However, adverse events should be c

However, adverse events should be considered in spite of the effectiveness of bleomycin for scar treatment. Payapvipapong et al13 reported that bleomycin induced significantly more hyperpigmentation compared to TAC, while there were no statistical differences of other adverse events including pain, pruritus, burn,vesicle, and atrophy between two treatments. Also, bleomycin can induce ulceration as well as hyperpigmentation and pain, whereas TAC can induce atrophy, hypopigmentation, and telangiectasia.14 Kabel et al16 demonstrated that all methods including bleomycin and 5-FU alone or with TAC caused hyperpigmentation withoutstatistical differences after treatment in patients with keloid or hypertrophic scar. However, bleomycin induced more pain than 5-FU and 5-FU combined with TAC, while ulceration rate was statistically more increased in 5-FU alone or with TAC compared to bleomycin.Moreover, Naeini et al15 showed that patients treated with bleomycin experienced hyperpigmentation, while patients treated with TAC plus cryotherapy reported hypopigmentation and telangiectasia. Collectively, adverse effects of bleomycin, including hyperpigmentation, pain, and ulceration, should be explained for patients before starting treatment. Also, adequate managements, such as mixing bleomycin with lidocaine to reduce pain, can be used to prevent or treat adverse effects.