Verapamil (Intralesional — Keloid Anti-Fibrotic)

How it works

Within the scar it is thought to reduce fibroblast proliferation and extracellular matrix production while promoting collagenase activity, decreasing the excess collagen of keloid tissue.

Prescribing in practice

• Inject only into the scar tissue itself, as the intended effect and safety profile depend on local delivery rather than systemic calcium-channel blockade.
• It is generally reserved for resistant keloid or hypertrophic scars, often combined with other modalities, and repeated sessions are usually required for a sustained response.
• Avoid injecting into infected or inflamed skin and counsel that it is an unlicensed use with a less robust evidence base than corticosteroid.

Monitoring

Monitor scar response and the local injection site over successive treatments, with little need for systemic monitoring given the localised dose.

Counselling the patient

• This injection is given into the scar to help break down excess tissue and is an unlicensed use.
• Several treatment sessions are usually needed.
• Report pain, signs of infection or unexpected skin changes at the site.

Evidence & guidelines

Intralesional verapamil for keloid is supported by smaller studies and is used as an adjunct or alternative to corticosteroid in scar management.