This paper by Abedini et al., is a randomised observer blinded controlled trial comparing the efficacy, safety profile, and recurrence rates of intralesional verapamil versus intralesional triamcinolone acetonide in the treatment of keloid and hypertrophic scars. Whilst corticosteroids represent the most widely used intralesional agents for such lesions, their side-effect profile and contraindications in certain patient populations has necessitated the need for alternative agents. Verapamil has demonstrated in vitro anti-fibrotic activity, suggesting a potential role in keloid and hypertrophic scar treatment. Owing to the inconsistent results of previous papers comparing corticosteroids and verapamil, which focused on the efficacy of verapamil in combination with surgery on the prevention of relapse, and with small patient cohorts and without controls, the authors sought to further investigate the efficacy of these two agents. The methodology is clear; from 2014-2015, 50 patients with two or more keloid and hypertrophic scars, who also met other sound inclusion criteria, were invited to participate in the study. Exclusion criteria were also explicit. Local ethical approval was granted. Patients were allocated to either the intralesional triamcinolone or intralesional verapamil group using a computerised randomiser. No attempt was made to distinguish between the two types of scars, however, despite the majority of the previous literature focusing on keloids only. This may limit the comparability of results with existing literature. Assessment of the lesions was particularly robust. Post-treatment clinical assessments were all performed by a single, independent trained dermatologist, who was blinded to the treatment groups. The Vancouver Scar Scale (VSS) was also utilised for assessment, which represents one of the most widely applied scar assessment scales in clinical research. Three patients withdrew participation during the study owing to the responsiveness of verapamil. It is possible this may have affected final results by skewing values in favour of triamcinolone treatment. Findings revealed that verapamil was ineffective in reducing the scores of VSS parameters to zero or treatment goal. In contrast, with triamcinolone-treated lesions, the efficacy of therapy was observed on all the VSS parameters from the third week. Tabulated and graphical representation of this data was useful. It should be noted that the maximum follow-up time post-treatment was three months, shorter than other studies which have reported verapamil’s efficacy. The authors conclude that their results do not support verapamil’s capability in treatment of keloid or hypertrophic scars. Overall this was a good attempt by the authors to investigate a difficult clinical problem although the study would have benefitted from higher patient numbers and longer term follow-up.

Comparison of intralesional verapamil versus intralesional corticosteroids in treatment of keloids and hypertrophic scars: A randomised controlled trial.
Abedini R, Sasani P, Mahmoudi HR, et al.
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Marc-James Hallam

St John's Hospital, Livingstone, UK.

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