Liu Ruiquan, Yang Bin, Deng Zhu, Liu Liu, Zhao Xian
Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
Department of General Surgery, The First Affiliated Hospital, Kunming Medical University, Kunming, Yunnan, China.
Dermatol Ther. 2020 Jul;33(4):e13564. doi: 10.1111/dth.13564. Epub 2020 Jun 5.
The treatment of keloids and hypertrophic scars remains a challenge. Although triamcinolone acetonide (TAC) is one of the most common and effective treatments for keloids and hypertrophic scars, TAC is not effective in some patients, and some may even experience adverse outcomes. Verapamil might be considered a safe alternative to TAC. The aim of this study was to compare the efficacy and safety of verapamil and TAC for the treatment of keloids and hypertrophic scars. Three databases (Medline, EMBASE, and CENTRAL database) were electronically searched from 1997 to December 2019. Article selection was limited to randomized controlled trials (RCTs) and controlled clinical trials (CCTs). Two authors independently assessed the selection of studies, risk of bias, and extracted the data. Mean differences (MDs) were computed for continuous variables, risk ratios (RRs) were computed for dichotomous variables, and 95% confidence intervals (CIs) were calculated for both assessments. Five RCTs were included, comprising a total of 215 patients (273 scars). Vancouver Scar Scale (VSS) parameters (such as height, vascularity, pliability, and pigmentation) were reported as the outcome measures and provided detailed values in four studies. No significant differences were observed between verapamil and TAC in the reduction of height (MD 0.57, 95% CI -0.94 to 2.08, P = .46), vascularity (MD 0.30, 95% CI -0.42 to 1.02, P = .41), pliability (MD 0.67, 95% CI -1.12 to 2.47, P = .46), and degree of pigmentation (MD 0.14, 95% CI -0.41 to 0.69, P = .61). Adverse outcomes were reported in four studies. The results showed that the incidence of telangiectasia and skin atrophy that used verapamil was significantly lower than that for TAC. Concerning the treatment of keloids and hypertrophic scars, even though verapamil was safer than TAC, TAC worked faster than verapamil. Furthermore, we did not find any clear evidence that verapamil was more or less effective than TAC. Considering the high degree of safety of verapamil, we suggest that verapamil might be used as an alternative treatment when TAC results in adverse outcomes.
瘢痕疙瘩和增生性瘢痕的治疗仍然是一项挑战。尽管曲安奈德（TAC）是治疗瘢痕疙瘩和增生性瘢痕最常用且有效的方法之一，但TAC对一些患者无效，甚至有些患者可能会出现不良后果。维拉帕米可能是TAC的一种安全替代药物。本研究的目的是比较维拉帕米和TAC治疗瘢痕疙瘩和增生性瘢痕的疗效和安全性。对1997年至2019年12月期间的三个数据库（Medline、EMBASE和CENTRAL数据库）进行了电子检索。文章选择仅限于随机对照试验（RCT）和对照临床试验（CCT）。两位作者独立评估研究的选择、偏倚风险并提取数据。连续变量计算平均差（MD），二分变量计算风险比（RR），并对两项评估计算95%置信区间（CI）。纳入了五项RCT，共215例患者（273处瘢痕）。温哥华瘢痕量表（VSS）参数（如高度、血管分布、柔韧性和色素沉着）作为结局指标进行报告，四项研究提供了详细数值。维拉帕米和TAC在降低高度（MD 0.57，95%CI -0.94至2.08，P = 0.46）、血管分布（MD 0.30，95%CI -0.42至1.02，P = 0.41）、柔韧性（MD 0.67，95%CI -1.12至2.47，P = 0.46）和色素沉着程度（MD 0.14，95%CI -0.41至0.69，P = 0.61）方面未观察到显著差异。四项研究报告了不良后果。结果显示，使用维拉帕米的毛细血管扩张和皮肤萎缩发生率显著低于TAC。关于瘢痕疙瘩和增生性瘢痕的治疗，尽管维拉帕米比TAC更安全，但TAC起效比维拉帕米更快。此外，我们没有发现任何明确证据表明维拉帕米比TAC更有效或效果更差。考虑到维拉帕米的高度安全性，我们建议当TAC导致不良后果时，维拉帕米可作为替代治疗方法。
