School of Physics and Technology, Nantong University, NanTong, Jiangsu, China.
Nantong University Xinglin College, NanTong, Jiangsu, China.
Aesthetic Plast Surg. 2024 Oct;48(19):3765-3778. doi: 10.1007/s00266-024-04237-1. Epub 2024 Jul 11.
Addressing hypertrophic scars and keloids poses a significant challenge in the realm of preventive and curative medicine. Combination corticosteroid with 5-fluorouracil (5-FU) is presumed to enhance the treatment of hypertrophic scars and keloids, although supportive evidence is lacking. This study is aimed at comparing the efficacy and safety profile of a combined corticosteroid and 5-FU regimen in treating hypertrophic scars and keloids.
A comprehensive search was conducted for pertinent studies across various databases, including Web of Science, PubMed, Google Scholar, Cochrane Library, and Medline. The calculation of weighted mean difference (WMD), risk ratios (RR), odds ratios (OR), and 95% confidence intervals (CIs) was executed. Additionally, the Cochrane Collaboration's Risk of Bias Tool was utilized to evaluate potential bias risks.
A total of 15 studies were involved. The effectiveness based on patient self-assessment and the effectiveness based on observer assessment were significantly higher in the corticosteroid+5-FU group compared to those treated with control. A meta-analysis of scar height showed that the corticosteroid+5-FU group performed better than the control group (WMD = -0.38, 95% CI -0.58 to -0.18). There was no significant difference between the corticosteroid+5-FU group and the control group in improving scar vascularity, pliability and pigmentation. The result revealed that the corticosteroid+5-FU group of patients had less adverse effect of hypopigmentation, skin atrophy and telangiectasia than the control group.
The combined use of corticosteroids and 5-FU appears to be a more effective strategy for the treatment and prevention of hypertrophic scars and keloids, as evidenced by greater improvements in scar height and overall effectiveness, coupled with a reduced incidence of side effects.
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 .
在预防和治疗医学领域，处理增生性瘢痕和瘢痕疙瘩是一个重大挑战。联合使用皮质类固醇和 5-氟尿嘧啶（5-FU）被认为可以增强增生性瘢痕和瘢痕疙瘩的治疗效果，但缺乏支持性证据。本研究旨在比较皮质类固醇和 5-FU 联合治疗增生性瘢痕和瘢痕疙瘩的疗效和安全性。
通过对 Web of Science、PubMed、Google Scholar、Cochrane Library 和 Medline 等多个数据库进行全面检索，寻找相关研究。计算加权均数差（WMD）、风险比（RR）、比值比（OR）和 95%置信区间（CI）。此外，还使用 Cochrane 协作风险偏倚评估工具评估潜在的偏倚风险。
共纳入 15 项研究。基于患者自我评估的有效性和基于观察者评估的有效性，皮质类固醇+5-FU 组均明显高于对照组。瘢痕高度的 meta 分析显示，皮质类固醇+5-FU 组优于对照组（WMD=-0.38，95%CI-0.58 至-0.18）。在改善瘢痕血管化、柔韧性和色素沉着方面，皮质类固醇+5-FU 组与对照组之间无显著差异。结果表明，与对照组相比，皮质类固醇+5-FU 组患者发生色素减退、皮肤萎缩和毛细血管扩张的不良反应发生率较低。
皮质类固醇和 5-FU 的联合使用似乎是治疗和预防增生性瘢痕和瘢痕疙瘩的更有效策略，因为在瘢痕高度和整体有效性方面有更大的改善，同时副作用的发生率也降低。
证据等级 II：本杂志要求作者为每篇文章指定一个证据等级。有关这些循证医学评级的完整描述，请参考目录或在线作者指南 www.springer.com/00266 。
