Is 5-FU Injections better Than Kenalog For Problematic Scars?

Q: Hi Dr. Eppley, I emailed you about a month ago about getting 5-FU injections for lumpy scar tissue underneath my nipple for a revision gynecomastia surgery I had about 4 1/2 months ago.  I have been really busy at work and unable to get time off to make an appt.  Last time you emailed me about a month ago you said I could schedule an appt. and possibly get a 5-FU or kenalog injection.  I would really like to do this but an injection of kenalog makes me nervous due to the possibility of skin atrophy and other side effects I have heard about.  I have heard that 5-FU mixed with a small amount of kenalog does not really carry these side effects and can work quite effectively.  I have to travel about two hours or so to get there so I just want to make sure that 5-FU injections are a possibility before I make the trip.  Also I have an issue about the scar I have from the surgery I had and I saw on your website that you deal with scar management.  I know that the scar I have is only 4 1/2 months old but it does not seem to be getting any better and I was wondering if there are any non-surgical procedures or techniques, such as laser therapy, that you specialize in that could help to minimize this scar?  Thank you for any help you may be able to give me.

A: We can certainly do 5-FU injections for scar therapy as that is an item I keep stocked her for injection treatments. While it is uncertain whether 5-FU is really better than Kenalog, it does have a higher safety profile. Kenalog done judiciously (low dose), however, can be done without significant side effects as well. As for scar management, there are numerous options regarding non-surgical approaches depending upon the scar issue such as hypertrophy or redness. Most commonly we do pulsed light therapy (Broad Band Light, BBL) or laser treatments. That decision would have to be made at the time of examination.

Dr. Barry Eppley

Indianapolis Indiana

What Type Of Scar Revision Can Be Done For Scarring From Self-Mutilation?

Q: I self harmed for many years as a young person, I haven’t done so in almost a decade and I am a different person to the one I was back then. I find it almost unbearable to see the constant reminders on my arms and stomach. They are quite bad. I never go out in short sleeves and this has lead me to detest the summer as I am always covered up, miserable and uncomfortable. I wish I was like everybody else. Is surgery a good option for me to think about? I’m desperate to live a ‘normal’ life.

A: Self-mutilation leads to many linear and cross-hatched scars, often on the patient’s arms. They usually appear as fine white lines. They are white because of the unpigmented scar that is created from the often superficial lacerations. In general, the concept of simply wiping them away by laser resurfacing is not possible because the scar depth is too deep. At best, all one can do is trade-off a different type of scar for the self-mutilation scars. I have done deeper laser resurfacing to create a burned appearance as well as have even skin-grafted arm areas. The intent of this scar trade-off is that it can be more easily explained as part of a more socially accepted injury (e.g., burn) and not look like it was from self-mutilation  or from someone who is a ‘cutter’. If one can accept this scar trade-off, such a scar revision approach may be reasonable.

Dr. Barry Eppley

Indianapolis Indiana

Will Laser Resurfacing Make My Forehead Scar Go Away?

Q: I have a long and wide forehead scar that I would like to be made to look better. I have attached some pictures of it for you to review. I was wondering if you think that laser resurfacing will help. I have read that it can make scars go away. What is your opinion of it?

A: The origin of your question is will any form of laser resurfacing make your forehead scar disappear. The simple answer to your question is no, no matter what type of laser resurfacing technique is used. And let me explain to you why. Your forehead scar is composed of abnormal tissue which is why it does not feel or look like normal skin. It is in fact abnormal tissue or scar but, most relevantly, that scar involves the entire thickness of your skin. In other words, the skin has been replaced by full-thickness scar. You can smooth of the surface of the scar out all you want with any form of laser resurfacing but it will always appear just as wide, just as discolored and just as obvious. Laser resurfacing only smooths out the surface of the scar, which is helpful if the scar’s main problem is surface irregularities, but it will get rid of the actual full-thickness of the scar. Only cutting it out (excision) can do that. When excision is combined with a geometric broken-line closure, the scar will become more narrow and less obvious. Secondary touch-up with laser resurfacing may be helpful but it is an ineffective treatment to do first. I realize that grasping out the hope of laser resurfacing seem appealing but it is but a treatment mirage. Formal surgical scar revision is what would benefit you the most.

Dr. Barry Eppley

Indianapolis Indiana