Combination Therapy of 5-Fluorouracil and Triamcinolone Acetonide with Compression Therapy after Surgical Excision in the Management of Keloids in Ears. Indian J Plast Surg. 2025;58(2):105–109. doi:10.1055/s-0044-1801403