Abstract
Background
Patients often experience scar-related pruritus, which negatively affects quality of life. Triamcinolone acetonide (TAC) is widely used to treat pathological scars, and botulinum toxin type-A (BTX-A) reportedly improves scarring and associated discomfort.
Objectives
To investigate the clinical efficacy of the combined TAC and BTX-A (TAC/BTX-A) in reducing scar itch and their potential mechanisms via animal model.
Methods
In a clinical study, each scar on a patient was divided into 2 equal parts, with one part receiving TAC/BTX-A and the other TAC alone. Therapeutic interventions were administered over 3 sessions, each 4 weeks apart. Itch intensity was measured using visual analogue scale before each therapeutic intervention (V1, V2, V3) and 4 weeks after the last intervention (V4). In a rat model, rats were allocated into 5 groups: control, untreated burn, TAC, BTX-A, and TAC/BTX-A groups. We evaluated alloknesis in the right hind paw and analyzed possible molecular mechanisms.
Results
In humans, TAC/BTX-A significantly reduced scar itch compared with TAC alone at V4 (p = 0.04). In rats, post-burn itch was mitigated at 4 weeks after treatment with TAC, BTX-A, and TAC/BTX-A (p = 0.03, p = 0.0054, and p = 0.0053, respectively). TAC/BTX-A significantly decreased the density of intraepidermal nerve fibers post-burn relative to the untreated burn (p = 0.0008). TAC/BTX-A downregulated the expressions of nerve growth factor (NGF) and protein transient receptor potential vanilloid subtype 1 (TRPV1).
Conclusions
TAC/BTX-A therapy exhibited enhanced and sustained clinical efficacy in relieving scar itch, possibly via modulating epidermal innervation and TRPV1 expression.