2017-18 HSC Section 4 Green Book

V E RH I E L E T A L

TABLE 2. Details and Results of the Eight Studies That Were Included in the Second Category (Efficacy and Adverse Events of Verapamil in Hypertrophic Scars and Keloids)

Patient Characteristics Intervention Frequency Comparison

Reference Type of Study Study Size

Lee and

Case reports (5)

5 Hypertrophic scars

Intralesional

Two to five injections, variable intervals

None

colleagues 24

verapamil 2.5 mg/mL

Lawrence 34

Prospective

31 patients, 40 keloids

Keloids

Intralesional

First injection 7–14 days postoperatively, Second injection 1 month postoperatively Four injections; days 7, 14, 28 and during second month Five injections; intraoperatively, days 7, 14, 28 and during second month Thirteen injections; day 1 and 15, then every month

None

uncontrolled open-label trial

verapamil 2.5 mg/mL

Prospective nonrandomized controlled trial

44 Keloids

Intralesional

Only surgical excision and

D’Andrea and colleagues 35

verapamil 2.5 mg/mL

silicone sheets

Prospective

22 Keloids

Intralesional

Copcu and

None

colleagues 36

uncontrolled open-label trial

verapamil 2.5 mg/mL

Skaria 37

Case reports (8)

8 Hypertrophic scars (2) and keloids (6) 54 Hypertrophic scars and keloids

Intralesional

None

verapamil 2.5 mg/mL

Prospective

Intralesional

Every 3 weeks, maximum 6 months

Intralesional

Margaret

randomized single-blinded controlled trial randomized single-blinded controlled trial Historical control clinical trial Prospective

verapamil 2.5 mg/mL

triamcinolone 40 mg/mL

Shanthi and colleagues 38

40 patients, 48 scars

Hypertrophic scars and keloids

Intralesional

Every 3 weeks, maximum of 8 injections

Intralesional

Ahuja and

Chatterjee 39

verapamil 2.5 mg/mL

triamcinolone 40 mg/mL

120 New scars after abdominoplasty (60) and mammoplasty (60)

Boggio and

Gel containing verapamil at a concentration of 50 m M

Beginning at day 7 postoperatively, 2 times a day for 90 days

None

colleagues 40

Follow-Up Period

Level of Evidence

Reference Cointervention

Efficacy

Adverse Events

Lee and

None

2–8 months Efficient in 3/5 cases (decrease in volume and vascularity)

None

Level 4

colleagues 24

Lawrence 34

Pressure earrings for a minimum of 6 months Surgical excision and silicone sheets

Mean follow- up of 28 months

Twenty-two keloids (55%) in 16 patients (52%) were cured

Not reported

Level 4

18 months Fifty-four percentage complete result (vs 0% in controls), 36% partial result (vs 18% in controls)

Not reported

Level 2

D’Andrea and colleagues 35

Surgical excision 24 months Recurrence: 1 keloid, 2 keloids smaller than original lesion, 2 hypertrophic scars, and 4 times pruritus

Tolerable pain caused by

Level 4

Copcu and

colleagues 36

injection (6 pt)

Skaria 37

Surgical excision? (not clear), immobilization (Steri-strips/band- aid)

12 months Five show complete result,

Not reported

Level 4

2 partial result, and 1 no result

4 1 : 1 2 : D E C EMB E R 2 0 1 5

201