Clinical and histopathological assessment of botulinum toxin-A injection for treatment of hypertrophic scars and keloids

Background Various treatments for hypertrophic scars (HTS) and keloids are available. Not all treatment modalities have been adequately tested. Recently, it has been shown that botulinum toxin type A (BTX) positively affects wound healing, so it might contribute in treating HTS and keloids. Objective To assess the effect of BTX intralesional injection as a monotherapy for the treatment of HTS and keloids clinically and histopathologically. Patients and methods A total of 30 patients with HTS and keloids were treated by intralesional injection of BTX as a monotherapy. Each lesion was injected with BTX (5 IU/cm2 once every 4 weeks for four sessions). Immunohistochemical evaluation of the lesions before and after treatment was done. Moreover, Vancouver scar scale and clinical imaging were taken before and after treatment. Results There was a highly significant difference after treatment with BTX intralesional in both the epidermal thickness (P=0.001) and area% of fibroblast dermis (P=0.001). Additionally, there was a significant decline in Vancouver scar scale after treatment (P<0.001). Conclusion BTX injection of HTS and keloids can be considered as a promising effective and well tolerated therapeutic option acting on fibroblast activity of HTS and keloids.