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Pediatric Scar Management Using Tangential Excision With Intralesional Injections and Laser-Assisted 5-Fluorouracil

Kelli Lopes1, Samuel Lance2, Cyril Harfouche1

  • 1From the Division of Plastic Surgery, University of California, San Diego, CA.

Annals of Plastic Surgery
|May 1, 2025
PubMed
Summary

5-fluorouracil (5-FU) combined with tangential excision offers improved scar quality and reduced height in pediatric patients. This study confirms 5-FU

Keywords:
5-fluorouracilhypertrophic scarkeloid scarlaserpediatricsteroidtangential excisiontriamcinolone

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Area of Science:

  • Dermatology and Plastic Surgery
  • Pediatric Scar Management
  • Regenerative Medicine

Background:

  • Traditional pediatric scar treatments include intralesional steroid injections.
  • Emerging therapies like 5-fluorouracil (5-FU) and tangential excision offer improved outcomes.
  • The safety and efficacy of 5-FU in pediatric scar management require further investigation.

Purpose of the Study:

  • To compare the efficacy and safety of 5-fluorouracil (5-FU) versus triamcinolone for pediatric scar treatment.
  • To evaluate outcomes of tangential excision with immediate versus delayed 5-FU/triamcinolone injections.
  • To assess the impact of the number of injections on scar improvement.

Main Methods:

  • Retrospective multi-institution study (2012-2023) of 108 pediatric patients (≤17 years).
  • Treatments included CO2 laser-assisted 5-FU delivery, tangential excision with 5-FU, or triamcinolone injections.
  • Scar outcomes were assessed using the Modified Scar Rating Scale; statistical analysis included Mann-Whitney U and Fisher exact tests.

Main Results:

  • Tangential excision with 5-FU monotherapy significantly improved scar quality and reduced scar height.
  • Improved color match was observed with tangential excision plus fewer than 4 injections or delayed injections.
  • Complication and recurrence rates did not significantly differ across treatment groups, with no systemic complications reported.

Conclusions:

  • Tangential excision with 5-FU monotherapy is effective for improving pediatric scar height and overall quality.
  • CO2 laser-assisted 5-FU delivery showed comparable complication rates to other modalities.
  • This study supports the utility of 5-FU in pediatric scar therapy, including novel delivery approaches.