Letter to the Editor: Unlocking Better Keloid Treatment: Corticosteroid, 5‐Fluorouracil, and Hyaluronidase vs. Corticosteroid Alone—A Randomized Comparative Study
Bibliographic record
Abstract
I read the article titled “Unlocking Better Keloid Treatment: Corticosteroid, 5-Fluorouracil, and Hyaluronidase versus Corticosteroid Alone—A Randomized Comparative Study” by Ehsani et al. with great interest. The study by Ehsani et al. introduces an innovative approach for treating keloid scars through a triple-drug intralesional injection combining triamcinolone acetonide, 5-fluorouracil (5-FU), and hyaluronidase [1]. Their findings highlight superior outcomes in lesion height reduction, pliability, and Modified Vancouver Scar Scale (MVSS) scores compared to corticosteroid monotherapy. The biological rationale for adding hyaluronidase due to its potential to mitigate fibroblast proliferation and enhance drug spread adds depth to the study's clinical relevance. However, the inability to isolate hyaluronidase's independent effect due to the absence of a steroid + 5-FU comparison group needs further discussion. Methodologically, the trial presents several considerations, primarily due to its small sample size of sixteen participants (n = 16), which affects statistical power and generalizability. Although nonparametric tests were appropriately applied, the lack of reported effect sizes weakens the interpretability of the results [2]. Furthermore, the single-blinded design, with patients aware of their treatment group, introduces performance bias that may affect subjective measures such as pain and pruritus [3]. While there were positive trends in these outcomes, they did not reach statistical significance, likely due to both small sample size and potential placebo effects. Biological confounders also emerge in this trial. Including hyaluronidase seems logical due to its role in modulating interleukin-1 and remodeling tissue; however, its effect is hard to separate from the well-established effects of 5-FU and triamcinolone [4]. Furthermore, the authors detected better outcomes in color change, but differences in initial scar pigmentation between groups undermine this finding. Moreover, the short follow-up duration of 2 months is insufficient to assess the risk of keloid recurrence, which is a key consideration in evaluating any scar therapy [5]. To strengthen future research, larger multicenter trials with extended follow-up are needed. A multi-arm design isolating the effects of individual agents would provide greater clarity, while a double-blinded methodology could minimize bias and improve validity. Stratification by lesion site and prior treatment history may also yield more refined insights. Despite its limitations, this study offers an encouraging step toward reducing the burden of keloids and underscores the promise of hyaluronidase as a potentially transformative therapeutic agent. Asifa Zardari: writing – original draft, conceptualization, investigation, visualization, writing – review and editing. I would like to sincerely acknowledge Dr. Muhammad Umar from Khairpur Medical College, Khairpur Mirs, Pakistan Email: [email protected] for his continued support and mentorship throughout the preparation and publication of this article. Permission to include his name has been obtained. The author declares no conflicts of interest. The author has nothing to report.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.000 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.003 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".