Clinical Trials Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 7, 2022; 10(1): 166-176
Published online Jan 7, 2022. doi: 10.12998/wjcc.v10.i1.166
Low-dose intralesional injection of 5-fluorouracil and triamcinolone reduces tissue resident memory T cells in chronic eczema
Yun Wu, Guo-Jiang Wang, Hui-Qiong He, Hai-Hong Qin, Wen-Tong Shen, Yue Yu, Xun Zhang, Mao-Lin Zhou, Jian-Biao Fei
Yun Wu, Guo-Jiang Wang, Hui-Qiong He, Hai-Hong Qin, Wen-Tong Shen, Yue Yu, Xun Zhang, Mao-Lin Zhou, Jian-Biao Fei, Department of Dermatology, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai 201318, China
Author contributions: Wu Y, Fei JB, and Wang GJ designed/performed most of the investigation, data analysis and wrote the manuscript; Zhang X and Zhou ML provided pathological assistance; Qin HH, Shen WT, He HQ, and Yu Y contributed to the interpretation of the data and analyses; All of the authors have read and approved the manuscript.
Supported by Pudong New District Science and Technology Development Fund People’s Livelihood Scientific Research Special Fund (No. PKJ2018-Y42); the Shanghai Pudong New District Health System Discipline Construction Project (No. PWZzk 2017-14); and the School-level Scientific Research Project of Shanghai University of Medicine and Health Sciences Affiliated with Zhoupu Hospital (No. ZPXM-2019A-13).
Institutional review board statement: The study protocol conformed to the ethical guidelines of the 1975 Declaration of Helsinki and was approved by the Shanghai University of Medicine & Health Science Affiliated Zhoupu Hospital’s Research Ethics Committee (No. 2018-C-014-M01).
Clinical trial registration statement: This study has been registered at http://www.chictr.org.cn/ (No. ChiCTR2100043660).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: The datasets generated and analyzed during the present study are available from the corresponding author on reasonable request. Participants gave informed consent for data sharing.
CONSORT 2010 statement: The authors have read the CONSORT 2010 statement, and the manuscript was prepared and revised according to the CONSORT 2010 statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jian-Biao Fei, MD, Attending Doctor, Department of Dermatology, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, No. 1500 Zhouyuan Road, Pudong District, Shanghai 201318, China. zpyyfeijianbiao@163.com
Received: April 26, 2021
Peer-review started: April 26, 2021
First decision: October 18, 2021
Revised: October 29, 2021
Accepted: November 28, 2021
Article in press: November 28, 2021
Published online: January 7, 2022
Processing time: 248 Days and 0.4 Hours
Abstract
BACKGROUND

Tissue resident memory T (TRM) cells have been reported to play a significant role in the pathogenesis and relapse of chronic eczema.

AIM

To compare the efficacy and safety of the intralesional injection of 5-fluorouracil (5-FU) and triamcinolone (TA) with those associated with TA alone for the treatment of chronic eczema.

METHODS

A total of 168 patients were randomized to 5-FU+TA or TA groups and received a one-time intralesional injection of 5-FU+TA or TA only. Biopsies were collected before and 2 wk after treatment for evaluation of histopathological changes. All patients were followed up monthly for up to 1 year.

RESULTS

No serious adverse event was observed in either group. Although the mean atopic dermatitis severity index scores and effective rates were comparable between the two groups after 2 wk of treatment, the relapse rate was significantly lower in the 5-FU+TA group than in the TA group. Histological examination showed significantly fewer CD8+ and CD103+ T cells but not CD4+ T cells in the 5-FU+TA group.

CONCLUSION

One-time intralesional injection of 5-FU+TA is effective and safe for chronic eczema treatment and can further reduce the retention of TRM cells in the lesional skin and the relapse rate of chronic eczema.

Keywords: Chronic eczema; 5-Fluorouracil; Triamcinolone; Intralesional injection; Tissue resident memory T cell

Core Tip: Chronic eczema is characterized by recurrent itchy papules and plaques with lichenification and hyperpigmentation, in which tissue resident memory T (TRM) cells play a significant role. Intralesional injection of 5-fluorouracil (5-FU) and triamcinolone (TA) can effectively reduce local inflammation and recurrence in a mouse model, but no clinical study has been reported. In this study, low-dose intralesional injection of 5-FU+TA was found to effectively and safely treat the localized rash, by significantly reducing the retention of TRM cells in the skin lesion, and to lower the relapse rate of chronic eczema. This combination may provide a new treatment option for chronic eczema patients with hypertrophy and localized rash.