Comparison of intralesional methotrexate with triamcinolone acetonide in treatment of hypertrophic scars

Background: Keloid and hypertrophic scars are common dermatological complaints produced by disruption of the normal wound-healing process. Since their earliest description, keloids have beleaguered patients and clinicians alike. These scars can be aesthetically disfiguring, functionally debilitating, and emotionally distressing. Objective: Our study was carried out on 40 patients complaining of keloids divided into two equal groups A and B from November 2019 to June 2020: Group A: treated by triamcinolone acetinoid (TAC) every three weeks, and Group B treated by methotrexate (MTX) every three weeks for maximum eight sessions, We used multiple intralesional injections until the lesion was blanched. Patients were selected from out-patient clinic of Dermatology, Venereology and Andrology Department of Al-Azhar University Hospitals. Results: The present study showed that the vascularity became normal (score 0) in 14 patients (70%), pink (score 1) in 6 patients (30%) in group A. Twelve patients (60%) became with normal vascularity (score 0), pink (score 1) in 8 patients (40%) in group B. Flatting of lesions (score 0) occurred in 14 patients (70%), while reduction to 2mm (score 1) documented in 6 patients (30%) in group A, and flattening (score 0) occurred in 10 patients (50%), reduction of the lesions to 2mm (score 1) occurred in 8 patient (40%) and 2 patient (10%) had score (2) height 2-5 mm in group B. Normal pigmentation (score 0) occurred in 16 patients (80%), mixed pigmentation (score 2) in 2 patients (10%) and hyperpigmentation (score 3) in 2 patients (10%) in group A and 6 patients (30%) showed normal pigmentation (score 0), 2 patients (10%) showed mixed pigmentation (score 2), 4 patients (10%) showed hypopigmentation(score 1) and 8 patients (40%) showed hyperpigmentation (score 3) in group B. Normal pliability in 16 patients (80%) (Score 0), 4 patients (20%) showed supple pliability (score 1) in group A. Normal pliability (score 0) was in 10 patients (50%), 2 patients (10%) showed yielding pliability (score 2), and 8 patients (40%) supple pliability (score 1) in group B. Assessment of the scar was based on Vancouver scar scale. Conclusion: Triamcinolone acetinoid (TAC) was effective in treatment of hypertrophic scars than methotrexate with statistically significant difference at end of treatment period and follow up.