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Comparative Efficacy and Safety of Common Therapies in Keloids and Hypertrophic Scars: A Systematic Review and Meta-analysis

  • Yawei Bao
  • Shanshan Xu
  • Zhipeng Pan
  • Jixiang Deng
  • Xinyi Li
  • Faming Pan
  • Xiaojing LiEmail author
Review Special Topics

Abstract

Objectives

At present, there are many therapies for treating keloids and hypertrophic scars, but there is still a lack of treatments that are relatively balanced in efficacy and safety. The study aims to evaluate comprehensively efficacy and safety of common therapies in keloids and hypertrophic scars.

Methods

The literature search was conducted up to May 2019. The traditional meta-analysis was performed on 17 therapies. Bayesian network meta-analysis was conducted on the four most common treatments. The outcome indicators were the numbers of patients with good-to-excellent effect, Vancouver Scar Scale (VSS) and adverse events.

Results

There was no significant difference in the efficacy of triamcinolone acetonide (TAC) compared with other monotherapies except for silicone gel sheet and neodymium-yttrium-aluminum-garnet in primary indicator. The combination therapies were superior to TAC, and the results were consistent after the pooled analysis (RR = 0.522, 95% CI 0.332–0.823). The level of VSS in TAC group was higher than that in 5-flurouracil (5-FU) and TAC + 5-FU group, but lower than that in verapamil (VER) group. And the patients treated with TAC were less safe than those treated with verapamil (P = 0.013). Surface under cumulative ranking ranked verapamil and TAC + 5-FU as the favorable efficacy therapies in terms of primary indicator and ranked TAC + 5-FU as the best therapy for VSS, while VER was ranked as the worst.

Conclusion

This meta-analysis showed that TAC + 5-FU may be the most effective therapy, while verapamil may be a better therapeutic strategy for safety.

Level of Evidence III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Keywords

Keloid Hypertrophic scar Treatment Meta-analysis 

Notes

Acknowledgements

We thank all patients and healthy subjects who provided the information necessary for our study. We would like to acknowledgement the national natural science foundation of China and Scientific Research Foundation of Translational Medicine of Anhui Province for their financial support.

Funding

The study was sponsored by the National Natural Science Foundation of China (81273169,81573218 and 81773514) and Scientific Research Foundation of Translational Medicine of Anhui Province (2017zhyx03).

Compliance with Ethical Standards

Conflict of interest

All authors state that there is no conflict of interest.

Informed Consent

For this type of study, informed consent is not required.

Statement of Human and Animal Rights, or Ethical Approval

This article does not contain any studies with human participants or animals performed by any of the authors.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2019

Authors and Affiliations

  1. 1.Department of Plastic SurgeryFirst Affiliated Hospital of Anhui Medical UniversityHefeiChina
  2. 2.Department of Epidemiology and Statistics, School of Public HealthAnhui Medical UniversityHefeiChina
  3. 3.Department of Medical OncologyFirst Affiliated Hospital of Anhui Medical UniversityHefeiChina

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