enalapril and Keloid

The pathogenesis of keloids involves a hyperproliferative state due to molecular abnormalities, cellular driving pathways, such as TGF, VEGF, and the inactivation of proapoptotic genes. We reviewed the literature and compared various treatment combina- tions in the treatment of keloids in a one patient observation.. Treatment modalities consisted of: intralesional 5- uorouracil (5-FU)/triamcinolone (TMC), 5-FU/verapamil, enal- april alone, verapamil alone, and fractional carbon dioxide laser. Size, height, and softness of the keloid, pain, itching, and pain were assessed.. 5-FU based treatments proved to be more ef cacious than the other modalities. 5-FU + TMC demonstrated the largest reduc- tion in keloid height and rmness. The greatest degree of scar softening and average size reduction was achieved with 5-FU/ TMC (80% and 70% reduction, respectively), followed by 5-FU/verapamil (50% and 33% reduction, respectively). The same combinations led to the greatest reduction in scar height (70% and 33%, respectively). All treatments led to resolution of pain and itching in the keloid.. The favorable effects of the 5-FU + verapamil combination are new and deserve further exploration. J Drugs Dermatol. 2016;15(11):1442-1447..

Topics: Adult; Drug Therapy, Combination; Enalapril; Fluorouracil; Humans; Injections, Intralesional; Keloid; Laser Therapy; Male; Treatment Outcome; Triamcinolone Acetonide; Verapamil

Hypertrophic scars and keloids are 2 forms of excessive cutaneous scarring that occur in predisposed individuals. The healing process varies greatly among patients, and the risk of a bad scar evolution is unpredictable. Keloids create disfiguring scars with associated erythema and pain or pruritus or restricted range of motion, and are a major cause of morbidity. A fortuitous observation was made by the first author of this study who, at age 54, developed an erythematous and painful postsurgical abdominal keloid scar after undergoing left colectomy for colon adenocarcinoma. Four months later, after treatment with low-dose enalapril (10 mg, once a day) for mild arterial hypertension, her keloid scar rapidly improved and she eventually made a complete recovery. second case involved a 70-year-old female with diabetes who was affected by a long-standing postsurgical abdominal keloid scar of 2 years' duration. She was intentionally treated with the same low dose of enalapril, and, after 6 months of therapy, the bad scar showed marked improvement. We conducted an exhaustive search of the literature pertaining to the wound healing process, specifically to determine whether angiotensin-converting enzyme (ACE) inhibitors have a healing effect on wounds. ACE inhibitors are known to induce reduction of left ventricular collagen content and to attenuate remodeling during the postinfarctual period (thus improving ventricular function), and they have been shown to exert a pulmonary antifibrotic effect. After conducting this literature search, it became apparent that no data on cutaneous scars and ACE inhibitors are available. During the posttraumatic or postoperative stage, it is useful to achieve the best possible aesthetic results and to decrease the risk of a disfiguring keloid scar, thereby avoiding revision surgery; to this purpose, an early treatment with a low dose of enalapril is a possible solution, even if further confirmatory observations are needed.

Topics: Aged; Angiotensin-Converting Enzyme Inhibitors; Cicatrix, Hypertrophic; Enalapril; Female; Humans; Keloid; Middle Aged; Postoperative Complications; Wound Healing

Keloids are pathologic conditions characterized by fibroblast hyper-proliferation and excess collagen deposition. Enalapril, one of the angiotensin-converting enzyme inhibitors, has recently been highlighted as a new therapeutic modality in treating keloids. This study evaluates the effectiveness of intralesional injection of enalapril versus triamcinolone acetonide (TAA) in keloids.. Forty patients with multiple keloids were enrolled in our study. Enalapril and TAA were injected intralesionally in one session per month for three sessions. The clinical outcomes were assessed via the Vancouver Scar Scale (VSS) and the Patient and Observer Scar Assessment Scale (POSAS).. In both groups, according to VSS and POSAS, there was a high statistically significant difference (p-value ≤ 0.01) before treatment, at the end of each session, and 3 months after treatment. There was no significant difference between both groups regarding degree of improvement. Patients treated with TAA developed more significant complications than those in the enalapril group (p-value < 0.05).. Both enalapril and TAA had the same clinical effect. Enalapril could be a safe alternative to steroids in the treatment of keloid and hypertrophic scars. Further studies on enalapril are needed on a large sample of patients with further focus on the mechanism of this innovative drug.

Topics: Cicatrix, Hypertrophic; Enalapril; Humans; Injections, Intralesional; Keloid; Triamcinolone Acetonide