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ARTICLE | TREATING SCARS | depigmentation and dermal atrophy has been noted.


Owing to its toxicity, clinicians are encouraged to be aware of potential associated problems. However, systemic toxic effects of intralesionally administered bleomycin appear to be rare69


. Bleomycin may, therefore,


represent a promising agent for the therapy of keloids and hypertrophic scars; however, further investigation and efficacy trials are necessary in order to include this agent in future treatment protocols.


Interferon injections IFN therapy has a potential therapeutic benefit in the treatment of abnormal scars based on the idea that it can decrease the synthesis of collagen types I and III69, 100


. Specifically, IFN-α2b has been proposed to


have anti-proliferative properties and may improve the pathologic features of dermal fibrosis directly, or by antagonising the effects of TGF-β and histamine101


. In vivo


systemic administration of IFN-α2b in severely burned patients resulted in improved clinical appearance of the hypertrophic scars and a lower Vancouver Scar Scale score102


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January/February 2012 | prime-journal.com


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intralesionally (at a concentration of 1.5 million IU, given twice daily over 4 days) was found to result in a 50% reduction of keloid size after 9 days, and was therefore more effective than intralesionally injected corticosteroids101


. Hypertrophic scars injected three times


weekly with IFN-α2b showed significant mean rates of improvement and sustained reduced serum TGF-β levels102


. Unfortunately, adverse events are common with


IFN treatment, including flu-like symptoms and pain on injection69


. Although IFN represents an expensive form of


therapy, it remains a promising therapeutic approach in the management of excessive scars.


Intralesional botulinum toxin A Botulinum toxin A has been used for the treatment of keloids by intralesional injection in a prospective, uncontrolled study103


. . IFN-α2b administered


Intralesional botulinum toxin was given at a concentration of 35 u/ml, with the total dose varying from 70–140 u per session, at 3-month intervals for a maximum of 9 months. At 1-year follow-up, three of the included 12 patients demonstrated excellent, five good, and four patients fair


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