Five Fluorouracil, Hyaluronidase, and Triamcinolone in the Nasal Region

Abstract

Introduction: The use of five fluorouracil (5 FU) as antifibrotic started in the 1960s, in the hands of ophthalmologists, to prevent adherence after glaucoma and pterigion surgery. In 1999, Fitzpatrick presented his experience in keloids and hypertrophic scars, making a great contribution to their treatment. Fibroblasts' main function is collagen synthesis; in vicious scar the amount of collagen is normal, but what is altered is the ratio between col-lagen subtypes. The use of triamcinolone, the previous standard treatment, produced different degrees of atrophy and telangiectasias. Technique: Infiltration is done in the center of fibrosis, weekly for the first month, then every 15 days until reaching the desired result. Softening, loss of volume and retraction are seen since the first session. Also pain and itching disappears. Histopathology: Biopsy of treated scars has organized collagen fibers and less fibroblasts compared to nontreated scars. Clinical applications: hypertrophic scars or keloids fixed to deep planes, "supratip" post-rhinoplasty fibrosis, post-rhinoplasty fibrosis (as preparation for other treatments), foreign body granulomas, and post-burn retractions. The use in supratip deformity when secondary to rhinoplasty fibrotic scar has proven very effective, and also as preparation for surgical (secondary rhinoplasty) and nonsurgical (bioplasty) procedures. Conclusion: Our experience in the treatment of nasal scars, fibrosis, and retraction with 5 FU is favorable. The results of infiltration with 5FU, hyaluronidase and triamcinolone in low dose have clinical and histological demonstration of collagen synthesis reduction and reorganization of collagen cicatrizal fibers.