Intralesional Treatments for Keloids and Hypertrophic Scars
Summary
Keloids and hypertrophic scars represent aberrant wound healing characterised by excessive collagen deposition, persistent inflammation and altered fibroblast activity. Intralesional injections deliver therapeutic agents directly into scar tissue, maximising local efficacy while minimising systemic exposure. Corticosteroids remain first-line, attenuating fibroblast proliferation and collagen synthesis; antimetabolites such as 5-fluorouracil disrupt DNA replication in scar fibroblasts and are often combined with steroids to enhance antifibrotic effects. Alternative agents including calcium channel blockers, botulinum toxin A and bleomycin target distinct pathways of matrix remodelling. Physical enhancement techniques—microneedling, microincision and photobiomodulation—are being incorporated to improve drug penetration and distribution. Advances in molecular profiling and single-cell transcriptomics are revealing the cellular heterogeneity and signalling networks driving scar persistence and recurrence. Despite progress, high relapse rates and variable patient responses remain challenges, prompting development of standardised dosing protocols, combination regimens and personalised approaches aimed at achieving durable cosmetic and functional outcomes across diverse populations.
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Intralesional Treatments for Keloids and Hypertrophic Scars publication trend
The graph below shows the total number of articles in intralesional treatments for keloids and hypertrophic scars across all publications each year (not limited to Nature Index journals).
Technical terms
Keloid: Fibrotic overgrowth of scar tissue extending beyond the original wound edges.
Hypertrophic scar: Raised scar remaining confined to the boundaries of the original injury.
Intralesional injection: Direct administration of therapeutic agents into scar tissue.
Triamcinolone acetonide: Synthetic corticosteroid that reduces inflammation and collagen synthesis.
5-Fluorouracil: Antimetabolite that inhibits fibroblast proliferation by blocking DNA synthesis.
Single-cell RNA sequencing: Technique for profiling gene expression in individual cells.
SUCRA: Surface under the cumulative ranking curve, a statistical measure ranking treatment efficacy in a network meta-analysis.
References
- Pharmacotherapy for Keloids and Hypertrophic Scars. International Journal of Molecular Sciences (2024).
- Deciphering the single-cell transcriptome network in keloids with intra-lesional injection of triamcinolone acetonide combined with 5-fluorouracil. Frontiers in Immunology (2023).
- Network Meta-Analysis of Different Clinical Commonly Used Drugs for the Treatment of Hypertrophic Scar and Keloid. Frontiers in Medicine (2021).
- Intralesional Corticosteroid Administration in the Treatment of Keloids: A Scoping Review on Injection Methods. Dermatology (2023).
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