Pirfesca Case Studies

Pirfenidone gel in post-traumatic hypertrophic scar of the shoulder

Patient Information

• Age: 23 years
• Gender: Female

Presenting Complaints

• Raised scar over the shoulder following trauma (Figure 1)
• Duration: More than 6 months

Diagnosis

Post-traumatic hypertrophic scar

Treatment Plan

• Topical therapy: Pirfenidone 8% gel, applied twice daily for 3 months
• Maintenance therapy: Pirfenidone 8% gel, applied once daily for an additional 3 months

Outcome

Progressive reduction in scar thickness and redness (Figure 2)

Expert Summary

Topical pirfenidone 8% gel, applied twice daily for 3 months followed by once daily maintenance for another 3 months, was associated with visible improvement in a post-traumatic hypertrophic shoulder scar.

Pirfenidone gel in the management of postoperative hypertrophic scar

Patient information

• Age: 23 years
• Gender: Female

Presenting complaints

• Postoperative scar on the forearm (Figure 3)
• Duration: 6 months

Diagnosis

Postoperative hypertrophic scar

Treatment History

• Previously treated with intralesional steroid (ILS) for 1-month
• No significant improvement observed

Treatment Plan

• Topical therapy: Pirfenidone 8% gel, applied twice daily for 3 months
• Maintenance therapy: Continued pirfenidone 8% gel twice daily for an additional 3 months.

Outcome

• Noticeable improvement in scar appearance after initiating pirfenidone (Figure 4)
• No itching or irritation reported

Expert Summary

Topical pirfenidone 8% gel, applied twice daily for 6 months, was associated with improvement in postoperative hypertrophic scar appearance following a suboptimal response to ILS. The treatment was well-tolerated.

Pirfenidone gel in the management of keloids with suboptimal response to intralesional steroid

Patient Information

• Age: 38 years
• Gender: Male

Presenting Complaints

• Keloid lesions
• Duration: 6–8 months

Diagnosis

Keloid (Figure 5)

Treatment History

• Initially treated with ILS injections along with topical tacrolimus 0.1% ointment and mometasone 0.1% cream applied on alternate days for 3 months.
• The response was slow, with minimal flattening and no significant cosmetic or symptomatic improvement

Treatment Plan

• Topical therapy: Pirfenidone 8% gel, applied twice daily for 3 months.
• Maintenance therapy: Pirfenidone 8% gel applied twice daily for an additional 3 months

Outcome

Significant cosmetic improvement with visible flattening of the keloid (Figure 6).

Expert Summary

Pirfenidone 8% gel improves keloid outcomes, especially when the initial response to ILS is suboptimal. When used concurrently with or after ILS therapy, it may act synergistically and support long-term maintenance.

Role of Pirfenidone Gel in the Management and Maintenance of Hypertrophic Scar

Patient Information

• Age: 28 years
• Gender: Male

Presenting Complaints

• Post-traumatic scar over the chest wall (Figure 7)
• Associated itching and pain
• Duration: 1 year

Diagnosis

Post-traumatic hypertrophic scar

Treatment Plan

• Systemic therapy: Levocetirizine 5 mg once daily for 4 weeks to relieve itching
• Topical therapy: Pirfenidone 8% gel, applied twice daily for 3 months
• Procedural therapy: Cryotherapy, performed once every 10 days for a total duration of 6 weeks (5 sessions)
• Maintenance therapy: Continued pirfenidone 8% get twice daily for an additional 4 months to maintain remission and prevent recurrence.

Outcome

• Gradual flattening of the hypertrophic scar (Figure 8)
• Decrease in erythema, itching, and pain

Expert Summary

• Pirfenidone 8% gel, along with cryotherapy and levocetirizine, resulted in symptomatic relief and visible improvement in a hypertrophic chest wall scar.
• Continued use of pirfenidone during the maintenance phase helped sustain remission and promote scar remodeling.

Combination Therapy with Pirfenidone Gel and Isotretinoin in Grade III Acne and Acne Scarring

Patient Information

• Age: 20 years
• Gender: Female

Presenting Complaints

• Acne with erythema, multiple papules, and early scarring (Figure 9)
• Duration: 3 months

Diagnosis

Grade III acne with acne scars

Treatment Plan

• Systemic therapy: Isotretinoin 20 mg once daily for 3 months
• Topical therapy:
  • Pirfenidone 8% gel, applied twice daily as prophylaxis
  • Adapalene 0.1% gel, applied at night
• Maintenance therapy:
  • Isotretinoin 5 mg at bedtime
  • Pirfenidone 8% gel, applied once daily at night.

Outcome

Improvement in early acne scars after 8–10 weeks of therapy (Figure 10)

Expert Summary

Combination therapy with oral isotretinoin and topical pirfenidone 8% gel was associated with improvement in inflammatory acne lesions and prevention of acne scars. The patient has remained free of facial acne and acne scars for the past 6 weeks.