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Kwon SH, Lee J, Yoo J, Jung Y. Artificial keloid skin models: understanding the pathophysiological mechanisms and application in therapeutic studies. Biomater Sci 2024; 12:3321-3334. [PMID: 38812375 DOI: 10.1039/d4bm00005f] [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: 05/31/2024]
Abstract
Keloid is a type of scar formed by the overexpression of extracellular matrix substances from fibroblasts following inflammation after trauma. The existing keloid treatment methods include drug injection, surgical intervention, light exposure, cryotherapy, etc. However, these methods have limitations such as recurrence, low treatment efficacy, and side effects. Consequently, studies are being conducted on the treatment of keloids from the perspective of inflammatory mechanisms. In this study, keloid models are created to understand inflammatory mechanisms and explore treatment methods to address them. While previous studies have used animal models with gene mutations, chemical treatments, and keloid tissue transplantation, there are limitations in fully reproducing the characteristics of keloids unique to humans, and ethical issues related to animal welfare pose additional challenges. Consequently, studies are underway to create in vitro artificial skin models to simulate keloid disease and apply them to the development of treatments for skin diseases. In particular, herein, scaffold technologies that implement three-dimensional (3D) full-thickness keloid models are introduced to enhance mechanical properties as well as biological properties of tissues, such as cell proliferation, differentiation, and cellular interactions. It is anticipated that applying these technologies to the production of artificial skin for keloid simulation could contribute to the development of inflammatory keloid treatment techniques in the future.
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Affiliation(s)
- Soo Hyun Kwon
- Center for Biomaterials, Korea Institute of Science and Technology, Seoul 02792, Republic of Korea.
| | - Jongmin Lee
- Center for Biomaterials, Korea Institute of Science and Technology, Seoul 02792, Republic of Korea.
- KU-KIST Graduate School of Converging Science and Technology, Korea University, Republic of Korea
| | - Jin Yoo
- Center for Biomaterials, Korea Institute of Science and Technology, Seoul 02792, Republic of Korea.
| | - Youngmee Jung
- Center for Biomaterials, Korea Institute of Science and Technology, Seoul 02792, Republic of Korea.
- School of Electrical and Electronic Engineering, YU-KIST Institute, Yonsei University, Seoul 03722, Republic of Korea
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Huang Y, Ren S, Yang Q. Efficacy and Safety of Excision Combination Therapies for Earlobe Keloids: A Systematic Review and Meta-analysis. Aesthetic Plast Surg 2024:10.1007/s00266-024-04092-0. [PMID: 38789810 DOI: 10.1007/s00266-024-04092-0] [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: 12/22/2023] [Accepted: 04/15/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND Different combinations of excision and adjuvant therapies have been applied to improve outcomes for earlobe keloids, though evidence in this field is still lacking. OBJECTIVES This study sought to systematically investigate efficacy and safety of these treatments. METHODS We conducted a systematic search on PubMed, Embase, Web of Science, and Cochrane Library to find all relevant studies. Meta-analysis of recurrence rates (RRs) and adverse event rates with 95% confidence intervals, and individual participants data (IPD) were calculated for each intervention when possible. Otherwise, narrative syntheses were performed. RESULTS A total of 85 articles, covering 23 treatments for earlobe keloids, were included, indicating a preference for multiple combination therapy. The estimated RRs for 6 interventions (i.e., excision monotherapy, combinations of excision with imiquimod, pressure therapy, radiotherapy, steroids, and steroids with pressure therapy) appeared to be comparable. Electron radiotherapy was found to have potential advantages over X-ray treatment, contributing to the observed heterogeneity. Further meta-analysis using IPD revealed that both combination therapies of excision plus steroid therapy (p=0.003) and excision plus radiotherapy (p=0.003) yielded better recurrence-free survival compared to excision alone. The median recurrence-free interval for combination therapy was 10 months. Adverse event rates were similar among different intervention groups. CONCLUSIONS This study suggests that combining excision with radiotherapy or perioperative steroid therapy has the potential to improve prognosis of earlobe keloids without increasing the risk of adverse events. Overall evaluation of patients' conditions and further studies with sufficient follow-up are warranted for clinical practice. LEVEL OF EVIDENCE IV 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)
- Ying Huang
- Department of Comprehensive Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Badachu Road 33, Beijing, People's Republic of China
| | - Shuofang Ren
- Department of Cardiac Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Qinghua Yang
- Department of Comprehensive Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Badachu Road 33, Beijing, People's Republic of China.
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3
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Savant SS, Savant SS, Daruwala F. Selective therapy (cryo or scalpel) combined with multimodal therapy for treating keloids. J Cutan Aesthet Surg 2024; 17:85-93. [PMID: 38800820 PMCID: PMC11126220 DOI: 10.4103/jcas.jcas_40_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024] Open
Abstract
Background Keloids are less responsive to any single treatment modality; hence, there is a need for combination therapy that can yield satisfactory outcomes. Objective The present study assessed efficacy and safety of combination therapy-surgical excision or cryotherapy and intralesional corticosteroids along with 5-fluorouracil [IL (S + 5-FU)] injection, followed by silicone gel sheet (SGS) under compression therapy in the treatment of keloids. Materials and Methods This was a retrospective, observational study comprising 21 clinically diagnosed keloid patients. All patients were treated with the stated combination therapy. Data about demographic, lesions, procedural characteristics, and treatment outcomes were reported. Results Of 21, 11 (52.4%) patients were treated with liquid nitrogen (LN2) cryotherapy, and 10 (47.6%) patients were treated with surgical excision. Mean age was 30.8 ± 7.6 (range: 14-44) years with slight male (52.4%) predominance. A mean surface area of keloid lesion was 96.8 ± 170.5 cm3. The most frequently involved site was auricle (8 [38.1%] patients). Patients received the following types of treatments: intralesional LN2 cryotherapy (6 [28.6%]), intralesional excisional surgery (6 [28.6%]), surface LN2 cryotherapy (5 [23.8%]), and extralesional excisional surgery (4 [19.0%]). Complications of recurrence (2 [9.5%]), secondary infections (2 [9.5%]), persistent postinflammatory hypopigmentation (1 [4.8%]), and atrophic scarring with postinflammatory hyperpigmentation (1 [4.8%]) were reported. After a study period of 2.5 years, 100% cure rate was achieved. Conclusion Combination therapy of surgical excision or cryotherapy and IL (S + 5-FU), followed by SGS under compression, was safe and effective in treating keloids.
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Affiliation(s)
- Sushil S Savant
- The Humanitarian Clinic, Skin: Hair and Laser Centre, Mumbai, Maharashtra, India
| | - Satish S Savant
- The Humanitarian Clinic, Skin: Hair and Laser Centre, Mumbai, Maharashtra, India
| | - Feral Daruwala
- The Humanitarian Clinic, Skin: Hair and Laser Centre, Mumbai, Maharashtra, India
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Zhang Y, Wu M, Liu D, Panayi AC, Xu X, Luo L, Feng J, Ou Y, Lin T, Cui Y. Recurrence and Complications of Peri-operative Steroid Injection of Keloids: A Systematic Review and Meta-analysis. Aesthetic Plast Surg 2024:10.1007/s00266-024-03935-0. [PMID: 38561576 DOI: 10.1007/s00266-024-03935-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/05/2024] [Indexed: 04/04/2024]
Abstract
Keloid scars are a particularly challenging fibroproliferative wound healing disorder with a variety of proposed management approaches including concurrent surgery and intralesional steroid injection. We aimed to identify the optimum time for triamcinolone injection of keloids, by comparing the recurrence and complication occurrence in patients who received pre-, intra- or post-operative injection. Studies reporting on the rate of recurrence and complication occurrence following treatment of keloid scarring with concurrent surgical excision and intralesional steroid injection were identified from the PubMed, Web of science and Embase databases. The I-squared (I2) statistic was used to quantify the variability in study estimates due to heterogeneity and to determine whether the fixed or random effect models will be employed. Publication bias was visualized through funnel plots and tested with the Egger's test. We found that the recurrence rate was significantly lower with post-operative injection compared to intra-operative injection (p < 0.001) and pre-operative injection (p = 0.009). A significant difference between intra-operative and pre-operative injection was not found (p = 0.46). In conclusion, post-operative steroid injection after surgical excision results in lower keloid recurrence compared to pre- and intra-operative injection.Level of Evidence IV "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)
- Yihan Zhang
- Shantou University Medical College, Shantou, 515041, China
- Department of Plastic and Reconstructive Surgery, Peking University Shenzhen Hospital, 1120 Lianghua Road, Shenzhen, 518036, Guangdong, People's Republic of China
| | - Mengfan Wu
- Department of Plastic and Reconstructive Surgery, Peking University Shenzhen Hospital, 1120 Lianghua Road, Shenzhen, 518036, Guangdong, People's Republic of China
| | - Dandan Liu
- Department of Plastic and Reconstructive Surgery, Peking University Shenzhen Hospital, 1120 Lianghua Road, Shenzhen, 518036, Guangdong, People's Republic of China
| | - Adriana C Panayi
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Xiangwen Xu
- Department of Plastic and Reconstructive Surgery, Peking University Shenzhen Hospital, 1120 Lianghua Road, Shenzhen, 518036, Guangdong, People's Republic of China
| | - Lin Luo
- Department of Plastic and Reconstructive Surgery, Peking University Shenzhen Hospital, 1120 Lianghua Road, Shenzhen, 518036, Guangdong, People's Republic of China
| | - Jun Feng
- Department of Plastic and Reconstructive Surgery, Peking University Shenzhen Hospital, 1120 Lianghua Road, Shenzhen, 518036, Guangdong, People's Republic of China
| | - Yanting Ou
- Shantou University Medical College, Shantou, 515041, China
- Department of Plastic and Reconstructive Surgery, Peking University Shenzhen Hospital, 1120 Lianghua Road, Shenzhen, 518036, Guangdong, People's Republic of China
| | - Tingyin Lin
- Shantou University Medical College, Shantou, 515041, China
- Department of Plastic and Reconstructive Surgery, Peking University Shenzhen Hospital, 1120 Lianghua Road, Shenzhen, 518036, Guangdong, People's Republic of China
| | - Yongyan Cui
- Department of Plastic and Reconstructive Surgery, Peking University Shenzhen Hospital, 1120 Lianghua Road, Shenzhen, 518036, Guangdong, People's Republic of China.
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Lawera NG, Madzia J, Casey LC, Guyton RL, Woodyard De Brito KC, Kinzer A, Ulma RM, Pan BS, Schwentker AR, Leto Barone AA. Keloid Intralesional Excision Reduces Recurrence: A Meta-analytic Study of the Available Literature on 608 Keloids. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5652. [PMID: 38463702 PMCID: PMC10923361 DOI: 10.1097/gox.0000000000005652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 01/16/2024] [Indexed: 03/12/2024]
Abstract
Background The objective of this meta-analysis was to examine the effectiveness of keloid intralesional excision (KILE) in preventing recurrence. Treatment of keloids using surgical excision alone leads to high rates of recurrence. To date, there are no widely accepted guidelines for keloid treatment, and a multitude of adjunctive therapies are used to reduce recurrence. Despite these efforts, recurrence remains high. In this study, we conducted a meta-analysis of the existing literature on KILE to determine its role in recurrence reduction. Methods A literature review using PubMed, Scopus, and Web of Science databases was performed. Two authors independently evaluated studies for eligibility. Incidence of keloid recurrence was recorded, and a comprehensive meta-analysis was performed to assess the pooled keloid recurrence rate, as well as the effect of additional therapies. Results Twenty-two studies evaluating intralesional excision of 608 keloids were included in the study. Average time to follow-up was 19.2 months (range 6-35 months). A meta-analysis of proportions was conducted, demonstrating a pooled recurrence rate of 13% (95% confidence interval, 9%-16%). There was no evidence that using therapies in addition to KILE had a significant effect on the overall pooled recurrence rate. Conclusions A meta-analysis of 608 keloids shows that KILE is an effective technique in preventing keloid recurrence, with a pooled recurrence rate of 13% compared with previously reported rates of 45%-100% after complete excision. Although there are no standard guidelines for keloid treatment, our meta-analysis shows that KILE is promising in recurrence reduction.
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Affiliation(s)
- Nathan G. Lawera
- From Division of Pediatric Plastic Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Jules Madzia
- From Division of Pediatric Plastic Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Liann C. Casey
- From Division of Pediatric Plastic Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Rodney L. Guyton
- From Division of Pediatric Plastic Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | | | - Alexandra Kinzer
- From Division of Pediatric Plastic Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Raquel M. Ulma
- From Division of Pediatric Plastic Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Brian S. Pan
- From Division of Pediatric Plastic Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Ann R. Schwentker
- From Division of Pediatric Plastic Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Angelo A. Leto Barone
- From Division of Pediatric Plastic Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Division of Plastic and Craniofacial Surgery, Nemours Children’s Hospital, Orlando, Fla
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Kaur A, Garg R, Mittal RK, Shah S, Patial T, Addiwal R. Comparative Efficacy of Intralesional Triamcinolone Acetonide and 5-Fluorouracil for Keloid Scars. PLASTIC AND AESTHETIC NURSING 2022; 42:184-189. [PMID: 36469388 DOI: 10.1097/psn.0000000000000465] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Intralesional triamcinolone acetonide (TAC; a synthetic corticosteroid) and 5-fluorouracil (5-FU; a cytotoxic chemotherapy drug) are the medications most commonly used to treat keloid scars. We investigated the clinical efficacy of TAC compared with 5-FU. We included 40 patients in the study and divided them into two equal groups ( n = 20 Group A; n = 20 Group B). Group A patients received 4 mg/cm 2 or 0.1 ml/cm 2 of intralesional TAC (40 mg/ml) at 3-week intervals. Group B patients received 10 mg/cm 2 or 0.2 ml/cm 2 of intralesional 5-FU (50 mg/ml) at 3-week intervals. We assessed the scar using the Vancouver Scar Scale (VSS), visual analog scale (VAS), and patient satisfaction score (PSS). We found that Group A patients had a lower VAS than Group B patients (2.09 vs. 3.18). We saw a reduction in the VSS in both treatment arms; however, we found that Group B patients had a more marked reduction in the VSS compared with Group A patients (2.57 vs. 2.68). The PSS was higher in Group A than in Group B (1.97 vs. 1.78). We concluded that intralesional 5-FU elicits a better response than intralesional TAC. Although 5-FU is less well tolerated and has more side effects than TAC, we found that 5-FU was more effective in resolving keloid scars. Notably, the PSS was higher in the TAC group, but the VSS and VAS were better in Group B.
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Affiliation(s)
- Amandeep Kaur
- Amandeep Kaur, MS, MCh, MBBS, is a plastic surgeon, Department of Burns, Hand, Plastic and Aesthetic Surgery, Ivy Hospital, Amritsar, Punjab, India
- Ramneesh Garg, MS, MCh, MBBS, is a professor of plastic surgery, Department of Plastic and Reconstructive Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
- Rajinder K. Mittal, MS, MCh, MBBS, is a professor of plastic surgery and department head, Department of Plastic and Reconstructive Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
- Sheerin Shah, MS, MCh, MBBS, is an associate professor of plastic surgery, Department of Plastic and Reconstructive Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
- Tushar Patial, MS, MCh, MBBS, is an assistant professor of plastic surgery, Department of Plastic and Reconstructive Surgery, Indira Gandhi Medical College and Hospital, Shimla, Himachal Pradesh, India
- Raman Addiwal, MS, MBBS, is a neurosurgery resident, Department of Neurosurgery, Mamata Medical College, Khamam, Telangana, India
| | - Ramneesh Garg
- Amandeep Kaur, MS, MCh, MBBS, is a plastic surgeon, Department of Burns, Hand, Plastic and Aesthetic Surgery, Ivy Hospital, Amritsar, Punjab, India
- Ramneesh Garg, MS, MCh, MBBS, is a professor of plastic surgery, Department of Plastic and Reconstructive Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
- Rajinder K. Mittal, MS, MCh, MBBS, is a professor of plastic surgery and department head, Department of Plastic and Reconstructive Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
- Sheerin Shah, MS, MCh, MBBS, is an associate professor of plastic surgery, Department of Plastic and Reconstructive Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
- Tushar Patial, MS, MCh, MBBS, is an assistant professor of plastic surgery, Department of Plastic and Reconstructive Surgery, Indira Gandhi Medical College and Hospital, Shimla, Himachal Pradesh, India
- Raman Addiwal, MS, MBBS, is a neurosurgery resident, Department of Neurosurgery, Mamata Medical College, Khamam, Telangana, India
| | - Rajinder K Mittal
- Amandeep Kaur, MS, MCh, MBBS, is a plastic surgeon, Department of Burns, Hand, Plastic and Aesthetic Surgery, Ivy Hospital, Amritsar, Punjab, India
- Ramneesh Garg, MS, MCh, MBBS, is a professor of plastic surgery, Department of Plastic and Reconstructive Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
- Rajinder K. Mittal, MS, MCh, MBBS, is a professor of plastic surgery and department head, Department of Plastic and Reconstructive Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
- Sheerin Shah, MS, MCh, MBBS, is an associate professor of plastic surgery, Department of Plastic and Reconstructive Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
- Tushar Patial, MS, MCh, MBBS, is an assistant professor of plastic surgery, Department of Plastic and Reconstructive Surgery, Indira Gandhi Medical College and Hospital, Shimla, Himachal Pradesh, India
- Raman Addiwal, MS, MBBS, is a neurosurgery resident, Department of Neurosurgery, Mamata Medical College, Khamam, Telangana, India
| | - Sheerin Shah
- Amandeep Kaur, MS, MCh, MBBS, is a plastic surgeon, Department of Burns, Hand, Plastic and Aesthetic Surgery, Ivy Hospital, Amritsar, Punjab, India
- Ramneesh Garg, MS, MCh, MBBS, is a professor of plastic surgery, Department of Plastic and Reconstructive Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
- Rajinder K. Mittal, MS, MCh, MBBS, is a professor of plastic surgery and department head, Department of Plastic and Reconstructive Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
- Sheerin Shah, MS, MCh, MBBS, is an associate professor of plastic surgery, Department of Plastic and Reconstructive Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
- Tushar Patial, MS, MCh, MBBS, is an assistant professor of plastic surgery, Department of Plastic and Reconstructive Surgery, Indira Gandhi Medical College and Hospital, Shimla, Himachal Pradesh, India
- Raman Addiwal, MS, MBBS, is a neurosurgery resident, Department of Neurosurgery, Mamata Medical College, Khamam, Telangana, India
| | - Tushar Patial
- Amandeep Kaur, MS, MCh, MBBS, is a plastic surgeon, Department of Burns, Hand, Plastic and Aesthetic Surgery, Ivy Hospital, Amritsar, Punjab, India
- Ramneesh Garg, MS, MCh, MBBS, is a professor of plastic surgery, Department of Plastic and Reconstructive Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
- Rajinder K. Mittal, MS, MCh, MBBS, is a professor of plastic surgery and department head, Department of Plastic and Reconstructive Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
- Sheerin Shah, MS, MCh, MBBS, is an associate professor of plastic surgery, Department of Plastic and Reconstructive Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
- Tushar Patial, MS, MCh, MBBS, is an assistant professor of plastic surgery, Department of Plastic and Reconstructive Surgery, Indira Gandhi Medical College and Hospital, Shimla, Himachal Pradesh, India
- Raman Addiwal, MS, MBBS, is a neurosurgery resident, Department of Neurosurgery, Mamata Medical College, Khamam, Telangana, India
| | - Raman Addiwal
- Amandeep Kaur, MS, MCh, MBBS, is a plastic surgeon, Department of Burns, Hand, Plastic and Aesthetic Surgery, Ivy Hospital, Amritsar, Punjab, India
- Ramneesh Garg, MS, MCh, MBBS, is a professor of plastic surgery, Department of Plastic and Reconstructive Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
- Rajinder K. Mittal, MS, MCh, MBBS, is a professor of plastic surgery and department head, Department of Plastic and Reconstructive Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
- Sheerin Shah, MS, MCh, MBBS, is an associate professor of plastic surgery, Department of Plastic and Reconstructive Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
- Tushar Patial, MS, MCh, MBBS, is an assistant professor of plastic surgery, Department of Plastic and Reconstructive Surgery, Indira Gandhi Medical College and Hospital, Shimla, Himachal Pradesh, India
- Raman Addiwal, MS, MBBS, is a neurosurgery resident, Department of Neurosurgery, Mamata Medical College, Khamam, Telangana, India
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A Novel Method of Steroid Delivery to Improve the Efficacy of Intralesional Injection in Keloid Treatment. Dermatol Surg 2022; 48:631-635. [PMID: 35653557 DOI: 10.1097/dss.0000000000003432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Keloids are a chronic disease and cause pain, pruritus, and limitation of motion. Intralesional corticosteroid injection is the first-line treatment, but its effects can be limited, even with repeated injections. OBJECTIVE To investigate the efficacy and safety of a tunneling method of corticosteroid injection compared with conventional intralesional injection. MATERIALS AND METHODS A retrospective review was conducted of keloid patients treated with intralesional corticosteroid injection by conventional and tunneling methods. RESULTS A total of 119 cases of keloid were included in the study. Among 78 patients treated with 20 mg/mL triamcinolone, the Investigators' Global Assessment effectiveness score and Observer Scar Assessment Scale (OSAS) score were significantly higher in the tunneling group than the conventional group at 1 month. At 6 months, the tunneling group showed significantly higher effectiveness in the OSAS score than the conventional group. In the tunneling group, the interval between treatments was significantly longer than in the conventional group. The occurrence of side effects was lower in the tunneling method group than in the conventional method group. CONCLUSION This study reveals the benefits of the tunneling method over the conventional method for therapeutic effect and side effects in keloid treatment.
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Dong W, Qiu B, Fan F. Adjuvant Radiotherapy for Keloids. Aesthetic Plast Surg 2022; 46:489-499. [PMID: 34415398 DOI: 10.1007/s00266-021-02442-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 06/20/2021] [Indexed: 11/24/2022]
Abstract
Radiotherapy is one of the therapeutic methods for keloids, and the irradiation technique has innovated from superficial X-ray to brachytherapy after decades of clinical practice. At present, the application of adjuvant radiotherapy has been widely accepted by clinicians, while the consensus of optimal adjuvant radiotherapy strategies for keloids has not been reached. Factors such as radiation timing, dose, fractions, and lesion locations may be associated with the clinical outcomes of patients with keloids after radiotherapy while a comprehensive review is lacking. Herein, this review summarized the published literature of adjuvant radiotherapy for keloids involving mechanism, timing, dose, fractions, and complications, etc., which may facilitate clinical decision making.Level of Evidence III 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)
- Wenfang Dong
- The Twelfth Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 33 Badachu Road, Shijingshan District, Beijing, 100144, China
| | - Bin Qiu
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, 100191, China
| | - Fei Fan
- The Twelfth Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 33 Badachu Road, Shijingshan District, Beijing, 100144, China.
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Yuan P, Qiu X, Liu T, Tian R, Bai Y, Liu S, Chen X, Jin Y. Substrate-independent polymer coating with stimuli-responsive dexamethasone release for on-demand fibrosis inhibition. J Mater Chem B 2020; 8:7777-7784. [PMID: 32744264 DOI: 10.1039/d0tb01127d] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Tissue fibrosis caused by implantation of tissue engineering scaffolds is an urgent problem in clinical research. In this work, a substrate-independent coating with on-demand release of an antifibrotic drug has been fabricated to effectively address this issue. This coating was formed through a substrate-independent layer-by-layer (LBL) technique via a cationic polyelectrolyte (poly-diallyldimethylammonium, PDDA) and an anionic polyelectrolyte (poly-styrenesulfonate, PSS), where parts of PSS and PDDA were physically replaced by carboxyl functionalized polyethylene glycol grafted onto antifibrotic drug dexamethasone (DEX-PEG-COOH). Considering the easy generation of local inflammation after implantation, an ester bond was designed between PEG-COOH and DEX. Therefore, the overexpressed esterase under inflammatory conditions hydrolyzes the ester bond and thereby releases DEX from the film to inhibit fibrosis occurring in the tissue repair process. The in vivo capacity of this coating to restrain tissue fibrosis was investigated by a skin defect model using porous polycaprolactone (PCL) scaffolds as substrates. The experimental results showed that the fibrosis-related proteins (Col-I, TGF-β and fibronectin) and the infiltration of myofibroblasts (α-SMA) of skin tissues in the coated PCL scaffold group were significantly lower than those in the blank control group and pure PCL scaffold group. Moreover, the histological evaluations showed that the coating group could significantly decrease the deposition of collagen and meanwhile promote the partial regeneration of skin appendages. These results successfully demonstrate that the universal coating prepared with a simple protocol would be an effective strategy to address the fibrosis issues during tissue engineering.
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Affiliation(s)
- Pingyun Yuan
- School of Chemical Engineering and Technology, Shaanxi Key Laboratory of Energy Chemical Process Intensification, Institute of Polymer Science in Chemical Engineering, Xi'an Jiao Tong University, Xi'an 710049, P. R. China.
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Keloids: Which Types Can Be Excised without Risk of Recurrence? A New Clinical Classification. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2582. [PMID: 32537319 PMCID: PMC7253266 DOI: 10.1097/gox.0000000000002582] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 10/22/2019] [Indexed: 11/25/2022]
Abstract
A surgical team from Interplast-Germany removed 387 keloids in 302 patients during 4 visits to Goma, Democratic Republic of the Congo, from 2015-2018. Preoperative and postoperative photographs and a thorough anamnesis of keloids were done for all patients. In addition, 18 selected biopsies from 4 types of keloids were histologically examined in Germany. Methods Treatment options were tested and keloid recurrence rates were compared with data from questionnaires, photographs, and histology. Results Keloids were classified accordingly as follows: (1) fresh nodular (continuously growing) keloids had a 30% recurrence rate after surgery: no common adjuvant therapy but triamcinolone acetonide (TAC) injections on onset, only; (a) earlobe keloids had the lowest recurrence rate after complete excision with negative resection margins; (2) superficial spreading (or butterfly) keloids were treated with TAC injections only; (3) mature (nongrowing or burned-out) keloids had also a low recurrence rate of 4.5%, which were then treated with TAC on onset, only; and (4) multiple keloids comprise various types in different stages. Conclusions According to this classification, about 50% of keloids may be removed surgically without risk of recurrence in the examined patient population in Africa, where only TAC injections, but no radiation, are available. Adjuvant TAC or radiation should be started at the onset of recurrence and not generally.
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Abstract
Keloids are pathological scars that grow over time and extend beyond the initial site of injury after impaired wound healing. These scars frequently recur and rarely regress. They are aesthetically disfiguring, can cause pain, itching, discomfort as well as psychological stress, often affecting quality of life. Many treatment modalities, including surgical and non-surgical, have been explored and have been reported to be beneficial; however, none have been absolutely satisfactory or optimal for the treatment of all keloid subtypes to date. This poses a major challenge to clinicians. Often, a combinational therapeutic approach appears to offer the best results with higher patient satisfaction compared to monotherapy. The aetiopathogenesis of keloids is not fully elucidated; however, with recent advances in molecular biology and genetics, insight is being gained on the complex process of scar formation and hence new therapeutic and management options for keloids. In this paper, we explore the literature and summarise the general concepts surrounding keloid development and review both current (corticosteroids, surgical excision, silicone-based products, pressure therapy, radiotherapy, cryotherapy, laser therapy, imiquimod and 5-fluorouracil) and emerging (stem cell therapy, mitomycin C, verapamil, interferons, bleomycin, botulinum toxin type A and angiotensin-converting enzyme inhibitors) treatments. Increased knowledge and understanding in this area may potentially lead to the discovery and development of novel therapeutic options that are more efficacious for all keloid types. LAY SUMMARY Keloids are problematic scars that are difficult to treat and manage. The aetiopathogenesis of keloids is not clear; however, recent advances in molecular biology and genetics are beginning to shed light on the underlying mechanisms implicated in keloid scar formation which will hopefully lead to the development of treatment options for all keloid types. This review summarises current and emerging therapies.
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Affiliation(s)
- Nkemcho Ojeh
- Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Bridgetown, Barbados, West Indies
| | - Ambadasu Bharatha
- Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Bridgetown, Barbados, West Indies
| | - Uma Gaur
- Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Bridgetown, Barbados, West Indies
| | - Andrew LeRoy Forde
- Pine Medical Centre, 3rd Avenue Belleville, St. Michael, Barbados, West Indies
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Rasaii S, Sohrabian N, Gianfaldoni S, Hadibarhaghtalab M, Pazyar N, Bakhshaeekia A, Lotti T, Ramirez-Pacheco LA, Lange CS, Matta J, Seifi V, Ramirez-Fort MK, Feily A. Intralesional triamcinolone alone or in combination with botulinium toxin A is ineffective for the treatment of formed keloid scar: A double blind controlled pilot study. Dermatol Ther 2019; 32:e12781. [PMID: 30422367 DOI: 10.1111/dth.12781] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 09/24/2018] [Accepted: 10/16/2018] [Indexed: 11/29/2022]
Abstract
Cutaneous injury can ignite excessive fibroproliferative growth that results in keloid formation. Keloids are associated with significant morbidity related to disfigurement and/or symptoms (e.g., pain and pruritus). First-line treatment of formed keloids involves topical or intralesional steroids. Recurrent or resistant keloids are managed by surgical excision or cryotherapy, followed by steroidal application or adjuvant irradiation. Although adjuvant irradiation appears to be most efficacious, alternative therapeutic options are needed for patients without access to radiation centers. Botulinum Toxin A (BTA) appears to have similar inhibitory effects to irradiation on the cell cycle via downregulation of pathogenic cytokines. Herein, we conducted a study to compare the efficacy of intralesional triamcinolone used alone, or in combination with BTA, in the treatment of formed keloid scars. Twenty patients with a cumulative of 40 keloids completed the study. There was no significant difference between treatment arms with respect to height vascularization, pliability, and pigmentation scores. The addition of BTA resulted in significant symptomatic improvement of pain and pruritus as compared to intralesional triamcinolone alone (p < 0.001). Irradiation is only effective when administered in the adjuvant setting where inhibitory effects on cell cycle and migration are optimized. Future studies with intralesional triamcinolone and BTA should be performed adjuvantly.
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Affiliation(s)
- Sima Rasaii
- Dermatology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Nasibe Sohrabian
- Dermatology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | | | - Nader Pazyar
- Dermatology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | - Torello Lotti
- Dermatology, University G. Marconi of Rome, Rome, Italy
| | | | - Christopher S Lange
- Radiation Oncology, State University Hospital of New York at Downstate, Brooklyn, New York
| | - Jaime Matta
- Division of Pharmacology and Toxicology, Department of Basic Sciences, Ponce Health Sciences University, Ponce, Puerto Rico
| | - Vahid Seifi
- Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Amir Feily
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Goutos I. Intralesional excision as a surgical strategy to manage keloid scars: what's the evidence? Scars Burn Heal 2019; 5:2059513119867297. [PMID: 31565400 PMCID: PMC6755860 DOI: 10.1177/2059513119867297] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Keloid scars are a particularly challenging clinical entity and a variety of management approaches have been described in the literature including intralesional surgery. The current literature lacks a summative review to ascertain the evidence base behind this surgical approach. METHODS A comprehensive English literature database search was performed using PubMed Medline, EMBASE and Web of Science from their individual dates of inception to March 2018. We present the different rationales proposed for the use of this technique, the clinical outcomes reported in the literature as well as the scientific basis for intralesional excision of keloid scars. DISCUSSION A number of arguments have been proposed to support intralesional excision including avoiding injury to neighbouring non-keloidal skin and the deep layer of the dermis, removal of the most proliferative fibroblastic group as well as debulking to facilitate the administration of injectable steroid. The most current literature does not provide sufficient support for the adoption of intralesional excisions based on data emerging from basic science as well as clinical outcome studies. CONCLUSION Emerging evidence supports the extralesional excision of keloid scars based on current mechanobiological, histological as well as clinical outcome data. Further trials comparing extralesional and intralesional surgical practices are eagerly awaited to ascertain the role of intralesional excisions in the keloid management arena.
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Affiliation(s)
- Ioannis Goutos
- Centre for Cutaneous Research, Blizard Institute,
London, UK
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Keloid Skin Flap Retention and Resurfacing in Facial Keloid Treatment. Aesthetic Plast Surg 2018; 42:304-309. [PMID: 28791472 DOI: 10.1007/s00266-017-0949-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 07/13/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Facial keloids commonly occur in young patients. Multiple keloid masses often converge into a large lesion on the face, representing a significant obstacle to keloid mass excision and reconstruction. We describe a new surgical method that excises the keloid mass and resurfaces the wound by saving the keloid skin as a skin flap during facial keloid treatment. METHODS Forty-five patients with facial keloids were treated in our department between January 2013 and January 2016. Multiple incisions were made along the facial esthetic line on the keloid mass. The keloid skin was dissected and elevated as a skin flap with one or two pedicles. The scar tissue in the keloid was then removed through the incision. The wound was covered with the preserved keloid skin flap and closed without tension. Radiotherapy and hyperbaric oxygen were applied after surgery. Patients underwent follow-up examinations 6 and 12 months after surgery. RESULTS Of the 45 total patients, 32 patients were cured and seven patients were partially cured. The efficacy rate was 88.9%, and 38 patients (84.4%) were satisfied with the esthetic result. CONCLUSION We describe an efficacious and esthetically satisfactory surgical method for managing facial keloids by preserving the keloid skin as a skin flap. LEVEL OF EVIDENCE IV 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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Srivastava S, Patil AN, Prakash C, Kumari H. Comparison of Intralesional Triamcinolone Acetonide, 5-Fluorouracil, and Their Combination for the Treatment of Keloids. Adv Wound Care (New Rochelle) 2017; 6:393-400. [PMID: 29098115 DOI: 10.1089/wound.2017.0741] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Accepted: 06/19/2017] [Indexed: 11/12/2022] Open
Abstract
Objective: Despite the myriad options available, there is no universally accepted treatment for keloids. Our objective was to compare three regimens and establish superiority in terms of objective and subjective outcomes. Approach: In this randomized parallel group study, 60 patients were enrolled and randomly allocated to three groups. Patients received intralesional injections of triamcinolone acetonide (TAC) in Group TAC, 5-fluorouracil (5FU) in Group 5FU, and a combination in Group T + F every 3 weeks till 24 weeks or till the keloid resolved. Results: There was a reduction in all parameters at every successive assessment in all three groups. Improvement in terms of height, vascularity, and pliability was fastest with 5FU, TAC, and T + F group, respectively, which was statistically significant. Decrease in pigmentation was significantly faster with T+F. Reduction in pruritus, however, was significantly faster with 5FU than the other groups, but the difference in reduction of pain among the three groups was not significant. Telangiectasias and skin atrophy were seen most commonly in TAC group, while skin ulceration was a common problem in 5FU group. Conclusion: TAC, 5FU, and their combination are all effective in keloid scars. A combination of TAC +5FU seems to offer the balanced benefit of faster and more efficacious response with lesser adverse effects when compared to individual drugs.
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Affiliation(s)
- Sunil Srivastava
- Department of Plastic Surgery, Sawai Man Singh Medical College and Hospital, Rajasthan University of Health Sciences, Jaipur, India
| | - Aditya Nanasaheb Patil
- Department of Plastic Surgery, Sawai Man Singh Medical College and Hospital, Rajasthan University of Health Sciences, Jaipur, India
| | - Chaitra Prakash
- Department of Dermatology, Sawai Man Singh Medical College and Hospital, Rajasthan University of Health Sciences, Jaipur, India
| | - Hiranmayi Kumari
- Department of Plastic Surgery, Sawai Man Singh Medical College and Hospital, Rajasthan University of Health Sciences, Jaipur, India
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Shin JY, Kim JS. Could 5-Fluorouracil or Triamcinolone Be an Effective Treatment Option for Keloid After Surgical Excision? A Meta-Analysis. J Oral Maxillofac Surg 2015; 74:1055-60. [PMID: 26529198 DOI: 10.1016/j.joms.2015.10.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 10/03/2015] [Accepted: 10/05/2015] [Indexed: 11/19/2022]
Abstract
PURPOSE There is no universally accepted treatment regimen to decrease the recurrence rate of keloid formation after its removal, although many treatment options have been suggested. The purpose of this study was to investigate treatment options to prevent keloid recurrence after surgical excision. MATERIALS AND METHODS A systematic literature review and meta-analysis was performed using the Medline, Embase, and Cochrane databases. Predictor variables were 5-fluorouracil (5-FU) or triamcinolone adjuvant therapy, and the outcome variable was keloid recurrence rate. The Newcastle-Ottawa scale was used to assess the quality of the studies and the Cochrane risk-of-bias tool was used. Publication bias was evaluated using a funnel plot. RESULTS There were 1,224 publications identified; after screening, 5 were selected for review (1 retrospective cohort, 3 prospective cohorts, and 1 randomized controlled trial). The mean level of keloid recurrence was statistically lower in patients who received 5-FU compared with those who did not (control group; risk ratio, 0.18; 95% confidence interval [CI], 0.04 to 0.75). Triamcinolone was ineffective in lowering the keloid recurrence (risk difference, 0.06; 95% CI, -0.16 to 0.28). CONCLUSION 5-FU can be considered an effective treatment to decrease keloid recurrence after surgical excision, although further research, including a randomized controlled trial, is required.
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Affiliation(s)
- Jin Yong Shin
- Professor, Department of Plastic and Reconstructive Surgery, College of Medicine, Chonbuk National University, Jeonju, Korea
| | - Jong Seung Kim
- Professor, Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Chonbuk National University, Jeonju, Korea.
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Combination of Radiofrequency and Intralesional Steroids in the Treatment of Keloids. Dermatol Surg 2015; 41:731-5. [DOI: 10.1097/dss.0000000000000360] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Jones CD, Guiot L, Samy M, Gorman M, Tehrani H. The Use of Chemotherapeutics for the Treatment of Keloid Scars. Dermatol Reports 2015; 7:5880. [PMID: 26236447 PMCID: PMC4500869 DOI: 10.4081/dr.2015.5880] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2011] [Accepted: 03/23/2015] [Indexed: 02/03/2023] Open
Abstract
Keloid scars are pathological scars, which develop as a result of exaggerated dermal tissue proliferation following cutaneous injury and often cause physical, psychological and cosmetic problems. Various theories regarding keloidogenesis exist, however the precise pathophysiological events remain unclear. Many different treatment modalities have been implicated in their management, but currently there is no entirely satisfactory method for treating all keloid lesions. We review a number of different chemotherapeutic agents which have been proposed for the treatment of keloid and hypertrophic scars while giving insight into some of the novel chemotherapeutic drugs which are currently being investigated. Non-randomized trials evaluating the influence of different chemotherapeutic agents, such as 5-fluorouracil (5-FU); mitomycin C; bleomycin and steroid injection, either alone or in combination with other chemotherapeutic agents or alternative treatment modalities, for the treatment of keloids were identified using a predefined PubMed search strategy. Twenty seven papers were identified. Scar improvement ≥50% was found in the majority of cases treated with 5-FU, with similar results found for mitomycin C, bleomycin and steroid injection. Combined intralesional 5-FU and steroid injection produced statistically significant improvements when compared to monotherapy. Monotherapy recurrence rates ranged from 0-47% for 5-FU, 0-15% for bleomycin and 0-50% for steroid injection. However, combined therapy in the form of surgical excision and adjuvant 5-FU or steroid injections demonstrated lower recurrence rates; 19% and 6% respectively. Currently, most of the literature supports the use of combination therapy (usually surgery and adjuvant chemotherapy) as the mainstay treatment of keloids, however further investigation is necessary to determine success rates over longer time frames. Furthermore, there is the potential for novel therapies, but further investigation is required to elucidate their true efficacy.
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Affiliation(s)
| | | | - Mike Samy
- St. Bartholomew’s and The London School of Medicine and Dentistry, Merseyside, UK
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19
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Abstract
This article presents an overview of the literature regarding treatments for keloid disease, hypertrophic scars, and striae distensae in dark pigmented skin. Striae, keloid, and hypertrophic scarring present a challenging problem for both the clinician and patient. No single therapy is advocated for hypertrophic scars, keloid scars, or striae distensae. New therapies have shown promise in the treatment of hypertrophic and keloid scars, and in patients with dark pigmented skin. This article provides guidance on the assessment and determination of patients' suitability for certain treatment options, as well as advice on the follow-up of patients affected with problematic scarring and striae.
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Affiliation(s)
- Sara Ud-Din
- Plastic and Reconstructive Surgery Research, Manchester Institute of Biotechnology, University of Manchester, 131 Princess Street, Manchester M1 7DN, UK; Plastic and Reconstructive Surgery Research, Faculty of Medical and Human Sciences, Institute of Inflammation and Repair, University Hospital of South Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Ardeshir Bayat
- Plastic and Reconstructive Surgery Research, Manchester Institute of Biotechnology, University of Manchester, 131 Princess Street, Manchester M1 7DN, UK; Plastic and Reconstructive Surgery Research, Faculty of Medical and Human Sciences, Institute of Inflammation and Repair, University Hospital of South Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.
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Son IP, Park KY, Kim B, Kim MN. Pilot Study of the Efficacy of 578 nm Copper Bromide Laser Combined with Intralesional Corticosteroid Injection for Treatment of Keloids and Hypertrophic Scars. Ann Dermatol 2014; 26:156-61. [PMID: 24882968 PMCID: PMC4037666 DOI: 10.5021/ad.2014.26.2.156] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Revised: 03/08/2013] [Accepted: 03/08/2013] [Indexed: 11/30/2022] Open
Abstract
Background Treatments including intralesional corticosteroid injection, pressure therapy, cryotherapy, and various laser therapies have had limited success for keloids and hypertrophic scars. Objective This trial evaluated the efficacy of a combination of 578 nm copper bromide laser and the more traditional intralesional corticosteroid injection for the treatment of keloids and hypertrophic scars with respect to scar color. Methods Keloids or hypertrophic scars of 12 Korean patients were treated five times by the combined treatment at 4-week intervals. Clinical improvement was assessed by the physicians' global assessment (PGA) comparing pre- and post-treatment photographs, as well as 4 weeks after the last treatment. Erythema intensity was quantified using a mexameter. Results Most scars showed significant clinical improvement in PGA and decreased erythema intensity after 5 treatments. All patients showed improvements in symptoms like pruritus. Conclusion The combined treatment is effective for keloids and hypertrophic scars, especially when the telangiectatic portion of the scars is prominent. The adjunctive use of 578 nm copper bromide laser decreased the telangiectatic side effects of an intralesional corticosteroid injection by reducing the vascular components of scars.
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Affiliation(s)
- In Pyeong Son
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Kui Young Park
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Beomjoon Kim
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Myeung Nam Kim
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
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Rasheed IA, Malachy AE. The management of helical rim keloids with excision, split thickness skin graft and intralesional triamcinolone acetonide. J Cutan Aesthet Surg 2014; 7:51-3. [PMID: 24761102 PMCID: PMC3996793 DOI: 10.4103/0974-2077.129981] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Keloids of the helical rim are disfiguring. A cosmetically acceptable reconstruction is difficult especially in moderate to large sized lesions because the helical rim is a 3-dimensional structure with curved and thin cartilage. We report our experience in the management of moderate (4-10 cm) and large (>10 cm) helical rim keloids in five patients. Six helical rim keloids were reconstructed. There were four moderate (4-10 cm) and two large (>10 cm) helical rim keloids. Four were on the right helix and two on the left helix. One patient had bilateral helical rim keloids. The follow-up period ranged from 6 months to 4 years. No secondary surgical revision was required to improve the contour of the reconstructed helical rim. The aesthetic results were satisfactory in all the patients.
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Affiliation(s)
- Ibrahim Abdul Rasheed
- Department of Surgery, Division of Plastic Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna, Nigeria
| | - Asuku E Malachy
- Department of Surgery, Division of Plastic Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna, Nigeria
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Fredman R, Tenenhaus M. Cushing's syndrome after intralesional triamcinolone acetonide: A systematic review of the literature and multinational survey. Burns 2013; 39:549-57. [DOI: 10.1016/j.burns.2012.09.020] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Revised: 08/14/2012] [Accepted: 09/22/2012] [Indexed: 01/04/2023]
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Ud-Din S, Bowring A, Derbyshire B, Morris J, Bayat A. Identification of steroid sensitive responders versus non-responders in the treatment of keloid disease. Arch Dermatol Res 2013; 305:423-32. [PMID: 23479004 DOI: 10.1007/s00403-013-1328-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Revised: 02/05/2013] [Accepted: 02/11/2013] [Indexed: 12/17/2022]
Abstract
Intralesional corticosteroid injection is a well-recognised treatment modality for keloid disease (KD). Approximately 50% of KD cases are considered non-responders (or steroid resistant) with no consensus or indicators in detecting steroid-sensitive cases. In view of the undesirable side effects, uncertainty in timing and regularity of steroid treatment, we planned to identify responders and non-responders to target treatment more effectively. A scar injection proforma was developed capturing a detailed history focusing on symptoms and signs (redness, appearance, contour, texture, distortion and severity) associated with KD. The cause, site, number of keloid scars and scar recurrence were recorded as the lesions were injected on a monthly basis. A detailed description of response to steroid injection was documented and photographs were taken. Demographic data were collected on 65 patients (11 to 74 years with mean age 34.7 years, 60% were females, 50% were Caucasian). 77% (n = 50) were classified as steroid responders and showed improvement in symptoms and signs within 3 months. There was a statistically significant correlation between patients with higher contour scores of KD prior to treatment (p = 0.013) and frequency of injections (p = 0.003). Thus, the odds of being a responder were greater for patients with more than one injection and with higher contour scores. This preliminary case series has provided early evidence in enabling identification of steroid responders versus non-responders within a 3-month period. Selection of KD non-responders to steroid treatment can avoid potentially painful injection, its subsequent side effects and unnecessary continuation of redundant therapy and follow-up.
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Affiliation(s)
- Sara Ud-Din
- Plastic and Reconstructive Surgery Research, Manchester Institute of Biotechnology, University of Manchester, 131 Princess Street, Manchester M1 7ND, UK
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Weshahy AH, Abdel Hay R. Intralesional cryosurgery and intralesional steroid injection: a good combination therapy for treatment of keloids and hypertrophic scars. Dermatol Ther 2013; 25:273-6. [PMID: 22913446 DOI: 10.1111/j.1529-8019.2012.01456.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Hypertrophic scars and keloids exhibit high recurrence rates following surgical excision. Intralesional cryosurgery (ILC) can achieve a higher degree of effectiveness than the surface cryotherapy. The aim of this study is to assess the clinical efficacy of ILC using Weshahy cryoneedles followed by IL steroid in a trial of getting rid of the fibrous mass by destruction, not by surgery to avoid being under tension of the new scar. This study included 22 patients. Evaluation of the volume reduction of the lesions was done after a single ILC session followed by IL steroid injections. There was a significant decrease in the volume of the lesions after 4 months (P < 0.01), with a volume reduction of 93.5%. By using ILC at the base of keloids or hypertrophic scars, we can change the old fibrous tissue into a recent scar or granulation tissue which will respond more successfully to IL steroid injection.
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Affiliation(s)
- Ahmed Hany Weshahy
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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Park TH, Seo SW, Kim JK, Chang CH. Earlobe Keloids: Classification According to Gross Morphology Determines Proper Surgical Approach. Dermatol Surg 2012; 38:406-12. [DOI: 10.1111/j.1524-4725.2011.02199.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bermueller C, Rettinger G, Keck T. Auricular keloids: treatment and results. Eur Arch Otorhinolaryngol 2009; 267:575-80. [DOI: 10.1007/s00405-009-1059-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2009] [Accepted: 07/21/2009] [Indexed: 01/19/2023]
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Morosolli ARC, De Oliveira Moura Cardoso G, Murilo-Santos L, Niccoli-Filho W. Surgical treatment of earlobe keloid with CO2 laser radiation: case report and clinical standpoints. J COSMET LASER THER 2009; 10:226-30. [PMID: 18951235 DOI: 10.1080/14764170802307957] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Keloids are considered to be benign hyperproliferative growths of dense fibrous tissue and overabundant deposition of disorganized, thick, hyalinized collagen that result from an abnormal tissue response to cutaneous injury. Keloids do not have a specific cause, although genetic predisposition is heavily implicated. We present a case report of a patient with an earlobe keloid that was treated with carbon dioxide laser radiation (CO(2)) with an 0.8-mm focus, 7 W, a power density of 2.5 W/cm(2), in a continuous mode. The patient was seen for follow-up 6 months later. An intact hole for placement of an earring was observed with a very good esthetic and functional result.
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Affiliation(s)
- Aline Rose Cantarelli Morosolli
- Stomatologic Clinic, School of Dentistry, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
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Abstract
Mechanisms for keloid formation include drastic changes in growth factor actions, collagen turnover, mechanical forces applied over the skin, and genetic and immunologic contributions. The use of corticosteroids to manage keloids increases basic fibroblast growth factor production while decreasing transforming growth factor-β1 production by human dermal fibroblasts, endogenous vascular endothelial growth factor, and insulin-like growth factor-1. The use of corticosteroid injections is, to date, the core treatment available for the management of excessive tissue production in scars. Currently, the most effective and safe regimen for keloid management appears to be the use of corticotherapy—injection of intradermal steroids after a surgical excision.
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Affiliation(s)
- Claude Roques
- Pediatric Rehabilitation Centre, CSRE Lamalou le Haut,
Lamalou les Bains, France,
| | - Luc Téot
- Burn and Plastic Surgery Unit, Hôpital Lapeyronie, Montpellier,
France
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