What is the role of verapamil in the treatment of keloids and hypertrophic scars?

Updated: May 29, 2020
  • Author: Brian Berman, MD, PhD; Chief Editor: Dirk M Elston, MD  more...
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Answer

Verapamil is a calcium channel blocker that blocks the synthesis and secretion of extracellular matrix molecules (eg, collagen, GAGs, fibronectin) and increases fibrinase.

In a study of 22 patients with keloids, patients were treated with surgical excision in combination with reconstruction with W-plasty or skin grafting and injection of verapamil (5 treatments of verapamil at 2.5 mg/mL-varying doses from 0.5-5 mL), depending on keloid size) over a 2-month period and were evaluated at 2-year follow-up. Two patients had keloids that decreased in size from the original lesion, 2 patients had hypertrophic scars, 4 patients had pruritus, and 1 patient had a keloid on the donor site (skin grafting site). The case series reported an average of 6.4 in patient satisfaction on a scale from 1 to 10. [38]

D’Andrea et al, from a case-control comparative study, reported resolution in 54% of the patients who had their keloids treated by a combination of surgical excision, silicon sheeting, and intralesional verapamil versus 18% in the control group without intralesional verapamil. [39] The recurrence rate was 36% in the active group after 18 months of follow up.

In a case series, Skaria reported complete resolution of 4 of 6 keloids and 1 of 2 hypertrophic scars at 1-year follow-up after surgical removal of the scar and further intralesional injection of verapamil at doses of 2.5 mg/mL. [40]

Lawrence reported 55% cured earlobe keloids in 52% of the patients after the combination of surgical excision, intralesional verapamil, and pressure earrings after an average of 28 months of follow-up. [41]

In a randomized clinical trial, Margaret Shanthi et al compared intralesional verapamil and intralesional TAC for the treatment of keloids and hypertrophic scars, reporting a reduction in vascularity, pliability, height, and width in both groups after 3 weeks of treatment. This result was maintained at 1 year after stopping the treatment. Although the rate of improvement was faster in the TAC group, overall, no difference was noted between the 2 groups. [42]

Ahuja et al studied 40 patients (48 scars) and compare the effects of triamcinolone and verapamil injections. This group concluded that even though the criterion standard first-line treatment is still triamcinolone, verapamil is almost equally effective, with very few adverse effects, and offers a therapeutic option to treat larger and recalcitrant scars. [43]


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