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Goyal A, Mehta H, Narang T, Vinay K, Chhabra S, Shilpa, Kaushik H, Kaur M, Sachdeva N, Dogra S. A double-blinded randomised control study to compare the effectiveness and safety of intralesional vitamin D 3 with intralesional triamcinolone and its correlation with tissue expression of vitamin D receptors in patients with keloid. Wound Repair Regen 2024. [PMID: 39262166 DOI: 10.1111/wrr.13209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 07/24/2024] [Accepted: 07/30/2024] [Indexed: 09/13/2024]
Abstract
Intralesional steroids commonly used for keloid treatment have adverse effects like cutaneous atrophy and telangiectasias. Safer and more effective therapies are needed. Preliminary studies suggest intralesional vitamin D as a potential alternative treatment. The aim of this study was to compare efficacy and safety of intralesional vitamin D with triamcinolone for keloids, and correlate tissue expression of vitamin D receptors (VDRs) with treatment outcomes. Sixty patients were randomly assigned to two groups: Group A (intralesional vitamin D) and Group B (intralesional triamcinolone). Four injections were given at 4-week intervals, with an 8-week follow-up. Biopsies were taken pre- and post-treatment to examine VDR expression levels and treatment response correlation. The primary outcome of interest was the proportion of patients achieving a 50% reduction in Vancouver Scar Scale (VSS). Secondary outcomes included incidence of adverse effects, and changes in VDR expression before and after treatment. Baseline VSS scores were 9.73 ± 1.01 (vitamin D group) and 10.13 ± 1.07 (triamcinolone group). After treatment, mean VSS decreased to 5.17 ± 0.59 (vitamin D group, p < 0.001) and 4.77 ± 0.77 (triamcinolone group, p < 0.001), with significantly better response in latter (p = 0.03). More than 50% reduction in VSS score was higher in the triamcinolone group (76.7% vs. 50%, p = 0.032). No recurrences were noted during the 8-week follow-up. Hypopigmentation (80% vs. 36.7%, p < 0.001) and atrophy (73.3% vs. 40%, p = 0.009) were more common in the triamcinolone group. No significant difference in pre- and post-treatment VDR receptor expression was observed in either group. Both triamcinolone acetonide and vitamin D were effective for keloids. Triamcinolone was more efficacious, whereas vitamin D was safer, suggesting it as a viable alternative for keloid management.
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Affiliation(s)
- Aman Goyal
- Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Hitaishi Mehta
- Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Tarun Narang
- Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Keshavamurthy Vinay
- Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Seema Chhabra
- Department of Immunopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shilpa
- Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Hitaishi Kaushik
- Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manjot Kaur
- Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Naresh Sachdeva
- Department of Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sunil Dogra
- Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Clauss KD, Bineshfar N, Walsh HL, Johnson TE. Burn-Induced Cicatricial Eyelid Retraction: A Challenging Case and Review of Management Principles. J Burn Care Res 2024; 45:1076-1079. [PMID: 38666609 DOI: 10.1093/jbcr/irae072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2024]
Abstract
Thermal and chemical burns can result in cicatricial eyelid retraction, characterized by an abnormal resting position of the eyelid margin and increased palpebral fissure height. Eyelid retraction often leads to exposure keratopathy, which can cause complications ranging from mild dry eye to globe-threatening ulceration and perforation. Prompt intervention includes aggressive lubrication, moisture chambers, eyelid tarsorrhaphy, and retraction repair surgery. Discussed here is a burn patient that developed severe cicatricial eyelid retraction and ectropion, leading to severe exposure keratopathy and infectious corneal ulceration with perforation. The patient required aggressive medical intervention, as well as 2 surgeries to restore the normal eyelid anatomy to protect the globe.
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Affiliation(s)
- Kevin D Clauss
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Niloufar Bineshfar
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Hannah L Walsh
- University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Thomas E Johnson
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
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Tsubouchi H, Awaji T, Hirose R, Kishida K, Yamashita S, Furuya K, Chang Y, Shikado K, Kohta M, Ogita K. Preventive Effect of Hydrocolloid Dressings on Hypertrophic Scarring of Post-Cesarean Section Wounds: A Randomized Pilot Study. Adv Skin Wound Care 2024; 37:360-367. [PMID: 38899817 DOI: 10.1097/asw.0000000000000155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
OBJECTIVE To determine the prophylactic effect of hydrocolloid dressings on hypertrophic scarring in post-cesarean section wounds. METHODS Patients who underwent cesarean section (C/S) at the authors' hospital and provided informed consent to participate were randomly assigned to the intervention and control groups. The intervention group commenced applying hydrocolloid dressings to the wound on postoperative day 7 or 8 and continued with weekly dressing changes for 6 months. The control group refrained from any dressing application but was followed up. In each group, the condition of the wound was evaluated 6 and 12 months postoperatively using the Japan Scar Workshop Scar Scale 2015, the Patient and Observer Scar Assessment Scale version 2.0, the modified Vancouver Scar Scale, and patient-reported outcomes. RESULTS During this period, 135 patients underwent C/S at the authors' institution, and 47 (23 in the intervention group and 24 in the control group) were included in the analysis. In all assessment methods, the intervention group scored lower than the control group at 6 and 12 months after C/S. Twelve months after C/S, hypertrophic scarring (Japan Scar Workshop Scar Scale 2015 score of 6-15) was found in 14 of the 47 (29.8%) patients: 11 of 24 (45.8%) in the control group and 3 of 23 (13.0%) in the intervention group. The intervention's relative risk was 0.623 (95% CI, 0.417-0.930). The risk factor for hypertrophic scarring was midline vertical incision, with an odds ratio of 20.53 (95% CI, 4.18-100.92). CONCLUSIONS The study reveals that the application of hydrocolloid dressings to wounds reduces the risk of hypertrophic scarring after C/S.
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Affiliation(s)
- Hiroaki Tsubouchi
- In the Department of Obstetrics and Gynecology, Rinku General Medical Centre, Izumisano, Osaka, Japan, Hiroaki Tsubouchi, MD, PhD, is Deputy Chief; Takuya Awaji, MD, is Deputy Chief; Rikuto Hirose, MD, is Senior Resident; Kenji Kishida, MD, is Physician; Saya Yamashita, MD, PhD, is Deputy Head Physician; Kiichiro Furuya, MD, PhD, is Deputy Head Physician; Yangshil Chang, MD, is Deputy Head Physician; and Kayoko Shikado, MD, is Staff Doctor. Masushi Kohta, PhD, is Senior Assistant Professor, Research Center for Implementation Nursing Science Initiative, Fujita Health University, Toyoake, Aichi, Japan. Also in the Department of Obstetrics and Gynecology, Rinku General Medical Centre, Kazuhide Ogita, MD, PhD, is Chief Obstetrician
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Mavilakandy AK, Vayalapra S, Minty I, Parekh JN, Charles WN, Khajuria A. Comparing Combination Triamcinolone Acetonide and 5-Fluorouracil with Monotherapy Triamcinolone Acetonide or 5-Fluorouracil in the Treatment of Hypertrophic Scars: A Systematic Review and Meta-Analysis. Plast Reconstr Surg 2024; 153:1318-1330. [PMID: 37337341 DOI: 10.1097/prs.0000000000010867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
BACKGROUND Keloids and hypertrophic scars cause physical and psychosocial problems. A combination of 5-fluorouracil (5-FU) and triamcinolone acetonide (TAC) may enhance the treatment of pathologic scars, although the evidence base is limited. The authors compared the efficacy and complication rates of combination intralesional TAC and 5-FU with those of monotherapy intralesional TAC or 5-FU for the treatment of keloids and hypertrophic scars. METHODS Embase, MEDLINE, and CENTRAL were searched by two independent reviewers. The primary outcome was treatment efficacy (51% to 100% improvement). Study quality and risk of bias were assessed using the Cochrane risk of bias tool. RESULTS Of 277 articles screened, 13 studies were included, comprising 12 randomized control trials and one nonrandomized study. Six studies compared combination intralesional therapy versus monotherapy 5-FU, and nine studies compared combination intralesional therapy versus monotherapy TAC. The combined group demonstrated superior objective treatment efficacy compared with the monotherapy TAC group (OR, 3.45; 95% CI, 2.22 to 5.35; I 2 = 0%; P < 0.00001) and monotherapy 5-FU group (OR, 4.17; 95% CI, 2.21 to 7.87; I 2 = 0%; P < 0.0001). Telangiectasia was less frequent in combination therapy (OR, 0.24; 95% CI, 0.11 to 0.52; I 2 = 0%; P = 0.0003) compared with monotherapy TAC. CONCLUSIONS Combined intralesional TAC and 5-FU administration demonstrated superior treatment efficacy outcomes compared with monotherapy TAC or 5-FU. Patient-reported outcome measures should be incorporated in the design of future research to justify clinical recommendations. CLINICAL RELEVANCE STATEMENT Combined TAC and 5-FU has demonstrated superior treatment efficacy outcomes compared to monotherapy TAC or 5-FU in the treatment of hypertrophic scars and keloids.
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Affiliation(s)
| | | | - Iona Minty
- University of Liverpool
- University College London Hospital
| | - Jvalant N Parekh
- Department of Plastic Surgery, Sandwell Hospital, Sandwell and West Birmingham NHS Trust
| | | | - Ankur Khajuria
- Department of Surgery and Cancer, Imperial College London
- Kellogg College, Nuffield Department of Surgical Sciences, University of Oxford
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Zhuang ZM, Wang Y, Feng ZX, Lin XY, Wang ZC, Zhong XC, Guo K, Zhong YF, Fang QQ, Wu XJ, Chen J, Tan WQ. Targeting Diverse Wounds and Scars: Recent Innovative Bio-design of Microneedle Patch for Comprehensive Management. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2024; 20:e2306565. [PMID: 38037685 DOI: 10.1002/smll.202306565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/16/2023] [Indexed: 12/02/2023]
Abstract
Wounds and the subsequent formation of scars constitute a unified and complex phased process. Effective treatment is crucial; however, the diverse therapeutic approaches for different wounds and scars, as well as varying treatment needs at different stages, present significant challenges in selecting appropriate interventions. Microneedle patch (MNP), as a novel minimally invasive transdermal drug delivery system, has the potential for integrated and programmed treatment of various diseases and has shown promising applications in different types of wounds and scars. In this comprehensive review, the latest applications and biotechnological innovations of MNPs in these fields are thoroughly explored, summarizing their powerful abilities to accelerate healing, inhibit scar formation, and manage related symptoms. Moreover, potential applications in various scenarios are discussed. Additionally, the side effects, manufacturing processes, and material selection to explore the clinical translational potential are investigated. This groundwork can provide a theoretical basis and serve as a catalyst for future innovations in the pursuit of favorable therapeutic options for skin tissue regeneration.
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Affiliation(s)
- Ze-Ming Zhuang
- Department of Plastic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 East Qingchun Road, Hangzhou, 310016, P. R. China
| | - Yong Wang
- Department of Plastic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 East Qingchun Road, Hangzhou, 310016, P. R. China
| | - Zi-Xuan Feng
- Department of Plastic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 East Qingchun Road, Hangzhou, 310016, P. R. China
| | - Xiao-Ying Lin
- Department of Plastic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 East Qingchun Road, Hangzhou, 310016, P. R. China
| | - Zheng-Cai Wang
- Department of Plastic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 East Qingchun Road, Hangzhou, 310016, P. R. China
| | - Xin-Cao Zhong
- Department of Plastic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 East Qingchun Road, Hangzhou, 310016, P. R. China
| | - Kai Guo
- Department of Plastic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 East Qingchun Road, Hangzhou, 310016, P. R. China
| | - Yu-Fan Zhong
- Department of Plastic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 East Qingchun Road, Hangzhou, 310016, P. R. China
| | - Qing-Qing Fang
- Department of Plastic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 East Qingchun Road, Hangzhou, 310016, P. R. China
| | - Xiao-Jin Wu
- Department of Ultrasound in Medicine, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, 322000, P. R. China
| | - Jian Chen
- Department of Ultrasound in Medicine, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, 322000, P. R. China
| | - Wei-Qiang Tan
- Department of Plastic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 East Qingchun Road, Hangzhou, 310016, P. R. China
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Murakami T, Shigeki S. Pharmacotherapy for Keloids and Hypertrophic Scars. Int J Mol Sci 2024; 25:4674. [PMID: 38731893 PMCID: PMC11083137 DOI: 10.3390/ijms25094674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 04/19/2024] [Accepted: 04/23/2024] [Indexed: 05/13/2024] Open
Abstract
Keloids (KD) and hypertrophic scars (HTS), which are quite raised and pigmented and have increased vascularization and cellularity, are formed due to the impaired healing process of cutaneous injuries in some individuals having family history and genetic factors. These scars decrease the quality of life (QOL) of patients greatly, due to the pain, itching, contracture, cosmetic problems, and so on, depending on the location of the scars. Treatment/prevention that will satisfy patients' QOL is still under development. In this article, we review pharmacotherapy for treating KD and HTS, including the prevention of postsurgical recurrence (especially KD). Pharmacotherapy involves monotherapy using a single drug and combination pharmacotherapy using multiple drugs, where drugs are administered orally, topically and/or through intralesional injection. In addition, pharmacotherapy for KD/HTS is sometimes combined with surgical excision and/or with physical therapy such as cryotherapy, laser therapy, radiotherapy including brachytherapy, and silicone gel/sheeting. The results regarding the clinical effectiveness of each mono-pharmacotherapy for KD/HTS are not always consistent but rather scattered among researchers. Multimodal combination pharmacotherapy that targets multiple sites simultaneously is more effective than mono-pharmacotherapy. The literature was searched using PubMed, Google Scholar, and Online search engines.
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Affiliation(s)
- Teruo Murakami
- Laboratory of Biopharmaceutics and Pharmacokinetics, Faculty of Pharmaceutical Sciences, Hiroshima International University, Higashi-Hiroshima 731-2631, Japan;
| | - Sadayuki Shigeki
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Higashi-Hiroshima 731-2631, Japan
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Barańska-Rybak W, Świerczewska Z, Lemiec A, Walker L. Triamcinolone Injection in the Treatment of Malar Edema. Dermatol Pract Concept 2024; 14:dpc.1402a117. [PMID: 38810029 PMCID: PMC11136127 DOI: 10.5826/dpc.1402a117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2023] [Indexed: 05/31/2024] Open
Abstract
INTRODUCTION Tear-through deformities can be a detectable sign of facial aging. Over recent years, minimally invasive procedures such as hyaluronic acid filler injections have been shown to be effective in improving this area. Malar edema is the accumulation of fluid over the malar eminence persisting for 1 month or more. Given its nature, the management remains problematic. The most commonly reported treatment modality is injection with hyaluronidase. OBJECTIVES To determine the safety and efficacy of triamcinolone injection in the treatment of malar edema. METHODS A total of 15 female patients with malar edema, with a mean age of 43.77 years, were treated with triamcinolone injections. The volume injected was chosen by the investigator. Prior to the triamcinolone injection, all patients had been treated with hyaluronidase, which turned out to be ineffective in all cases. Patients were asked to note all adverse effects. RESULTS Satisfactory results were achieved after a single treatment session for 14 patients and after two treatments for one patient. Overall, injections with triamcinolone were well tolerated and no adverse reactions were reported. CONCLUSIONS Injection with triamcinolone appears to be a safe and effective option for the management of malar edema following hyaluronic acid filler injection. Nevertheless, further research with larger patient groups is compulsory.
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Affiliation(s)
- Wioletta Barańska-Rybak
- Department of Dermatology, Venereology and Allergology, Faculty of Medicine, Medical University of Gdańsk, Poland
| | - Zuzanna Świerczewska
- Department of Dermatology, Venereology and Allergology, Faculty of Medicine, Medical University of Gdańsk, Poland
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Mozafari N, Mollaabasi F, Mansouri P, Robati RM. The Combined Application of Bleomycin and Triamcinolone for Treating Refractory Keloids. Dermatol Surg 2024; 50:267-271. [PMID: 38113179 DOI: 10.1097/dss.0000000000004056] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
BACKGROUND Triamcinolone acetate injections are considered the first treatment option for keloids, but quite high proportions of keloids either do not respond to triamcinolone or develop recurrence. Beneficial effects of intralesional bleomycin have been recently shown in the treatment of keloids and hypertrophic scars. However, the efficacy of combination therapy using intralesional triamcinolone and bleomycin remains undetermined. OBJECTIVE The purpose of this study was to evaluate the efficacy of using bleomycin and triamcinolone mixture to treat refractory keloids. MATERIALS AND METHODS In total, 33 patients with resistant keloids (including 8 men and 25 women) and a mean age of 36.52 years (age range of 18-65 years) were enrolled in this study. A mixture of bleomycin (1 u/cc) with triamcinolone acetonide (13.3 mg/cc) was injected intralesionally into the keloids every 4 to 6 weeks for a maximum of 6 cycles. The clinical improvement was evaluated using the Japan Scar Scale (JSS) and the physician's global assessment of the flattening of the lesions. Side effects were also noted and recorded. RESULTS In all patients, the total JSS scores decreased significantly after treatment (2.33 ± 1.05), compared with baseline (11.61 ± 2.59), ( p < .001); 26 keloids (78.8%) showed an excellent response (75%-100% flattening), 7 keloids (21.2%) showed a fair response (25%-75% flattening), and 0 keloids (0%) showed a poor response (<25% flattening). Observed side effects were ulceration (33.3%), hyperpigmentation (33.3%), hypopigmentation (15.15%), secondary infection (33.3%), and telangiectasis (15.15%). CONCLUSION The combined use of bleomycin and triamcinolone offers a promising treatment option for individuals who have not responded well to traditional therapies.
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Affiliation(s)
- Nikoo Mozafari
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Dermatology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Faeghe Mollaabasi
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Dermatology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parvin Mansouri
- Medical Laser Research Centers, Academic Center of Education, Culture and Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza M Robati
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Dermatology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Tomtschik J, Anand N, Bustos SS, Martinez-Jorge J, Wyles SP. Practical management of hypertrophic scarring: the mayo clinic experience. Arch Dermatol Res 2024; 316:77. [PMID: 38244097 DOI: 10.1007/s00403-023-02802-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 12/04/2023] [Accepted: 12/14/2023] [Indexed: 01/22/2024]
Abstract
Hypertrophic scarring is a potential consequence of wound healing that causes functional and aesthetic disability. Common treatments include intralesional pharmacotherapy (e.g., triamcinolone), surgical excision, and energy-based laser devices. While numerous treatment methods have been described for hypertrophic scarring, an optimal treatment strategy has yet to be established given variability in clinical presentation. This study aims to identify patient- and provider-preferred treatment patterns. This is a single-center, retrospective study of adult patients that developed post-surgical hypertrophic scarring between 2007 and 2017. Specifically, trends in procedural management for hypertrophic scarring among this cohort were examined. A total of 442 procedures (intralesional steroid injection, surgical excision, laser-based treatment) were identified in 218 patients with a clinical diagnosis of hypertrophic scarring. Approximately 73% were female; 87% were Caucasian. The median age at first procedure was 45.6 years (SD = 17.4). The most frequent anatomical locations for procedures were the trunk (n = 242; 54.8%), followed by head/neck (n = 86; 19.5%), upper extremities (n = 67; 15.2%), and lower extremities (n = 45; 10.2%). Procedural therapies included intralesional steroid injection (n = 221; 50%), surgical excision (n = 112; 25.3%) and laser (fractional non-ablative laser vs. pulsed dye laser; n = 109; 24.5%). Treatment modality varied by stage of treatment, scar anatomical location, and scar size. This single-center series of patients with hypertrophic scarring highlights a patient-centered management approach and offers clinical guidelines for provider-patient shared decision making.
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Affiliation(s)
- Julia Tomtschik
- Department of Dermatology, Mayo Clinic, 200 First Street S.W., Rochester, MN, 55905, USA.
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
| | - Nimay Anand
- Department of Dermatology, Mayo Clinic, 200 First Street S.W., Rochester, MN, 55905, USA
| | - Samyd S Bustos
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Saranya P Wyles
- Department of Dermatology, Mayo Clinic, 200 First Street S.W., Rochester, MN, 55905, USA
- Center for Regenerative Medicine and Biotherapeutics, Mayo Clinic, Rochester, MN, USA
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Anggraini YE, Trisnowati N, Martien R, Danarti R. A randomised clinical trial study assessing the efficacy of 5% losartan potassium loaded in ethosomal gel to treat human keloids: a trial protocol. Trials 2024; 25:12. [PMID: 38167064 PMCID: PMC10759551 DOI: 10.1186/s13063-023-07880-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 12/15/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Keloid is a skin disorder that results from excessive fibrous tissue growth in the area of the initial trauma. Treating keloids can be challenging since the success of various treatments varies from one study to another. Triamcinolone acetonide injection, a standard treatment, can cause undesirable side effects. Meanwhile, the effectiveness of existing topical therapies for keloids is not always reliable. The pro-inflammatory, pro-proliferative, and pro-fibrotic effects of angiotensin II in human skin contribute to keloid formation. Losartan potassium, an angiotensin II blocker, has the potential to act as an anti-keloid agent. Due to the thicker skin structure of a keloid and ease of application, ethosome gel is chosen as a safe and comfortable carrier for losartan potassium, making it a good choice for treating keloids. METHODS In this randomised clinical trial, 46 adults with keloids were divided into two treatment groups. One group of 23 participants received 5% losartan potassium loaded in ethosomal gel, while the other group of 23 participants received intralesional injections of 10% triamcinolone acetonide. Over 12 weeks, changes in POSAS 3.0 scores, degree of erythema and pigmentation, surface area, thickness, and pliability of the keloids will be measured at four different times: baseline, 4 weeks, 8 weeks, and 12 weeks. Statistical analysis will be conducted using SPSS software version 24, with a significance level of p < 0.05. DISCUSSION Losartan potassium is believed to be beneficial for keloid management because it inhibits the angiotensin II receptor, which plays a role in inflammation, proliferation, and fibrosis. This study examines the efficacy of 5% losartan potassium loaded in ethosomal gel for human keloids. TRIAL REGISTRATION Clinicaltrial.gov identifier NCT05893108 . Registered on 7 June 2023.
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Affiliation(s)
- Yuni Eka Anggraini
- Faculty of Medicine, Universitas Riau, Kota Pekanbaru, Indonesia
- Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Niken Trisnowati
- Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Ronny Martien
- Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Retno Danarti
- Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
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Yang HA, Jheng WL, Yu J, Huang JY, Cheng KY, Lee JJ. Comparative Efficacy of Drug Interventions for Keloids: A Network Meta-analysis. Ann Plast Surg 2024; 92:S52-S59. [PMID: 38285997 DOI: 10.1097/sap.0000000000003759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Abstract
BACKGROUND Keloids are common benign skin lesions originating from a disorganized fibroproliferative collagen response; these lesions often lead to both physical and psychological problems. The optimal treatment for keloids is yet to be standardized. Intralesional injection, which is simple and nontraumatic, is one of the most commonly used treatment modalities for these lesions. In this study, we compared 5 different drugs (intralesional injections) for the treatment of keloids in terms of efficacy. METHODS We systemically searched relevant studies on PubMed, EMBASE, and Cochrane Library. Randomized clinical trials on the safety and efficacy of triamcinolone acetonide (TAC), 5-fluorouracil (5-FU), botulinum toxin A (BTA), verapamil, and bleomycin were included in this study. RESULTS This network meta-analysis included a total of 1114 patients from 20 randomized controlled trials. Botulinum toxin A alone and TAC plus 5-FU exhibited significantly better efficacy than did 5-FU, TAC, and verapamil. No significant difference in efficacy between BTA alone and TAC combined with 5-FU was observed. No significant differences were noted in the adverse event rate between BTA, TAC plus 5-FU, 5-FU, and TAC. Furthermore, we performed surface under the cumulative ranking curve analyses to predict the rank of each intervention (by efficacy and adverse event rate). The predicted ranking by efficacy was as follows: TAC plus 5-FU, BTA, bleomycin, TAC, 5-FU, and verapamil; the predicted ranking by adverse events was as follows: TAC, 5-FU, TAC plus 5-FU, and BTA. Funnel plot analysis revealed no publication bias. CONCLUSIONS Botulinum toxin A and TAC plus 5-FU appear to have outstanding therapeutic efficacy for keloids. The rate of adverse events was similar among BTA, TAC, 5-FU, and TAC plus 5-FU. Nonetheless, additional reviews of rigorous, large-scale randomized controlled trials are warranted for further validation of our findings.
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Affiliation(s)
| | | | | | | | - Kai-Yuan Cheng
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung City, Taiwan
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12
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Zhou J, Hao F, Huang L, Fu Q, Yuan L, Luo G, Tan J. Treatment of hypertrophic scars with ablative fractional carbon dioxide laser assisted with different topical triamcinolone delivery ways. Heliyon 2023; 9:e22818. [PMID: 38125450 PMCID: PMC10730585 DOI: 10.1016/j.heliyon.2023.e22818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 11/17/2023] [Accepted: 11/20/2023] [Indexed: 12/23/2023] Open
Abstract
Objectives Ablative fractional carbon dioxide laser has been used with triamcinolone to treat hypertrophic scars, resulting in promising success rates. However, there are different topical triamcinolone delivery methods used in scar treatment. To assess the efficacy among the different triamcinolone delivery methods, this study was designed to compare the efficacy and safety of ablative fractional carbon dioxide laser followed by penetration and injection of topical triamcinolone into thicker hypertrophic scars (height score of VSS ≥2). Study design/materials and methods We performed a retrospective study of 155 thicker hypertrophic scar patients (height score of VSS ≥2), including 88 patients in the triamcinolone external application group and 67 patients in the triamcinolone intralesional injection group. One month after the patients had 3 treatment sessions at 4-week intervals, the scars were assessed by photography, the Vancouver Scar Scale (VSS), durometry and spectrocolorimetry. Any adverse effects were also evaluated. Results The VSS scores and the hardness of the scars in both groups improved significantly compared to baseline. Moreover, the patients in the triamcinolone intralesional injection group had higher treatment efficacy (19.77 ± 21.25 %) based on their VSS scores than the patients in the triamcinolone external application group (5.94 ± 24.07 %), especially in the improvement of scar pliability, height and hardness. Meanwhile, in the triamcinolone injection group, more patients had mild and moderate improvement than in the triamcinolone application group. However, there were no differences in the distribution of the adverse effects in either group. Conclusions This study demonstrated that using the ablative fractional carbon dioxide laser followed by different topical triamcinolone delivery methods is effective and safe for thicker hypertrophic scar improvement. The method of using the ablative fractional carbon dioxide laser assisted with triamcinolone injection had a better therapeutic outcome in thicker hypertrophic scars, as compared with triamcinolone penetration.
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Affiliation(s)
| | | | - Ling Huang
- Institute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injury, Chongqing Key Laboratory for Disease Proteomics, Southwest Hospital, Army Medical University, Chongqing, 400038, China
| | - Qingqing Fu
- Institute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injury, Chongqing Key Laboratory for Disease Proteomics, Southwest Hospital, Army Medical University, Chongqing, 400038, China
| | - Lili Yuan
- Institute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injury, Chongqing Key Laboratory for Disease Proteomics, Southwest Hospital, Army Medical University, Chongqing, 400038, China
| | - Gaoxing Luo
- Institute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injury, Chongqing Key Laboratory for Disease Proteomics, Southwest Hospital, Army Medical University, Chongqing, 400038, China
| | - Jianglin Tan
- Institute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injury, Chongqing Key Laboratory for Disease Proteomics, Southwest Hospital, Army Medical University, Chongqing, 400038, China
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13
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Rimmer SN, Chandy RJ, Khan D, Feldman SR. Recurrence rates in the treatment of keloids and hypertrophic scars with intralesional triamcinolone combined with other intralesional agents. Arch Dermatol Res 2023; 315:2757-2767. [PMID: 37432467 DOI: 10.1007/s00403-023-02662-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/10/2023] [Accepted: 06/25/2023] [Indexed: 07/12/2023]
Abstract
Hypertrophic scars (HTS) and keloids are pathologic scars that are products of a wound healing pathway error attributed to genetic and inflammatory causes (Leventhal et al., Arch Facial Plast Surg 8(6):362-368. https://doi.org/10.1001/archfaci.8.6.362 , 2006). Methods of pathologic scar treatment include intralesional agents, cryotherapy, surgical excision, pressure dressings, topical agents, laser resurfacing, radiotherapy, and other investigational therapies (Leventhal et al. 2006). The recurrence of pathologic scar is high across all treatment modalities, including the use of intralesional agents (Trisliana Perdanasari et al., Arch Plast Surg 41(6):620-629. https://doi.org/10.5999/aps.2014.41.6.620 , 2014). In the treatment of pathologic scar, combination approaches using intralesional agents, such as triamcinolone (TAC), 5-fluorouracil (5FU), verapamil (VER), bleomycin (BLM), and botulinum toxin (BTX), are superior therapies when compared to monotherapy (Yosipovitch et al., J Dermatol Treat 12(2):87-90. https://doi.org/10.1080/095466301317085363 , 2001; Yang et al., Front Med 8:691628. https://doi.org/10.3389/fmed.2021.691628 , 2021; Sun et al., Aesthetic Plast Surg 45(2):791-805. https://doi.org/10.1007/s00266-019-01570-8 , 2021). This review assesses recurrence and the reporting of recurrence in pathologic scar after treatment with intralesional triamcinolone (TAC) in combination with another intralesional agent. A literature review was conducted using research journals from PubMed using the following search terms: [(keloid) AND (triamcinolone) AND (combination) AND (intralesional)], as well as [(keloid) AND (triamcinolone) AND (combination)]. Articles were reviewed and included if the article analyzed or compared intralesional agents for pathologic scar treatment within the last 10 years. The average follow-up period of included articles (n = 14) that utilized combination intralesional therapy (TAC-X) was approximately 11 months (range 1-24 months). Consistent recurrence rate reporting across studies was lacking. The combination agent with the highest recurrence rate was TAC-5FU (23.3%). The range of reported recurrence rates was 7.5-23.3%. Six studies using various intralesional combination regimens reported 0% recurrence over the follow-up period (TAC-5FU, TAC-BTX, TAC-BLM, TAC-CRY). Three studies did not report recurrence rates. While the efficacy of combination therapy is typically assessed via scar scales, the assessment of recurrence across studies of combination therapy is inconsistent and inadequate, with truncated follow-up periods. While scar recurrence can take place during 1-year post-treatment, long-term follow-up (18-24 months) is needed to characterize recurrence in the treatment of pathologic scar using various intralesional agents. Long-term follow-up periods allow patients to receive accurate prognostic information regarding recurrence after combination intralesional therapy. There are limitations to this review in that comparisons were made across studies with varying outcome variables, including scar size, injection concentration and interval, and follow-up period. Standardized follow-up periods and recurrence rate reporting are integral to furthering the understanding of these therapies and enhancing patient care.
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Affiliation(s)
- Sarah N Rimmer
- Department of Dermatology, Center for Dermatology Research, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
| | - Rithi J Chandy
- Department of Dermatology, Center for Dermatology Research, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Danyaal Khan
- Department of Dermatology, Center for Dermatology Research, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Steven R Feldman
- Department of Dermatology, Center for Dermatology Research, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Dermatology, University of Southern Denmark, Odense, Denmark
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14
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Abstract
Wound healing occurs as a response to disruption of the epidermis and dermis. It is an intricate and well-orchestrated response with the goal to restore skin integrity and function. However, in hundreds of millions of patients, skin wound healing results in abnormal scarring, including keloid lesions or hypertrophic scarring. Although the underlying mechanisms of hypertrophic scars and keloid lesions are not well defined, evidence suggests that the changes in the extracellular matrix are perpetuated by ongoing inflammation in susceptible individuals, resulting in a fibrotic phenotype. The lesions then become established, with ongoing deposition of excess disordered collagen. Not only can abnormal scarring be debilitating and painful, it can also cause functional impairment and profound changes in appearance, thereby substantially affecting patients' lives. Despite the vast demand on patient health and the medical society, very little progress has been made in the care of patients with abnormal scarring. To improve the outcome of pathological scarring, standardized and innovative approaches are required.
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Affiliation(s)
- Marc G Jeschke
- Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada.
| | - Fiona M Wood
- Burns Service of Western Australia, Fiona Stanley Hospital, Perth Children's Hospital, Perth, Western Australia, Australia
- Burn Injury Research Unit, University of Western Australia, Perth, Western Australia, Australia
| | - Esther Middelkoop
- Burn Center, Red Cross Hospital, Beverwijk, Netherlands
- Association of Dutch Burn Centers (ADBC), Beverwijk, Netherlands
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Amsterdam Movement Sciences (AMS) Institute, Amsterdam UMC, Amsterdam, Netherlands
| | - Ardeshir Bayat
- Medical Research Council Wound Healing Unit, Hair and Skin Research Lab, Division of Dermatology, Department of Medicine, University of Cape Town & Groote Schuur Hospital, Cape Town, South Africa
| | - Luc Teot
- Department of Plastic Surgery, Burns, Wound Healing, Montpellier University Hospital, Montpellier, France
| | - Rei Ogawa
- Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School, Tokyo, Japan
| | - Gerd G Gauglitz
- Department of Dermatology and Allergy, Ludwig-Maximilian University Munich, Munich, Germany
- Haut- und Laserzentrum Glockenbach, Munich, Germany
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15
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Bharadia SK, Burnett L, Gabriel V. Hypertrophic Scar. Phys Med Rehabil Clin N Am 2023; 34:783-798. [PMID: 37806697 DOI: 10.1016/j.pmr.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Hypertrophic scars frequently develop post-burn, and are characterized by their pruritic, painful, raised, erythematous, dyschromic, and contractile qualities. This article aims to synthesize knowledge on the clinical and molecular development, evolution, management, and measurement of hypertrophic burn scar for both patient and clinician knowledge.
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Affiliation(s)
- Shyla Kajal Bharadia
- Cumming School of Medicine, University of Calgary, Foothills Medical Centre, 1403-29 Street Northwest, Calgary, Alberta T2N 2T9, Canada
| | - Lindsay Burnett
- Alberta Health Services, University of Calgary, Foothills Medical Centre, 1403-29 Street Northwest, Calgary, Alberta T2N 2T9, Canada
| | - Vincent Gabriel
- Department of Clinical Neurosciences, University of Calgary, Foothills Medical Centre, 1403-29 Street Northwest, Calgary, Alberta T2N 2T9, Canada; Department of Surgery, University of Calgary, Foothills Medical Centre, 1403-29 Street Northwest, Calgary, Alberta T2N 2T9, Canada; Medical Director, Calgary Firefighters Burn Treatment Centre, Foothills Medical Centre, 1403-29 Street Northwest, Calgary, Alberta T2N 2T9, Canada.
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16
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Tawk K, Goshtasbi K, Frank M, Martin EC, Abouzari M, Djalilian HR. Triamcinolone Injection for Cochlear Implant Magnet Adherence Issues. Otol Neurotol 2023; 44:e572-e576. [PMID: 37550870 PMCID: PMC10529445 DOI: 10.1097/mao.0000000000003974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
OBJECTIVES To evaluate the effectiveness of triamcinolone injections in treating external magnet displacement in cochlear implant (CI) patients with adhesions problems of their processor. PATIENTS We present seven CI patients with magnet adhesion issues who presented to our tertiary care neurotology clinic. None of the patients had a history of head trauma, postimplant MRI, or surgery in the head and neck other than the cochlear implantation. INTERVENTION Triamcinolone 40 mg/mL injected subcutaneously at the CI magnet site. MAIN OUTCOME MEASURE Reduction of scalp thickness and successful magnet retention. RESULTS Our cohort consisted of seven patients (eight implant sites) of which five were overweight or obese. The temporoparietal scalp thickness measured on preoperative CT scans varied between 8.4 and 15.9 mm. Initial conservative measures such as hair shaving at the magnet site, using a headband, and increasing magnet strength failed in all patients. After receiving triamcinolone injections at the CI receiver site, six out of seven patients (seven out of eight CI sites) were able to use their processor again without the need for a headband for an average of 9.55 hours/day. The average number of injections required for each patient was 2.57 (SD = 2.18), median (range) = 1 (1-7). One patient required a flap thinning surgery but showed no improvement even after flap thinning. None of the patients showed skin irritation, breakdown, ulceration, necrosis, or magnet exposure during follow-up period. CONCLUSIONS The significant improvement in CI retention shows that triamcinolone injections are effective in making the subcutaneous tissue thinner and allowing magnet retention.
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Affiliation(s)
- Karen Tawk
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine, USA
| | - Khodayar Goshtasbi
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine, USA
| | - Madelyn Frank
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine, USA
| | - Elaine C. Martin
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine, USA
| | - Mehdi Abouzari
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine, USA
| | - Hamid R. Djalilian
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine, USA
- Department of Biomedical Engineering, University of California, Irvine, USA
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17
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Xia Y, Wang Y, Hao Y, Shan M, Liu H, Liang Z, Kuang X. Deciphering the single-cell transcriptome network in keloids with intra-lesional injection of triamcinolone acetonide combined with 5-fluorouracil. Front Immunol 2023; 14:1106289. [PMID: 37275903 PMCID: PMC10235510 DOI: 10.3389/fimmu.2023.1106289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 05/08/2023] [Indexed: 06/07/2023] Open
Abstract
Objectives Keloid is a highly aggressive fibrotic disease resulting from excessive extracellular matrix deposition after dermal injury. Intra-lesional injection of triamcinolone acetonide (TAC) in combination with 5-fluorouracil (5-FU) is a commonly used pharmacological regimen and long-term repeated injections can achieve sustained inhibition of keloid proliferation. However, the molecular mechanisms underlying the inhibitory effect on keloids remain insufficiently investigated. Methods and materials This study performed single-cell RNA sequencing analysis of keloids treated with TAC+5-FU injections, keloids, and skins to explore patterns of gene expression regulation and cellular reprogramming. Results The results revealed that TAC+5-FU interrupted the differentiation trajectory of fibroblasts toward pro-fibrotic subtypes and induced keloid atrophy possibly by inhibiting the FGF signaling pathway in intercellular communication. It also stimulated partial fibroblasts to develop the potential for self-replication and multidirectional differentiation, which may be a possible cellular source of keloid recurrence. T cell dynamics demonstrated elevated expression of secretory globulin family members, which may be possible immunotherapeutic targets. Schwann cell populations achieved functional changes by increasing the proportion of apoptotic or senescence-associated cell populations and reducing cell clusters that promote epidermal development and fibroblast proliferation. Conclusions Our findings elucidated the molecular and cellular reprogramming of keloids by intra-lesional injection of TAC+5-FU, which will provide new insights to understand the mechanism of action and therapeutic targets.
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Affiliation(s)
- Yijun Xia
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Youbin Wang
- Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Yan Hao
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Mengjie Shan
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Hao Liu
- Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Zhengyun Liang
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Xinwen Kuang
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
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18
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Mony MP, Harmon KA, Hess R, Dorafshar AH, Shafikhani SH. An Updated Review of Hypertrophic Scarring. Cells 2023; 12:cells12050678. [PMID: 36899815 PMCID: PMC10000648 DOI: 10.3390/cells12050678] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/01/2023] [Accepted: 02/08/2023] [Indexed: 02/24/2023] Open
Abstract
Hypertrophic scarring (HTS) is an aberrant form of wound healing that is associated with excessive deposition of extracellular matrix and connective tissue at the site of injury. In this review article, we provide an overview of normal (acute) wound healing phases (hemostasis, inflammation, proliferation, and remodeling). We next discuss the dysregulated and/or impaired mechanisms in wound healing phases that are associated with HTS development. We next discuss the animal models of HTS and their limitations, and review the current and emerging treatments of HTS.
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Affiliation(s)
- Manjula P. Mony
- Department of Surgery, Division of Plastic & Reconstructive Surgery, Rush University Medical Center, Chicago, IL 60612, USA
| | - Kelly A. Harmon
- Department of Surgery, Division of Plastic & Reconstructive Surgery, Rush University Medical Center, Chicago, IL 60612, USA
| | - Ryan Hess
- Department of Surgery, Division of Plastic & Reconstructive Surgery, Rush University Medical Center, Chicago, IL 60612, USA
| | - Amir H. Dorafshar
- Department of Surgery, Division of Plastic & Reconstructive Surgery, Rush University Medical Center, Chicago, IL 60612, USA
| | - Sasha H. Shafikhani
- Department of Medicine, Division of Hematology and Oncology and Cell Therapy, Rush University Medical Center, Chicago, IL 60612, USA
- Cancer Center, Rush University Medical Center, Chicago, IL 60612, USA
- Correspondence:
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19
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Zhang W, Li X, Li X. Efficacy and Safety of Verapamil Versus Triamcinolone Acetonide in Treating Keloids and Hypertrophic Scars: A Systematic Review and Meta-Analysis. Aesthetic Plast Surg 2023; 47:473-482. [PMID: 36562775 DOI: 10.1007/s00266-022-03229-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 12/11/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Keloids and hypertrophic scars can affect the appearance and normal function of patients, and may severely affect patients' physical and mental health. Many methods have been used for the treatment of keloids and hypertrophic scars, there is no standardized method so far. The aim of this study was to compare the efficacy and safety of verapamil and triamcinolone acetonide (TAC) in treating keloids and hypertrophic scars. METHODS All studies from their inception date up to August 2022 were searched using four databases (PubMed, Cochrane Library, MEDLINE, and EMBASE). The weighted mean differences and the risk ratio were calculated for comparing continuous variables and dichotomous variables, respectively. RESULTS A total of nine randomized controlled trials involving 567 patients were identified. This meta-analysis indicated that TAC group showed significantly better effects compared with verapamil group in the reduction of height at 3 and 9 weeks, pliability at 3, 9, and 18 weeks, vascularity at 3, 6, 9, 12, 18, and 24 weeks, whereas verapamil group showed significantly better effects compared with TAC group in the reduction of pliability at 21 and 24 weeks. Verapamil group showed a significantly lower incidence of skin atrophy, telangiectasia, and hypopigmentation compared with TAC group. However, the incidence of burning sensation in verapamil group was higher than that in TAC group. CONCLUSION Concerning the treatment of keloids and hypertrophic scars, TAC was more effective than verapamil for improving vascularity; TAC was superior to verapamil in improving height within 9 weeks of treatment; TAC produced superior result for improving pliability within 18 weeks of treatment, whereas verapamil produced superior result between 18 and 24 weeks of treatment. Verapamil had fewer adverse events than TAC and can be used as a safer alternative for the treatment of keloids and hypertrophic scars. LEVEL OF EVIDENCE II This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Wei Zhang
- Department of Plastic Surgery, The First Affiliated Hospital of Anhui Medical University, 218# Ji-Xi Road, Hefei, 230022, Anhui, China
| | - Xiaojing Li
- Department of Plastic Surgery, The First Affiliated Hospital of Anhui Medical University, 218# Ji-Xi Road, Hefei, 230022, Anhui, China
| | - Xinyi Li
- Department of Plastic Surgery, The First Affiliated Hospital of Anhui Medical University, 218# Ji-Xi Road, Hefei, 230022, Anhui, China.
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20
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Zhang J, He Z, Tang Y, Xiao X, Yang F. CO 2 fractional laser combined with triamcinolone acetonide injection for the hypertrophic scars: which is first? Lasers Med Sci 2022; 38:7. [PMID: 36539641 DOI: 10.1007/s10103-022-03693-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 11/19/2022] [Indexed: 12/24/2022]
Abstract
The aim of this study is to investigate and analyze the effect of different application sequences of CO2 fractional laser and triamcinolone acetonide injection on the application effect of hypertrophic scar in one operation. Patients with hypertrophic scars who received CO2 lattice laser combined with triamcinolone acetonide injection from January 2021 to December 2022 were retrospectively analyzed. According to the different initial operations, they were divided into CO2 FL-TA group and TA-CO2 FL group. The Vancouver Scar Scale score and scar thickness of the two groups before and after treatment were analyzed. The complications occurred in the two groups during the treatment period. The clinical efficacy of the two groups before and after the treatment was calculated. Before treatment, there was no difference in scar thickness and VSS score between the two groups (P > 0.05). After treatment, the above indexes in CO2 FL-TA group were significantly better than those in TA-CO2 FL group (P < 0.05); the incidence of adverse reactions in CO2 FL-TA group was 9.38%, which was significantly lower than that in TA-CO2 FL group (18.75%) (P < 0.05); the total effective rate of CO2 FL-TA group was 90.63%, which was significantly higher than that in TA-CO2 FL group (65.63%) (P < 0.05). In the process of combined CO2 fractional laser and triamcinolone acetonide injection in the treatment of hypertrophic scars, CO2 fractional laser treatment first, and then triamcinolone acetonide injection can reduce the number of treatments, reduce the incidence of adverse reactions, and achieve more satisfactory treatment effect.
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Affiliation(s)
- Jianfei Zhang
- Burn and Plastic Surgery Department, The Second Affiliated Hospital, Hengyang Medical School, University of South China, No. 35, Jiefang Avenue, Zhengxiang District, Hengyang City, 421000, Hunan Province, China
| | - Ziqing He
- Burn and Plastic Surgery Department, The Second Affiliated Hospital, Hengyang Medical School, University of South China, No. 35, Jiefang Avenue, Zhengxiang District, Hengyang City, 421000, Hunan Province, China
| | - Yujun Tang
- Burn and Plastic Surgery Department, The Second Affiliated Hospital, Hengyang Medical School, University of South China, No. 35, Jiefang Avenue, Zhengxiang District, Hengyang City, 421000, Hunan Province, China
| | - Xia Xiao
- Burn and Plastic Surgery Department, The Second Affiliated Hospital, Hengyang Medical School, University of South China, No. 35, Jiefang Avenue, Zhengxiang District, Hengyang City, 421000, Hunan Province, China
| | - Feng Yang
- Burn and Plastic Surgery Department, The Second Affiliated Hospital, Hengyang Medical School, University of South China, No. 35, Jiefang Avenue, Zhengxiang District, Hengyang City, 421000, Hunan Province, China.
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21
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Disphanurat W, Sivapornpan N, Srisantithum B, Leelawattanachai J. Efficacy of a triamcinolone acetonide-loaded dissolving microneedle patch for the treatment of hypertrophic scars and keloids: a randomized, double-blinded, placebo-controlled split-scar study. Arch Dermatol Res 2022; 315:989-997. [PMID: 36383222 DOI: 10.1007/s00403-022-02473-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 11/09/2022] [Accepted: 11/10/2022] [Indexed: 11/17/2022]
Abstract
The treatment of hypertrophic scars (HTSs) and keloids remains a challenge. Intralesional triamcinolone acetonide (TAC) is the mainstay treatment for these conditions. Despite its efficacy, TAC has several adverse side effects, including telangiectasias, skin atrophy, pigmentary changes, and skin necrosis. Dissolving microneedles (DMN) use the poke-and-release method to create microchannels that enhance drug delivery to the target tissue in the dermis, without causing pain and with a decreased risk of transmission of blood-borne diseases. To evaluate and compare the efficacy of a TAC-DMN versus a drug-free DMN patch for the treatment of HTSs and keloids, 20 patients (10 with HTSs and 10 with keloids) received a split-scar treatment: one half of the scar length was treated with TAC-DMNs and the other half was treated with drug-free DMN for three sessions at 14-day intervals. Efficacy was assessed by measuring the scar volume through a multispectral imaging system and using the Patient and Observer Scar Assessment Scale (POSAS). The HTSs treated with TAC-DMNs showed a significant reduction in the mean scar volume 2 weeks after the second treatment and 1 month after the third treatment (p = 0.028 and 0.020, respectively), while the HTSs treated with drug-free DMNs showed no significant reduction in the scar volume. Both sides of the keloids showed no significant reduction in mean scar volume. Using the POSAS, significant improvement in the appearance of both halves of the HTSs was observed 1 month after the treatments. A significant improvement (evaluated by POSAS) was also observed in the keloids treated with TAC-DMNs 2 weeks after the second treatment and 1 month after the third treatment. No significant improvement was observed from the patients' perspective as evaluated by POSAS in the keloids treated with drug-free DMNs. However, no significant difference was observed between the treatment and control halves. TAC-DMN is an effective treatment for HTSs. Increasing the dosage and duration of keloid scar treatment is required in future studies to determine whether it would result in a significant therapeutic outcome. This trial is registered in the Thai Clinical Trials Registry (TCTR20220318004; date of registration, March 17, 2022).
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Wang X, Liang B, Li J, Pi X, Zhang P, Zhou X, Chen X, Zhou S, Yang R. Identification and characterization of four immune-related signatures in keloid. Front Immunol 2022; 13:942446. [PMID: 35967426 PMCID: PMC9365668 DOI: 10.3389/fimmu.2022.942446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 06/27/2022] [Indexed: 11/29/2022] Open
Abstract
A keloid is a fibroproliferative disorder of unknown etiopathogenesis that requires ill-defined treatment. Existing evidence indicates that the immune system plays an important role in the occurrence and development of keloid. However, there is still a lack of research on the immune-related signatures of keloid. Here we identified immune-related signatures in keloid and explored their pathological mechanisms. Transcriptomic datasets (GSE7890, GSE92566, and GSE44270) of keloid and normal skin tissues were obtained from the Gene Expression Omnibus database. The overlap of differentially expressed genes and immune-related genes was considered as differentially expressed immune-related genes (DEIGs). Functional analysis, expression, and distribution were applied to explore the function and characteristics of DEIGs, and the expression of these DEIGs in keloid and normal skin tissues was verified by immunohistochemistry. Finally, we conducted interactive network analysis and immune infiltration analysis to determine the therapeutic potential and immune correlation. We identified four DEIGs (LGR5, PTN, JAG1, and DKK1). In these datasets, only GSE7890 met the screening criteria. In the GSE7890 dataset, DKK1 and PTN were downregulated in keloid, whereas JAG1 and LGR5 were upregulated in keloid. In addition, we obtained the same conclusion through immunohistochemistry. Functional analysis indicated that these four DEIGs were mainly involved in stem cell, cell cycle, UV response, and therapy resistance. Through interactive network analysis, we found that these DEIGs were associated with drugs currently used to treat keloid, such as hydrocortisone, androstanolone, irinotecan, oxaliplatin, BHQ-880, and lecoleucovorin. Finally, many immune cells, including CD8+ T cells, resting memory CD4+ T cells, and M1 macrophages, were obtained by immune infiltration analysis. In conclusion, we identified four immune signaling molecules associated with keloid (LGR5, PTN, JAG1, and DKK1). These immune-related signaling molecules may be important modules in the pathogenesis of keloid. Additionally, we developed novel therapeutic targets for the treatment of this challenging disease.
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Affiliation(s)
- Xiaoxiang Wang
- Guangdong Medical University, Zhanjiang, China
- Department of Burn Surgery, The First People’s Hospital of Foshan, Foshan, China
| | - Bo Liang
- The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jiehua Li
- Department of Dermatology, The First People’s Hospital of Foshan, Foshan, China
| | - Xiaobing Pi
- Department of Dermatology, The First People’s Hospital of Foshan, Foshan, China
| | - Peng Zhang
- Neijiang Health Vocational College, Neijiang, China
| | - Xinzhu Zhou
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, China
| | - Xiaodong Chen
- Department of Burn Surgery, The First People’s Hospital of Foshan, Foshan, China
- *Correspondence: Xiaodong Chen, ; Sitong Zhou, ; Ronghua Yang,
| | - Sitong Zhou
- Department of Dermatology, The First People’s Hospital of Foshan, Foshan, China
- *Correspondence: Xiaodong Chen, ; Sitong Zhou, ; Ronghua Yang,
| | - Ronghua Yang
- Guangdong Medical University, Zhanjiang, China
- Department of Burn and Plastic Surgery, Guangzhou First People’s Hospital, South China University of Technology, Guangzhou, China
- *Correspondence: Xiaodong Chen, ; Sitong Zhou, ; Ronghua Yang,
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Obi E. Surgical Considerations In Skin of Colour. Clin Exp Dermatol 2022; 47:1429-1437. [PMID: 35187688 DOI: 10.1111/ced.15147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 02/13/2022] [Accepted: 02/16/2022] [Indexed: 11/29/2022]
Abstract
For most clinicians undertaking surgery and patients undergoing surgery, the primary aim is the success of the operation being undertaken. The secondary aim is for optimal wound healing with minimal scar formation. The normal wound healing process involves four distinct but overlapping stages: Haemostasis, inflammation, proliferation and remodelling. In some patients the cellular process involved in the proliferation and remodelling stages can be deranged, resulting in the formation of hypertrophic or keloid scars. This is more frequently seen in skin of Colour. Excessive scarring is thought to be first described in the Smith papyrus about 1700 BC. Many years later Mancini (in 1962) and Peacock (in 1970) classified excessive scarring into hypertrophic and keloid scar formation. Clinicians can minimize the risk of these pathological scars developing with good pre-operative, peri-operative/intra-operative and post-operative surgical practices. We review the wound healing processes in association with good surgical principles and practice, discuss how implementing these principles in practice helps in prevention and management of pathological surgical scars such as hypertrophic scars and keloid scars. This review offers a practical step by step clinical guide that can be used by any clinician.
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Affiliation(s)
- Ebube Obi
- Department of Opthalmology, Aneurin Bevan University Health Board, Newport, UK
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Coentro JQ, Di Nubila A, May U, Prince S, Zwaagstra J, Järvinen TAH, Zeugolis D. Dual drug delivery collagen vehicles for modulation of skin fibrosis in vitro. Biomed Mater 2022; 17. [PMID: 35176732 DOI: 10.1088/1748-605x/ac5673] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 02/17/2022] [Indexed: 11/11/2022]
Abstract
Single molecule drug delivery systems have failed to yield functional therapeutic outcomes, triggering investigations into multi-molecular drug delivery vehicles. In the context of skin fibrosis, although multi-drug systems have been assessed, no system has assessed molecular combinations that directly and specifically reduce cell proliferation, collagen synthesis and transforming growth factor β1 (TGFβ1) expression. Herein, a core-shell collagen type I hydrogel system was developed for the dual delivery of a TGFβ trap, a soluble recombinant protein that inhibits TGFβ signalling, and Trichostatin A (TSA), a small molecule inhibitor of histone deacetylases. The antifibrotic potential of the dual delivery system was assessed in an in vitro skin fibrosis model induced by macromolecular crowding (MMC) and TGFβ1. SDS-PAGE and HPLC analyses revealed that ~ 50 % of the TGFβ trap and ~ 30 % of the TSA were released from the core and shell compartments, respectively, of the hydrogel system after 10 days (longest time point assessed) in culture. As a direct consequence of this slow release, the core (TGFβ trap) / shell (TSA) hydrogel system induced significantly (p < 0.05) lower than the control group (MMC and TGFβ1) collagen type I deposition (assessed via SDS-PAGE and immunocytochemistry), α smooth muscle actin (αSMA) expression (assessed via immunocytochemistry) and cellular proliferation (assessed via DNA quantification) and viability (assessed via calcein AM and ethidium homodimer-I staining) after 10 days in culture. On the other hand, direct TSA-TGFβ supplementation induced the lowest (p < 0.05) collagen type I deposition, αSMA expression and cellular proliferation and viability after 10 days in culture. Our results illustrate the potential of core-shell collagen hydrogel systems for sustained delivery of antifibrotic molecules.
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Affiliation(s)
- João Q Coentro
- Regenerative, Modular & Developmental Engineering Laboratory (REMODEL) and Science Foundation Ireland (SFI) Centre for Research in Medical Devices (CÚRAM), National University of Ireland Galway, Biomedical Sciences Building, Galway, Galway, IRELAND
| | - Alessia Di Nubila
- Regenerative, Modular & Developmental Engineering Laboratory (REMODEL) and Science Foundation Ireland (SFI) Centre for Research in Medical Devices (CÚRAM), National University of Ireland Galway, Biomedical Sciences Building, Galway, Galway, IRELAND
| | - Ulrike May
- Faculty of Medicine & Health Technology, Tampere University, Kalevantie 4, Tampere, 33014, FINLAND
| | - Stuart Prince
- Faculty of Medicine & Health Technology, Tampere University, Kalevantie 4, Tampere, 33014, FINLAND
| | - John Zwaagstra
- Human Health Therapeutics Research Centre, National Research Council Canada, Human Health Therapeutics Research Centre, Montreal, Quebec, K1A 0R6, CANADA
| | - Tero A H Järvinen
- Faculty of Medicine & Health Technology, Tampere University, Faculty of Medicine & Health Technology, Tampere, 33014, FINLAND
| | - Dimitrios Zeugolis
- Regenerative, Modular & Developmental Engineering Laboratory (REMODEL), Charles Institute of Dermatology, University College Dublin, Conway Institute of Biomolecular & Biomedical Research and School of Mechanical & Materials Engineering, Dublin, 4, IRELAND
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Liu SY, Wu JJ, Chen ZH, Zou ML, Teng YY, Zhang KW, Li YY, Guo DY, Yuan FL. The m 6A RNA Modification Modulates Gene Expression and Fibrosis-Related Pathways in Hypertrophic Scar. Front Cell Dev Biol 2021; 9:748703. [PMID: 34869335 PMCID: PMC8634666 DOI: 10.3389/fcell.2021.748703] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 09/22/2021] [Indexed: 12/29/2022] Open
Abstract
Purpose: To systematically analyze the overall m6A modification pattern in hyperplastic scars (HS). Methods: The m6A modification patterns in HS and normal skin (NS) tissues were described by m6A sequencing and RNA sequencing, and subsequently bioinformatics analysis was performed. The m6A-related RNA was immunoprecipitated and verified by real-time quantitative PCR. Results: The appearance of 14,791 new m6A peaks in the HS sample was accompanied by the disappearance of 7,835 peaks. The unique m6A-related genes in HS were thus associated with fibrosis-related pathways. We identified the differentially expressed mRNA transcripts in HS samples with hyper-methylated or hypo-methylated m6A peaks. Conclusion: This study is the first to map the m6A transcriptome of human HS, which may help clarify the possible mechanism of m6A-mediated gene expression regulation.
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Affiliation(s)
- Si-Yu Liu
- Department of Medicine, Institute of Integrated Traditional Chinese and Western Medicine, Wuxi Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Traditional Chinese Medicine, Wuxi, China
| | - Jun-Jie Wu
- Institute of Integrated Chinese and Western Medicine, The Hospital Affiliated to Jiangnan University, Wuxi, China
| | - Zhong-Hua Chen
- Department of Medicine, The Nantong University, Nantong, China
| | - Ming-Li Zou
- Department of Medicine, Institute of Integrated Traditional Chinese and Western Medicine, Wuxi Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Traditional Chinese Medicine, Wuxi, China
| | - Ying-Ying Teng
- The Hospital Affiliated to Jiangnan University, Wuxi, China
| | - Kai-Wen Zhang
- Department of Medicine, Institute of Integrated Traditional Chinese and Western Medicine, Wuxi Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Traditional Chinese Medicine, Wuxi, China
| | - Yue-Yue Li
- The Hospital Affiliated to Jiangnan University, Wuxi, China
| | - Dang-Yang Guo
- The Hospital Affiliated to Jiangnan University, Wuxi, China
| | - Feng-Lai Yuan
- Department of Medicine, Institute of Integrated Traditional Chinese and Western Medicine, Wuxi Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Traditional Chinese Medicine, Wuxi, China.,Institute of Integrated Chinese and Western Medicine, The Hospital Affiliated to Jiangnan University, Wuxi, China.,The Hospital Affiliated to Jiangnan University, Wuxi, China
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Dastagir K, Obed D, Bucher F, Hofmann T, Koyro KI, Vogt PM. Non-Invasive and Surgical Modalities for Scar Management: A Clinical Algorithm. J Pers Med 2021; 11:jpm11121259. [PMID: 34945731 PMCID: PMC8703513 DOI: 10.3390/jpm11121259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 11/18/2021] [Accepted: 11/25/2021] [Indexed: 12/18/2022] Open
Abstract
Scars can lead to aesthetic and functional impairments. The treatment of scars requires meticulous planning and an individually adapted therapeutic strategy. A conceptual algorithm for scar treatment makes everyday clinical work easier for the practitioner and offers more safety for the patient. Based on a retrospective analysis of 1427 patients who presented for treatment of a variety of scars, we developed an algorithm for scar management and treatment. The treatments are presented using case descriptions. Additionally, an electronic search of MEDLINE, EMBASE, and ClinicalTrials.gov databases was performed utilizing combinations of relevant medical subject headings for "scar treatment", "hypertrophic scar treatment" and "keloid treatment". Reference lists of relevant articles and reviews were hand-searched for additional reports. Observed outcomes included: conservative scar therapy, minimally invasive scar therapy, and surgical scar therapy using local, regional and free flaps. With this work, we provide an algorithm for safe scar treatment. For better understanding, we have described a clinical case for each algorithm modality.
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The Effectiveness of Immediate Triamcinolone Acetonide Injection after Auricular Keloid Surgery: A Prospective Randomized Controlled Trial. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3729. [PMID: 34367855 PMCID: PMC8337065 DOI: 10.1097/gox.0000000000003729] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 06/08/2021] [Indexed: 11/26/2022]
Abstract
The earlobe and helix are common sites for keloids following ear piercing. First-line therapy involves intra-keloidal excision followed by triamcinolone acetonide (TA) injection. Yet, the optimal timing for TA injection after keloid excision remains debated. The objective of this study was to compare outcomes between immediate and delayed TA injection after auricular keloid excision. Methods This was a prospective, controlled trial with patients randomized into immediate or delayed groups. The Vancouver Scar Scale (VSS) and Patient and Observer Scar Assessment Scale (POSAS) were used to evaluate scar quality. The number of recurrent keloid cases was recorded, defined as a VSS height of 3, POSAS thickness greater than 5, or an increase in VSS height or POSAS thickness after keloid excision. Overall complications were recorded. A P value less than 0.05 was considered statistically significant. Results The immediate group contained 18 patients, and the delayed group had 16 patients. The mean age of patients was 25.52 years, and the mean maximum keloid diameter was 14.49 mm (7-32.5 mm). The immediate group reported a statistically significant lower recurrence rate than did the delayed group at 5 months (P = 0.042). No significant differences were noted between VSS and POSAS scores at 3 months, and no complications were recorded during the study. Conclusions Immediate TA injection is an acceptable option for auricular keloid treatment. Here, it was associated with a lower recurrence rate than with delayed injection and resulted in no complications. The immediate and delayed groups had similar outcomes for VSS and POSAS.
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Carter AR, Davies BM, Brindley DA. Gazing Long into a Clinical and Social Abyss? Treating Hypertrophic Scarring and Keloids. Rejuvenation Res 2021; 24:307-309. [PMID: 34155931 PMCID: PMC8403195 DOI: 10.1089/rej.2021.0037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
This commentary discusses the unmet clinical and social needs associated with hypertrophic scars and keloids. The authors critically appraise these issues within the context of contemporary clinical standards of care and social mores catalyzed by the COVID-19 pandemic.
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