A systematic review of transforming growth factor beta inhibitor treatments on keloid scars

Abstract

Keywords: Transforming growth factor beta inhibitor; treatment; keloid scar

Objectives: The primary objective of this study was to evaluate the most appropriate transforming growth factor beta (TGF-β) inhibitor drug on keloid scars.

Methods: Search strategy was done by using the PubMed, MEDLINE, and Wiley. The search terms were “keloids”, “treatment”, “transforming growth factor beta” and “scar”. Data was grouped and calculated proportionally, including 95% confidence interval by MEGASTAT.

Results: The TGF-β inhibitor drugs were found to be effective in treating keloids. There was consistency in the same direction of the improvement in keloid appearance. Complications and recurrent rate of each drug were investigated. Major complications of bleomycin and fluorouracil were hyperpigmentation that occurred after using drugs, which gradually subside after discontinuation or applying of bleaching agent. Botulinum toxin had less complication, but its use was limited to some sites for keloid formation. Side effects of imiquimod were local skin reaction and lymphadenopathy. Mitomycin C had some reports of infected wound. Low recurrent rate was seen in bleomycin, botulinum toxin, imiquimod (only earlobes), and mitomycin C.

Conclusion: TGF-β inhibitor drugs appeared to have less permanent side effects and lower recurrent rates in overall compared to the standard treatment; intralesional steroid. TGF-β inhibitor drugs were separated into the local infiltration group and the after surgery application group. For the local group, bleomycin and fluorouracil provided better results affecting keloids. Botulinum toxin injection was reported with a good result on keloids but its limitation on the injection site was still concerned. In the other group, mitomycin C was more effective than imiquimod. It could be applied on both earlobe and trunk with no systemic adverse effect. Therefore, TGF-β inhibitor drugs had proven to be a new effective option for keloids treatment.