GLUCOCORTICOSTEROID DURING PATCH APPLICATION TO IMPROVE SCAR OUTCOME
AFTER CENTRAL VENOUS CATHETER. A RANDOMIZED TRIAL
Abstract
Introduction: Children treated for cancer with a central venous catheter
are often bothered by scarring. We studied whether glucocorticosteroid
during patch occlusion has a beneficial effect on scar outcome in
children and adolescents treated for neoplastic disease. Methods: A
double-blinded placebo-controlled randomized clinical trial was
performed. The main outcome was the Vancouver Scar Scale (VSS).
Secondary outcomes were scar width and scar quality measured using the
Patient and observer scar assessment (POSAS). The patients were divided
into an intervention groups and a control group. The intervention group
was randomized into two groups; Active and placebo group. The active
treatment consisted of cream with glucocorticosteroid and fusidic acid.
The placebo treatment consisted of cream with fusidic acid. Both groups
were also treated with a silicone gel patch for three months after
central venous catheter removal. The control group did not receive any
specific skin care. Results: Assessment at 6 months were completed for
44 in the intervention group (21 in the active and 23 in the placebo
group) and 47 in the comtrol group. The intervention group had a
significantly lower VSS and a smaller scar compared to the control group
(p = 0.00, p = 0.02). The POSAS by the patients and the study nurse
showed no significant difference between the intervention and control
groups (p = 0.84, p= 0.36). Conclusions: Silicone gel sheet alone or in
combination with application of glucocorticosteroid during sheet
occlusion improved scar outcome after removal of central venous catheter
in children treated for neoplastic diseases.