Intralesional treatment of keloids with pentoxifylline

Pentoxifylline (P) is a methylxanthyne derivate largely used in the treatment of peripheral vascular diseases. As P inhibits tumor necrosis factor α (TNF-α) activity, it has been assumed that it can be used in the treatment of cutaneous diseases. Due to the interference of P with fibroblastic metabolism, it has been used in the therapy of cutaneous disorders characterized by increased activity of fibroblastics. In this study the efficacy of P in the treatment of keloids was evaluated in 20 patients affected by keloids of different origin and duration. 12 intralesional applications of P were made at 2-week intervals administering 10 mg/cm2 each time. During the treatment a silicone and vitamin-E lamina was applied to 10 patients permanently, except in the months of July and August when the lamina had been applyed only in the night hours, owing to excessive perspiration during the day. There have been no side-effects from intralesional application of P apart from local pain due to both the drug and to the fact that the skin have been stretched out by the intralesional injections. After 12 applications the keloids in all patients were reduced both in thickness and in extension. The best results were obtained in the most recent keloids. The minor efficacy of the treatment in the oldest keloids seems to be due to their diminished fibroblastic activity. This confirms that the validity of P in keloid treatment seems to be correlated to its action inhibiting metabolism and fibroblastic proliferation. Moreover, the results seem to have been obtained in less time in those patients who had also received the silicone and vitamin-E lamina.