LAUSR

BACKGROUND Clinical treatment of hypertrophic scars (HS) and keloids is often unsatisfactory. Intralesional injections of triamcinolone acetonide (TAC) and verapamil are widely used to treat HS and keloids, but their efficacy and safety are controversial. Objectives: To conduct a meta-analysis of the effectiveness and safety of verapamil and TAC in the treatment of HS and keloids. METHODS Embase, Google Scholar, and PubMed were searched for randomized controlled trials (RCTs) from inception to February 2020. RCTs that evaluated treatment effects with the Vancouver Scar Scale or reported adverse effects were included. The continuous data and the dichotomous variables were analyzed as mean difference (MD) and relative risk (RR), respectively. RESULTS Seven RCTs (461 patients) were included. Compared to baseline, TAC rapidly changed the △height (MD=0.07; P<0.05) and △pliability (MD=0.23; P<0.05) after the first session, with no significant differences in the △height (after last session: MD=0.50; P=0.42), △pigmentation (after first session: MD=0.07; P=0.51, after last session: MD=-0.10; P=0.14), △vascularity(after first session: MD=-0.25; P=0.57, after last session: MD=-0.02; P=0.79) and △pliability (after last session MD=0.52; P=0.48). Although total adverse effects (RR=0.42; P=0.1) were not significantly different, in the subgroup analysis, the incidence of telangiectasia (RR=0.04; P<0.05) and skin atrophy (RR=0.10; P<0.05) but not pain (RR=1.27; P=0.77) was significantly lower with verapamil than with TAC. CONCLUSIONS Verapamil may be an effective substitute for TAC. Although total adverse effects did not change, the incidence of telangiectasia and skin atrophy was lower with verapamil than with TAC.