Intralesional fluorouracil (50 mg per mL, two to three times per week) appears to shrink keloids safely while avoiding the tissue atrophy and telangiectasia that may occur with repeated corticosteroid injections. 30 Combining fluorouracil with corticosteroid injections and pulsed dye laser produced superior results more rapidly than corticosteroid injections alone or corticosteroids with fluorouracil. 13 Good to excellent responses at 12 weeks as rated by a blinded observer were 15 percent for triamcinolone acetonide, 40 percent for triamcinolone plus fluorouracil, and 70 percent for all three modalities (all significant). Combining corticosteroids and fluorouracil diminished the adverse effects of corticosteroids. Rare skin complications of fluorouracil may include hyperpigmentation and wound ulceration. No systemic adverse effects (., anemia, leucopenia, thrombocytopenia) occurred in this study.
Bleomycin is a chemotherapeutic agent that inhibits DNA synthesis in cells and viruses. 9 It causes acute tissue necrosis that may stimulate an immune response. 10 There is no consistent evidence regarding the effectiveness of bleomycin for nongenital cutaneous warts. In five RCTs, cure rates ranged from 16 to 94 percent; one trial even showed higher cure rates in the placebo group. 2 , 7 Adverse effects of bleomycin include pain, swelling, and redness for one week after treatment. Necrosis in the skin may cause scarring, pigment change, or nail damage. Because treatment can lead to significant systemic drug exposure, bleomycin should be avoided in children, pregnant women, and patients with peripheral vascular disease or Raynaud disease. 27 Patients are usually referred to a dermatologist for this treatment.
In patients with the adrenogenital syndrome, a single intramuscular injection of 40 mg every two weeks may be adequate. For maintenance of patients with rheumatoid arthritis , the weekly intramuscular dose will vary from 40 to 120 mg. The usual dosage for patients with dermatologic lesions benefited by systemic corticoid therapy is 40 to 120 mg of methylprednisolone acetate administered intramuscularly at weekly intervals for one to four weeks. In acute severe dermatitis due to poison ivy, relief may result within 8 to 12 hours following intramuscular administration of a single dose of 80 to 120 mg. In chronic contact dermatitis, repeated injections at 5 to 10 day intervals may be necessary. In seborrheic dermatitis, a weekly dose of 80 mg may be adequate to control the condition.