Department of Plastic Surgery, Peking University Third Hospital, Beijing, People's Republic of China.
Department of Plastic Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China.
Aesthet Surg J. 2021 May 18;41(6):NP567-NP575. doi: 10.1093/asj/sjaa357.
Clinical treatment of hypertrophic scars (HSs) and keloids is often unsatisfactory. Intralesional injections of triamcinolone acetonide (TAC) and verapamil are widely used to treat HSs and keloids, but their efficacy and safety are controversial.
The aim of this study was to conduct a meta-analysis of the effectiveness and safety of verapamil and TAC in the treatment of HSs and keloids.
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.
Seven RCTs (461 patients) were included. Compared with verapamil, TAC rapidly changed the ∆height (MD = 0.07; P < 0.05) and ∆pliability (MD = 0.23; P < 0.05) after the first session, but subsequent treatments resulted in no significant differences in the ∆height, ∆pigmentation, ∆vascularity, and ∆pliability. 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.
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.
临床上，增生性瘢痕（HS）和瘢痕疙瘩的治疗效果往往不尽人意。曲安奈德（TAC）和维拉帕米的皮损内注射被广泛用于治疗 HS 和瘢痕疙瘩，但它们的疗效和安全性存在争议。
本研究旨在对维拉帕米和 TAC 治疗 HS 和瘢痕疙瘩的疗效和安全性进行 meta 分析。
从建库到 2020 年 2 月，检索 Embase、Google Scholar 和 PubMed 中的随机对照试验（RCT）。纳入评估温哥华瘢痕量表治疗效果或报告不良反应的 RCT。连续性数据和二分类变量分别采用均数差（MD）和相对危险度（RR）进行分析。
纳入 7 项 RCT（461 例患者）。与维拉帕米相比，TAC 在第一次治疗后可迅速改变 ∆height（MD=0.07；P<0.05）和 ∆pliability（MD=0.23；P<0.05），但后续治疗在 ∆height、∆pigmentation、∆vascularity 和 ∆pliability 方面无显著差异。虽然总不良反应（RR=0.42；P=0.1）无显著差异，但亚组分析显示，维拉帕米组的毛细血管扩张（RR=0.04；P<0.05）和皮肤萎缩（RR=0.10；P<0.05）发生率低于 TAC 组，而疼痛（RR=1.27；P=0.77）发生率与 TAC 组无显著差异。
维拉帕米可能是 TAC 的有效替代品。虽然总不良反应无变化，但维拉帕米组的毛细血管扩张和皮肤萎缩发生率低于 TAC 组。
