Intralesional Therapy

In the treatment of hypertrophic scars and keloids, intralesional therapy plays an important role. In addition to the well-established local injection of corticosteroid and 5FU, intralesional cryosurgery shows promising results and should be considered in the treatment plan, especially of keloids. Corticosteroids and 5-FU inhibit the synthesis of collagen and glycosaminoglycan and the proliferation of fibroblasts in the scar tissue. With cryosurgery, the freezing of tissue induces changes in the microcirculation through thrombosis and cell death. Collagen fibers alternate into flat and normal structure with axes parallel to the skin surface. In the treatment of non-hypertrophic and atrophic scars, micro- and nanofat grafting play an important role in correction of contours, improvement of skin quality, and reduction of hyperpigmentation. All intralesional methods require repeated interventions and good patient education and management is mandatory. The therapy treatment concept should always be individualized, reassessed, and adjusted if necessary. Therefore, the attending physician should be familiar with all treatment options.