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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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2
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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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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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4
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Piccolo D, Crisman G, Conforti C, Fusco I, Bonan P. Efficacy of a multimodal approach of laser therapy for earlobe keloids management in dark population. Skin Res Technol 2023; 29:e13502. [PMID: 38009015 PMCID: PMC10591025 DOI: 10.1111/srt.13502] [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: 09/27/2023] [Accepted: 10/09/2023] [Indexed: 11/28/2023]
Abstract
BACKGROUND Patients with keloids are often younger than 30 years old and have darker skin. AIM To evaluate the efficacy and safety of CO2 laser therapy in the management of earlobe and helix keloids in dark subjects. METHODS A total of 21 dark patients (five men and 16 women) presented with the earlobe and ear helix keloids, with a mean age of 30.5 (±6.7) years and with phototype between III-VI, were enrolled. In order to improve their earlobe and helix keloids, all patients underwent a single session of CO2 laser therapy immediately followed by a pulsed Dye laser procedure. A single well-experienced doctor performed all treatment sessions and the response to treatment. Patients were followed-up for 6 months after termination of therapy. Clinical images were examined and collected: all patients were examined clinically and with Dermoscopy. RESULTS The majority of the patients treated show complete remission of keloid lesions. Clinical photographs show a visible aesthetic improvement of several types of keloids in dark subjects. CONCLUSIONS Our data demonstrate that this combined laser therapeutic protocol appears to be effective and well tolerated for the management of earlobe and helix keloids in dark subjects, with no high recurrence rate and avoiding the adverse effects and lengthy recovery time.
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Affiliation(s)
| | | | - Claudio Conforti
- Department of Dermatology and VenereologyDermatology ClinicMaggiore HospitalUniversity of TriesteTriesteItaly
- IDI‐IRCCSDermatological Research HospitalRomeItaly
| | | | - Paolo Bonan
- Laser Cutaneous Cosmetic and Plastic Surgery UnitVilla Donatello ClinicFlorenceItaly
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5
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Earlobe Rejuvenation: A Review of Current Treatment Modalities. Dermatol Surg 2023; 49:253-258. [PMID: 36809188 DOI: 10.1097/dss.0000000000003709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
BACKGROUND As one of the defining features of the face, the ear influences perceptions of beauty. Despite its significance, comparatively little is known about rejuvenation options for the ear. OBJECTIVE To provide a comprehensive review of minimally invasive options for earlobe rejuvenation. METHODS & Materials: Cochrane, Embase, and PubMed were used to identify articles exploring minimally invasive treatments for ear rejuvenation. RESULTS Topical medications, peels, fillers, lasers, photodynamic therapy, and dermabrasion are safe and efficacious for managing a variety of concerns related to earlobe aesthetics. CONCLUSION Numerous minimally invasive treatment modalities are available for earlobe rejuvenation; further investigation is needed to design a grading system and treatment algorithm.
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Frech FS, Hernandez L, Urbonas R, Zaken GA, Dreyfuss I, Nouri K. Hypertrophic Scars and Keloids: Advances in Treatment and Review of Established Therapies. Am J Clin Dermatol 2023; 24:225-245. [PMID: 36662366 DOI: 10.1007/s40257-022-00744-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2022] [Indexed: 01/21/2023]
Abstract
Hypertrophic scars and keloids can have significant detrimental effects on patients both psychosocially and functionally. A careful identification of patient risk factors and a comprehensive management plan are necessary to optimize outcomes. Patients with a history of dystrophic scarring should avoid unnecessary procedures and enhance the wound-healing process using various preventive strategies. As there is no single, fully efficacious treatment modality, prevention remains the best approach in reducing aberrant scar formation. When prevention therapies fail, keloids have been shown to be respond to a variety of therapies including topical and injectable corticosteroids, 5-fluorouracil, radiotherapy, lasers, and surgical excision, all with varying efficacies. As such, management should be tailored to the individual patient's risk factors with the use of combination therapies to reduce recurrence rates. Still, keloid and hypertrophic scar therapies are widely diverse with novel treatment modalities providing alternatives for recurring lesions. Laser-assisted drug delivery, skin priming, and novel topical therapies may provide alternative options for the management of hypertrophic scars and keloids.
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Affiliation(s)
- Fabio Stefano Frech
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, 1150 Northwest 14th Street, Miami, FL, 33136, USA.
| | - Loren Hernandez
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, 1150 Northwest 14th Street, Miami, FL, 33136, USA
| | - Rebecca Urbonas
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Ghufran Abo Zaken
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, 1150 Northwest 14th Street, Miami, FL, 33136, USA
| | - Isabella Dreyfuss
- Nova Southeastern University, Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, FL, USA
| | - Keyvan Nouri
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, 1150 Northwest 14th Street, Miami, FL, 33136, USA
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Mandour Y, Bake H, Mofty E, Ramadan E, Gomaa M, Akl E, Elrefae A. Topical versus interlesional mitomycin C in auricular keloids. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2021; 72:280-287. [PMID: 34535218 DOI: 10.1016/j.otoeng.2020.06.006] [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: 04/25/2020] [Accepted: 06/18/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND The Keloid is an elevated fibrous scar that may extend beyond the borders of the original wound. OBJECT To compare between topical and intralesional mitomycin C in the treatment of auricular keloids. PATIENTS AND METHODS Prospective randomized study in which 40 patients with auricular keloids were included. The patients were divided into 2 groups, Group I included 32 patients who underwent topical mitomycin C application after the surgical removal of the auricular keloids, while Group II included 8 cases who underwent intra-lesional injection of mitomycin C after surgical removal of the auricular keloids. RESULTS The two groups showed no significant difference regarding patient or lesion criteria (p>.05). VSS decreased significantly from 10.63 and 11.0 down to 1.38 and 3.0 after treatment in the topical and intra-lesional groups respectively (p<.001). However, greater improvement and satisfaction was detected in the topical group. CONCLUSION Both topical and intra-lesional mitomycin C injection are effective methods in managing auricular keloids. However, better VSS scores and patient satisfaction are reported with topical administration.
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Affiliation(s)
| | - Hossam Bake
- Faculty of Medicine, Benha University, Benha, Egypt
| | - Esmael Mofty
- Faculty of Medicine, Benha University, Benha, Egypt
| | - Eman Ramadan
- Faculty of Medicine, Benha University, Benha, Egypt
| | | | - Essam Akl
- Faculty of Medicine, Benha University, Benha, Egypt
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Topical versus interlesional mitomycin C in auricular keloids. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2021. [DOI: 10.1016/j.otorri.2020.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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9
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Taganov AV, Bragina AV. Keloid scars. Modern aspects of diagnosis and treatment. CONSILIUM MEDICUM 2021. [DOI: 10.26442/20751753.2021.8.201112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Cicatricial skin hypertrophy includes keloids and hypertrophic scars. Keloid scarring is thought to result from an imbalance between increased synthesis of collagen and extracellular matrix and decreased degradation of these products. Current knowledge of keloid pathophysiology prompts clinicians to investigate new methods for the diagnosis and treatment of keloids, as well as their prevention.
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Treatment of hypertrophic scars and keloids using an intralesional 1470 nm bare-fibre diode laser: a novel efficient minimally-invasive technique. Sci Rep 2020; 10:21694. [PMID: 33303965 PMCID: PMC7728807 DOI: 10.1038/s41598-020-78738-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 11/26/2020] [Indexed: 12/20/2022] Open
Abstract
Hypertrophic and keloid scars result from abnormal wound healing and can have a variable response to a number of available treatment modalities. The evolution of laser treatments in recent years has shown a wide range of clinical applications including their use in the treatment of scars. We investigated the effectiveness of a 1470 nm diode laser using an intralesional optical fibre delivery device in the treatment of hypertrophic and keloid scars. We evaluated its safety and efficacy as a novel and minimally invasive treatment alternative for scar modulation and volume reduction. A prospective cohort study was performed involving 21 patients with hypertrophic scars (HS) (n = 9) and keloids (n = 12) resulting from various aetiology. Patients were treated with one to three treatment sessions. Comprehensive evaluations were performed using the Vancouver Scar Scale, Doppler ultrasound, Cutometer, Mexameter and PeriCam PSI. Scar thickness was reduced by an average of 0.308 ± 0.138 cm (p < 0.001). In particular the two subgroups showed a significant 27.7% and 28.2% reduction in scar thickness of HS and Keloids, respectively. Scar firmness showed a significant improvement of 1.2% (p < 0.05) for HS, though for keloids this was 0.4% (p = 0.26). Keloids had a significant reduction in pigmentation at 21.3%. Blood perfusion had a significant reduction of 29.6% in HS and 22.7% in Keloids. Overall VSS total score improvement of 42% in the HS and at 37.9% in the Keloid subgroup. No adverse events such as hypo/hyperpigmentation, skin infection, or recurrence were reported. This study shows that the intralesional 1470 nm bare-fibre diode laser significantly improved hypertrophic and keloid scars based on both subjective and objective analyses and supports this type of laser therapy as a safe and effective minimally-invasive treatment option.
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Dachlan I, Wirohadidjojo YW, Wahyuningsih MSH, Aryandono T, Soebono H, Afandy D. The effect of 5α-oleandrin on keloid fibroblast activities. BMC Proc 2020; 13:14. [PMID: 31890007 PMCID: PMC6912934 DOI: 10.1186/s12919-019-0177-6] [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] [Indexed: 12/03/2022] Open
Abstract
Background Keloids develop due to hyperactivity of keloid fibroblast (KF) in proliferation, migration, and collagen deposition along with low rates of collagen degradation. These are a result of the Wnt/β catenin signaling pathways under stimulation of TGF-β. 5α-oleandrin can suppress Wnt-targeted genes of osteosarcoma cells. We aimed to evaluate the anti-fibrotic effects of 5α-oleandrin on KF activities. Methods We collected the core of keloid materials from six patients who underwent keloid debulking surgery. Passage 4 of KF cells were then treated with mitomycin-C, 5α-oleandrin, and dilution medium as the negative control. To determine the effective dose of 5α-oleandrin, we diluted 5α-oleandrin into various concentrations. The incubation periods were 24 h, 48 h, and 72 h. The anti-proliferation and anti-fibrotic properties were measured using standard assay. Results Both the mitomycin-C and 5α-oleandrin treated groups indicated decrease in proliferation index (86.16 ± 4.20% and 73.76 ± 4.94%, respectively), collagen deposition index (90.26 ± 1.72% and 71.35 ± 4.26%, respectively), and migration capacity (33.51 ± 1.50% and 28.57 ± 1.58%, respectively). These were significant changes (p ≤ 0.05) compared to the non-treated group. Antifibrotic activities of 5α-oleandrin in cellular proliferation and collagen deposition were better than mitomycin-C. Conclusions The 5α-oleandrin has good antifibrotic effect in keloid fibroblast activities.
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Affiliation(s)
- Ishandono Dachlan
- 1Plastic and Reconstructive Surgery Division, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Dr. Sardjito Hospital, Jl. Kesehatan No. 1, North Sekip, Yogyakarta, 55281 Indonesia
| | - Yohanes Widodo Wirohadidjojo
- 2Department of Dermato-venereology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/ Sardjito-Hospital, North Sekip, Yogyakarta, Indonesia
| | - Mae Sri Hartati Wahyuningsih
- 3Department of Pharmacology and Therapy, Faculty of Medicine, Universitas Gadjah Mada, North Sekip, Yogyakarta, Indonesia
| | - Teguh Aryandono
- 4Oncology Surgery Division, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/ Sardjito-Hospital, North Sekip, Yogyakarta, Indonesia
| | - Hardyanto Soebono
- 5Department of Dermato-venereology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/ Sardjito-Hospital, North Sekip, Yogyakarta, Indonesia
| | - Dwiki Afandy
- 6Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/ Sardjito-Hospital, North Sekip, Yogyakarta, Indonesia
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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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Histologic Evaluation of Healing Lip Defects Treated With Injected Onabotulinum Toxin A and Topical Mitomycin C. J Craniofac Surg 2019; 30:2646-2649. [PMID: 31567767 DOI: 10.1097/scs.0000000000005953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Using an experimental rat model, the efficacy of injected Onabotulinum Toxin A (BoNT-A) versus topical Mitomycin C in surgical wound healing of rat lip defects was evaluated. METHODS AND MATERIALS Sixty-seven male Wister rats received a triangular cut (7 × 7 × 4 mm) on their upper lip. Then they were divided randomly into 4 equal groups: group A (topical Mitomycin C plus injected BoNT-A); group B (topical Mitomycin C); group C or control group (saline solution) and group D (injected (BoNT-A). After 3 months, the animals were euthanized and scars were evaluated using hematoxylin and eosin and Masson's trichrome.For qualitative analysis, inflammatory cell density, new capillary formation, fibroblast proliferation, and collagen deposition were reported using relative ranks from 0 to 3 (absence, mild, moderate, marked). Data were analyzed by post hoc and Kruskal-Wallis tests. The significance level was P < 0.05. RESULT Mean collagen deposition values and fibroblast proliferation in the 4 groups showed statistically significant differences with each other (P value < 0.001). A significant difference between group A and controls existed for fibroblast proliferation (median 1 versus 2, P value < 0.001); also, collagen deposition (median 1 versus 2, P value < 0.001). A significant difference existed between the control and group D (median 2 versus 1, P value = 0.004); also, group A and B (median 1 versus 2, P value = 0.002) for collagen deposition. However, no significant differences existed between the 4 groups regarding inflammatory cells and angiogenesis (P value > 0.05). CONCLUSION Local injection of BoNT-A plus Mitomycin C followed by BoNT-A alone provided less collagen formation and fibroblastic proliferation in the healing lip defect in a rat model.
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Huang C, Liu L, You Z, Du Y, Ogawa R. Managing keloid scars: From radiation therapy to actual and potential drug deliveries. Int Wound J 2019; 16:852-859. [PMID: 30864269 DOI: 10.1111/iwj.13104] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 02/07/2019] [Accepted: 02/10/2019] [Indexed: 12/19/2022] Open
Abstract
The aetiology of keloids is becoming clearer, but many questions remain, including about the most optimal treatment. Current therapies include surgical excision, radiotherapy, and various pharmaceutical drugs. However, none of these drugs are keloid-specific. Moreover, all current interventions are associated with high recurrence rates. Here, we review the pharmaceutical interventions that are currently available. All are based on the fact that keloids are an expanding solid mass with intense chronic inflammation at its advancing edges. Consequently, current pharmaceuticals aim to reduce the mass and/or symptoms of keloids, similar to surgery and radiotherapy. They include chemotherapies, immunotherapies, volume-reducing therapies, and anti-inflammatory therapies. We also describe new advances in keloid pharmaceuticals. They include drugs that were designed to treat systemic diseases such as hypertension or breast cancer but were found to also treat keloids. Furthermore, recent progress in genetic, epigenetic, and stem cell therapies suggests that they could become useful in the keloid field. This review of pharmaceutical advances will hopefully promote additional research and the development of effective and specific pharmaceuticals for keloids.
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Affiliation(s)
- Chenyu Huang
- Department of Dermatology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Longwei Liu
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Zhifeng You
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Yanan Du
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Rei Ogawa
- Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School, Tokyo, Japan
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Amini-Nik S, Yousuf Y, Jeschke MG. Scar management in burn injuries using drug delivery and molecular signaling: Current treatments and future directions. Adv Drug Deliv Rev 2018; 123:135-154. [PMID: 28757325 PMCID: PMC5742037 DOI: 10.1016/j.addr.2017.07.017] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 07/14/2017] [Accepted: 07/20/2017] [Indexed: 12/14/2022]
Abstract
In recent decades, there have been tremendous improvements in burn care that have allowed patients to survive severe burn injuries that were once fatal. However, a major limitation of burn care currently is the development of hypertrophic scars in approximately 70% of patients. This significantly decreases the quality of life for patients due to the physical and psychosocial symptoms associated with scarring. Current approaches to manage scarring include surgical techniques and non-surgical methods such as laser therapy, steroid injections, and compression therapy. These treatments are limited in their effectiveness and regularly fail to manage symptoms. As a result, the development of novel treatments that aim to improve outcomes and quality of life is imperative. Drug delivery that targets the molecular cascades of wound healing to attenuate or prevent hypertrophic scarring is a promising approach that has therapeutic potential. In this review, we discuss current treatments for scar management after burn injury, and how drug delivery targeting molecular signaling can lead to new therapeutic strategies.
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Affiliation(s)
- Saeid Amini-Nik
- Sunnybrook Research Institute, Toronto, Canada; Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada; Department of Surgery, Division of Plastic Surgery, University of Toronto, Toronto, Canada.
| | - Yusef Yousuf
- Institute of Medical Science, University of Toronto, Toronto, Canada; Sunnybrook Research Institute, Toronto, Canada
| | - Marc G Jeschke
- Institute of Medical Science, University of Toronto, Toronto, Canada; Sunnybrook Research Institute, Toronto, Canada; Department of Surgery, Division of Plastic Surgery, University of Toronto, Toronto, Canada; Department of Immunology, University of Toronto, Toronto, Canada; Ross-Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, Canada.
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Abstract
This article provides a review of the surgical and nonsurgical options available to manage a variety of auricular scars. The basics of wound healing are discussed in addition to the etiology of keloids and the cauliflower ear. Many auricular scars can be revised with scar excision techniques, but separate discussions for the treatment of keloids and the cauliflower ear are provided. The management plan for auricular scarring requires appropriate patient counseling regarding the risk of recurrence in keloids, regrowth of scar tissue in cauliflower ears, scar hypertrophy at the line of closure, widening of the scar, and persisting ear contour deformities.
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Affiliation(s)
- Deborah Watson
- Division of Otolaryngology-Head and Neck Surgery, University of California, San Diego, 3350 La Jolla Village Drive, 112-C, San Diego, CA 92161, USA
| | - Bharat Panuganti
- Division of Otolaryngology-Head and Neck Surgery, University of California, San Diego, 3350 La Jolla Village Drive, 112-C, San Diego, CA 92161, USA.
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17
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Evidence-Based Scar Management: How to Improve Results with Technique and Technology. Plast Reconstr Surg 2017; 138:165S-178S. [PMID: 27556757 DOI: 10.1097/prs.0000000000002647] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Scars represent the visible sequelae of trauma, injury, burn, or surgery. They may induce distress in the patient because of their aesthetically unpleasant appearance, especially if they are excessively raised, depressed, wide, or erythematous. They may also cause the patient symptoms of pain, tightness, and pruritus. Numerous products are marketed for scar prevention or improvement, but their efficacy is unclear. METHODS A literature review of high-level studies analyzing methods to prevent or improve hypertrophic scars, keloids, and striae distensae was performed. The evidence from these articles was analyzed to generate recommendations. Each intervention's effectiveness at preventing or reducing scars was rated as none, low, or high, depending on the strength of the evidence for that intervention. RESULTS For the prevention of hypertrophic scars, silicone, tension reduction, and wound edge eversion seem to have high efficacy, whereas onion extract, pulsed-dye laser, pressure garments, and scar massage have low efficacy. For the treatment of existing hypertrophic scars, silicone, pulsed-dye laser, CO2 laser, corticosteroids, 5-fluorouracil, bleomycin, and scar massage have high efficacy, whereas onion extract and fat grafting seem to have low efficacy. For keloid scars, effective adjuncts to excision include corticosteroids, mitomycin C, bleomycin, and radiation therapy. No intervention seems to have significant efficacy in the prevention or treatment of striae distensae. CONCLUSION Although scars can never be completely eliminated in an adult, this article presents the most commonly used, evidence-based methods to improve the quality and symptoms of hypertrophic scars, as well as keloid scars and striae distensae.
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Shin JY, Yun SK, Roh SG, Lee NH, Yang KM. Efficacy of 2 Representative Topical Agents to Prevent Keloid Recurrence After Surgical Excision. J Oral Maxillofac Surg 2016; 75:401.e1-401.e6. [PMID: 27865791 DOI: 10.1016/j.joms.2016.10.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 09/08/2016] [Accepted: 10/06/2016] [Indexed: 12/13/2022]
Abstract
PURPOSE Keloids are difficult to remove successfully and there is no universally accepted treatment. After surgical excision of the keloid, there are various management methods for prevention of keloid recurrence, such as intralesional injection, radiation, and topical agents. A few studies have compared topical agents with other treatments. The aim of this study was to investigate effective topical agents for the prevention of recurrent keloid after surgical excision. MATERIALS AND METHODS Eligible articles were sought using core databases, including Medline, Embase, and Cochrane databases, up to April 2016. The predictor variables were mitomycin C (MC) and imiquimod cream treatment after keloid excision. The outcome variable was keloid recurrence rate. RESULTS The search strategy identified 120 publications. After screening, 9 articles were selected for review. Articles were divided into 2 groups: MC and imiquimod cream. The recurrence rate after surgical excision in the MC group was estimated to be 16.5%, and that in the imiquimod cream group was estimated to be 24.7%. CONCLUSION If intralesional injection or radiation is not available, then MC or imiquimod 5% cream could be an effective alternative in preventing keloid recurrence.
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Affiliation(s)
- Jin Yong Shin
- Professor, Department of Plastic and Reconstructive Surgery, Chonbuk National University Hospital, Jeonju, Korea
| | - Seok-Kweon Yun
- Professor, Department of Dermatology, Chonbuk National University Hospital, Jeonju, Korea
| | - Si-Gyun Roh
- Professor, Department of Plastic and Reconstructive Surgery, Chonbuk National University Hospital, Jeonju, Korea
| | - Nae-Ho Lee
- Professor, Department of Plastic and Reconstructive Surgery, Chonbuk National University Hospital, Jeonju, Korea.
| | - Kyung-Moo Yang
- Professor, Department of Plastic and Reconstructive Surgery, Chonbuk National University Hospital, Jeonju, Korea
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19
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Ren Y, Zhou X, Wei Z, Lin W, Fan B, Feng S. Efficacy and safety of triamcinolone acetonide alone and in combination with 5-fluorouracil for treating hypertrophic scars and keloids: a systematic review and meta-analysis. Int Wound J 2016; 14:480-487. [PMID: 27427423 DOI: 10.1111/iwj.12629] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 06/10/2016] [Indexed: 12/23/2022] Open
Abstract
Pathological scars, such as keloids and hypertrophic scars, readily cause physical and psychological problems. Combination 5-fluorouracil (5-FU) with triamcinolone acetonide (TAC) is presumed to enhance the treatment of pathological scars, although supportive evidence is lacking. We aimed to compare the efficacy and safety of TAC alone and in combination with 5-FU for the treatment of hypertrophic scars and keloids. Five databases (PubMed, Medline, Cochrane databases, Embase and CNKI) were searched with the limitations of human subjects and English-language text. Mean differences (MDs), odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. The Cochrane Collaboration's Risk of Bias Tool was used to assess the risk of bias. The control group received intralesional TAC alone, and the experimental group received TAC combined with 5-FU injection. A pooled analysis of the effectiveness based on patient self-assessment after treatment showed that the experimental group achieved better results than the control group (OR = 2·92, 95% CI = 1·63-5·22, P = 0·0003). Similarly, a pooled analysis of the effectiveness based on observer assessment following treatment produced the same conclusion (OR = 4·03, 95% CI = 1·40-11·61, P = 0·010). A meta-analysis of scar height after treatment showed that the experimental group performed better than the control group (MD = -0·14, 95% CI = -0·23-0·05, P = 0·002). The erythema score of the experimental group after treatment was superior (MD = -0·20, 95% CI = -0·34-0·06, P = 0·004). The heterogeneity test showed no heterogeneity among the studies (P > 0·1, I2 = 0%). TAC combined with 5-FU is more suitable for the treatment and prevention of hypertrophic scars and keloids, with greater improvement in scar height and patient satisfaction as well as fewer side effects.
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Affiliation(s)
- YiMing Ren
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, China
| | - XianHu Zhou
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, China
| | - ZhiJian Wei
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, China
| | - Wei Lin
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, China
| | - BaoYou Fan
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, China
| | - ShiQing Feng
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, China
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Trace AP, Enos CW, Mantel A, Harvey VM. Keloids and Hypertrophic Scars: A Spectrum of Clinical Challenges. Am J Clin Dermatol 2016; 17:201-23. [PMID: 26894654 DOI: 10.1007/s40257-016-0175-7] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Since their earliest description, keloids and hypertrophic scars have beleaguered patients and clinicians alike. These scars can be aesthetically disfiguring, functionally debilitating, emotionally distressing, and psychologically damaging, culminating in a significant burden for patients. Our current understanding of keloid pathophysiology has grown and continues to advance while molecular biology, genetics, and technology provide ever-deepening insight into the nature of wound healing and the pathologic perturbations thereof. Greater understanding will lead to the development and application of refined therapeutic modalities. This article provides an overview of our current understanding of keloids, highlighting clinical characteristics and diagnostic criteria while providing a comprehensive summary of the many therapeutic modalities available. The proposed mechanism, application, adverse events, and reported efficacy of each modality is evaluated, and current recommendations are summarized.
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Affiliation(s)
- Anthony P Trace
- Department of Radiology, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Clinton W Enos
- The School of Medicine, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Alon Mantel
- Hampton University Skin of Color Research Institute, Hampton University, Hampton, VA, USA
| | - Valerie M Harvey
- Hampton University Skin of Color Research Institute, Hampton University, Hampton, VA, USA.
- Department of Dermatology, Eastern Virginia Medical School, 721 Fairfax Ave., Norfolk, VA, 23507, USA.
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21
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Sidgwick GP, McGeorge D, Bayat A. A comprehensive evidence-based review on the role of topicals and dressings in the management of skin scarring. Arch Dermatol Res 2015; 307:461-77. [PMID: 26044054 PMCID: PMC4506744 DOI: 10.1007/s00403-015-1572-0] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 04/11/2015] [Accepted: 04/29/2015] [Indexed: 12/22/2022]
Abstract
Wound healing after dermal injury is an imperfect process, inevitably leading to scar formation as the skin re-establishes its integrity. The resulting scars have different characteristics to normal skin, ranging from fine-line asymptomatic scars to problematic scarring including hypertrophic and keloid scars. Scars appear as a different colour to the surrounding skin and can be flat, stretched, depressed or raised, manifesting a range of symptoms including inflammation, erythema, dryness and pruritus, which can result in significant psychosocial impact on patients and their quality of life. In this paper, a comprehensive literature review coupled with an analysis of levels of evidence (LOE) for each published treatment type was conducted. Topical treatments identified include imiquimod, mitomycin C and plant extracts such as onion extract, green tea, Aloe vera, vitamin E and D, applied to healing wounds, mature scar tissue or fibrotic scars following revision surgery, or in combination with other more established treatments such as steroid injections and silicone. In total, 39 articles were included, involving 1703 patients. There was limited clinical evidence to support their efficacy; the majority of articles (n = 23) were ranked as category 4 LOE, being of limited quality with individual flaws, including low patient numbers, poor randomisation, blinding, and short follow-up periods. As trials were performed in different settings, they were difficult to compare. In conclusion, there is an unmet clinical need for effective solutions to skin scarring, more robust long-term randomised trials and a consensus on a standardised treatment regime to address all aspects of scarring.
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Affiliation(s)
- G. P. Sidgwick
- />Plastic and Reconstructive Surgery Research, Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, Manchester Institute of Biotechnology, University of Manchester, 131 Princess Street, Manchester, M1 7DN UK
| | - D. McGeorge
- />Grosvenor Nuffield Hospital, Wrexham Road, Chester, CH4 7QP England, UK
| | - A. Bayat
- />Plastic and Reconstructive Surgery Research, Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, Manchester Institute of Biotechnology, University of Manchester, 131 Princess Street, Manchester, M1 7DN UK
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22
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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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23
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Abstract
Patients and clinicians use skin color attributes such as color uniformity, color distribution, and texture to infer physiologic health status. Normalization of skin color, surface texture, and height are important treatment goals in the treatment of scars. Skin color, structure, and response to trauma, vary with ethnicity. The incidence of hypertrophic and keloid scar formation is influenced by these inherent skin attributes. Skin type influences the response to various modalities including laser therapy and surgical intervention, and skin differences must be considered in treatment planning to achieve optimal results.
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Affiliation(s)
- Marty O Visscher
- Skin Sciences Program, Division of Plastic Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA; Department of Surgery, College of Medicine, University of Cincinnati, Cincinnati, OH 45267, USA.
| | - J Kevin Bailey
- Division of Trauma, Critical Care and Burn, Wexner Medical Center, The Ohio State University, 410 West 10th Avenue, Columbus, OH 43210, USA
| | - David B Hom
- Division of Facial Plastic & Reconstructive Surgery, Department of Otolaryngology-Head & Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
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24
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Kerwin LY, El Tal AK, Stiff MA, Fakhouri TM. Scar prevention and remodeling: a review of the medical, surgical, topical and light treatment approaches. Int J Dermatol 2014; 53:922-36. [DOI: 10.1111/ijd.12436] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
| | - Abdel Kader El Tal
- Department of Dermatology; Wayne State University; Dearborn MI USA
- Department of Dermatology; American University of Beirut; New York NY USA
| | - Mark A. Stiff
- Department of Dermatology; Wayne State School of Medicine; Southfield MI USA
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25
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Wang YW, Ren JH, Xia K, Wang SH, Yin TF, Xie DH, Li LH. Effect of mitomycin on normal dermal fibroblast and HaCat cell: an in vitro study. J Zhejiang Univ Sci B 2013; 13:997-1005. [PMID: 23225855 DOI: 10.1631/jzus.b1200055] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate the effects of mitomycin on the growth of human dermal fibroblast and immortalized human keratinocyte line (HaCat cell), particularly the effect of mitomycin on intracellular messenger RNA (mRNA) synthesis of collagen and growth factors of fibroblast. METHODS The normal dermal fibroblast and HaCat cell were cultured in vitro. Cell cultures were exposed to 0.4 and 0.04 mg/ml of mitomycin solution, and serum-free culture medium was used as control. The cellular morphology change, growth characteristics, cell proliferation, and apoptosis were observed at different intervals. For the fibroblasts, the mRNA expression changes of transforming growth factor (TGF)-β1, basic fibroblast growth factor (bFGF), procollagen I, and III were detected by reverse transcription polymerase chain reaction (RT-PCR). RESULTS The cultured normal human skin fibroblast and HaCat cell grew exponentially. A 5-min exposure to mitomycin at either 0.4 or 0.04 mg/ml caused marked dose-dependent cell proliferation inhibition on both fibroblasts and HaCat cells. Cell morphology changed, cell density decreased, and the growth curves were without an exponential phase. The fibroblast proliferated on the 5th day after the 5-min exposure of mitomycin at 0.04 mg/ml. Meanwhile, 5-min application of mitomycin at either 0.04 or 0.4 mg/ml induced fibroblast apoptosis but not necrosis. The apoptosis rate of the fibroblast increased with a higher concentration of mytomycin (p<0.05). A 5-min exposure to mitomycin at 0.4 mg/ml resulted in a marked decrease in the mRNA production of TGF-β1, procollagen I and III, and a marked increase in the mRNA production of bFGF. CONCLUSIONS Mitomycin can inhibit fibroblast proliferation, induce fibroblast apoptosis, and regulate intracellular protein expression on mRNA levels. In addition, mitomycin can inhibit HaCat cell proliferation, so epithelial cell needs more protecting to avoid mitomycin's side effect when it is applied clinically.
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Affiliation(s)
- Yao-wen Wang
- Otolaryngology-Head and Neck Surgery Department, Ningbo First Hospital, Ningbo 315000, China
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26
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Goodman GJ. Treating Scars: Addressing Surface, Volume, and Movement to Expedite Optimal Results. Part 2: More-Severe Grades of Scarring. Dermatol Surg 2012; 38:1310-21. [DOI: 10.1111/j.1524-4725.2012.02439.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Localized resistant plaques of psoriasis often remain despite highly effective anti-psoriasis treatment. Intralesional therapy is often used to treat various malignant, infectious or inflammatory cutaneous diseases, including psoriasis. Despite the presence of many review articles on the treatment of psoriasis, no articles exist which review the use of intralesional therapy for psoriasis. In this article, we review the published literatures of intralesional therapy for psoriasis. Corticosteroids, methotrexate, cyclosporin, biologics, botulinum toxin type-A, 15-hydroxyeicosatetraenoic acid, and chemotherapy agents such as 5-fluorouracil are discussed. Also, agents which may be used intralesionally and have the potential to treat psoriasis will also be reviewed such as bleomycin, vincristine or vinblastine, mitomycin-C, aminophylline, 5-aminolevulinic acid, rituximab, bevacizumab and pentoxifylline are included.
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Affiliation(s)
- Ting-Shun Wang
- Department of Dermatology, National Taiwan University Hospital, Taipei, Taiwan, Republic of China
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Abstract
Keloids result from an abnormal wound-healing process in which the normal regulatory pathways during tissue regeneration and scar remodeling are disrupted. While the pathogenesis of keloids continues to be investigated, numerous treatment options exist. Although prevention of keloid formation is the best management, early recognition of keloid formation is integral in treatment and prevention of recurrence. Surgical resection with adjuvant silicone gel sheeting or triamcinolone injection is common, but can still result in recurrence. New treatments include chemotherapeutics such as 5-fluorouracil, bleomycin, and mitomycin C. Although further clinical investigation is required for newer treatments, initial results are promising.
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Affiliation(s)
- Douglas M Sidle
- Division of Facial Plastic Surgery, Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, 676 North Street Clair, Suite 1325, Chicago, IL 60611, USA.
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A Controlled Clinical Trial With Pirfenidone in the Treatment of Pathological Skin Scarring Caused by Burns in Pediatric Patients. Ann Plast Surg 2012; 68:22-8. [DOI: 10.1097/sap.0b013e31821b6d08] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Seo SH, Sung HW. Treatment of keloids and hypertrophic scars using topical and intralesional mitomycin C. J Eur Acad Dermatol Venereol 2011; 26:634-8. [DOI: 10.1111/j.1468-3083.2011.04140.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Tracheal resection with end-to-end anastomosis for post-intubation cervical tracheal stenosis: study of 14 cases. The Journal of Laryngology & Otology 2011; 125:958-61. [PMID: 21729445 DOI: 10.1017/s002221511100137x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVES The incidence of acquired laryngeal stenosis is increasing. This retrospective study aimed to assess the long term results of circumferential resection with end-to-end tracheal anastomosis for isolated post-intubation stenosis of the cervical trachea, and to review the relevant literature. METHODS Twelve male and two female patients (aged 16-30 years, mean age 24 years) treated between February 2003 and December 2008 were included. Hospital and office records were reviewed and relevant surgical details recorded. RESULTS Indications for tracheal resection anastomosis were post-intubation stenosis (78.57 per cent) and trauma (21.42 per cent). One to five tracheal rings were resected (i.e. 1-2.5 cm of cervical trachea). Tracheal anastomosis was considered successful if the patient remained asymptomatic for 24 months of close follow up (involving regular flexible bronchoscopy and neck X-ray). The anastomotic success rate was 92.85 per cent. CONCLUSION Tracheal resection and end-to-end anastomosis is relatively safe and reliable for definitive treatment of benign tracheal stenosis in appropriate patients. Local application of mitomycin C prevents granulation and aids long term airway patency.
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Role of mitomycin C in reducing keloid recurrence: patient series and literature review. The Journal of Laryngology & Otology 2010; 125:297-300. [PMID: 20955637 DOI: 10.1017/s0022215110002045] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To study the role of mitomycin C in reducing keloid recurrence. STUDY DESIGN Prospective, randomised, controlled trial. SETTING Tertiary care referral centre. PATIENTS Case series of 20 patients presenting with 26 pinna swellings, mostly following ear piercing. INTERVENTIONS We used the technique of surgical shave excision combined with topical application of mitomycin C and secondary wound healing, in all 26 pinnae. RESULTS Patients were followed up six to 24 months post-operatively. No recurrences were noted during this period. CONCLUSION Keloids are fibrotic lesions resulting from abnormal wound healing. The uncontrolled proliferation of normal tissue healing processes results in scarring that enlarges well beyond the original wound margins. Successful treatment of keloids remains a challenge because this disease process has a high propensity for recurrence. Various therapies have previously been reported, and success rates are highly variable. We believe that shave excision followed by topical mitomycin C application is a promising treatment option for the management of pinna keloids.
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The emerging role of antineoplastic agents in the treatment of keloids and hypertrophic scars: a review. Ann Plast Surg 2010; 64:355-61. [PMID: 20179490 DOI: 10.1097/sap.0b013e3181afaab0] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The management of keloids and hypertrophic scars continues to challenge health-care providers. Though both forms of pathologic scarring are distinct entities at the macro and microscopic level, their etiologies and treatment are often similar. Potential treatment approaches are progressing, and combinations of treatment options have been proposed in the literature with promising outcomes. The treatment evolution has reached a level where molecular therapeutic modalities are being investigated. Currently, no gold standard treatment exists. Overall success rates and patient satisfaction seem to be slowly climbing, but additional investigational studies must continue to be performed. Several studies have investigated antineoplastic agents, and there seems to be a marked improvement in rates of recurrence, patient satisfaction, and overall quality of scar when these agents are used. Intralesional injection and/or wound irrigation with interferon-a2b, interferon-g, mitomycin-C, bleomycin, or 5-fluorouracil seems to have a positive effect on the reduction of pathologic scars. There is mounting evidence that these drugs used alone or in combination therapy, have the potential to be an integral part of the treatment paradigm for hypertrophic scars and keloids.
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A review of the effectiveness of antimitotic drug injections for hypertrophic scars and keloids. Ann Plast Surg 2010; 63:688-92. [PMID: 19887927 DOI: 10.1097/sap.0b013e3181978753] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Hypertrophic scars and keloids are common problems after injury and cause functional and cosmetic deformities. A wide variety of treatments have been advocated for hypertrophic scars and keloids regression. Unfortunately, the reported efficacy has been variable. This article explores antimitotic drugs described in the literature such as steroid injection, 5-FU, mitomycin C, and bleomycin, which mainly target the fibroblasts in scar tissue, have been proposed as the effective modalities for scar treatment and scar prevention after surgery, but restricted due to possible side effects. The current accepted treatment for hypertrophic scar and keloid are combination therapy and the early treatment which could achieve better efficacy and less adverse effect.
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Santos NRS, dos Santos JN, Sobrinho JBM, Ramalho LM, Carvalho CM, Soares LG, Pinheiro AL. Effects of Laser Photobiomodulation on Cutaneous Wounds Treated with Mitomycin C: A Histomorphometric and Histological Study in a Rodent Model. Photomed Laser Surg 2010; 28:81-90. [DOI: 10.1089/pho.2008.2380] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | | | | | - Carolina M. Carvalho
- Laser Center, School of Dentistry, Federal University of Bahia (UFBA), Salvador, Brazil
| | - Luiz G.P. Soares
- Laser Center, School of Dentistry, Federal University of Bahia (UFBA), Salvador, Brazil
| | - Antônio L.B. Pinheiro
- Laser Center, School of Dentistry, Federal University of Bahia (UFBA), Salvador, Brazil
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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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Froelich K, Staudenmaier R, Kleinsasser N, Hagen R. Therapy of auricular keloids: review of different treatment modalities and proposal for a therapeutic algorithm. Eur Arch Otorhinolaryngol 2007; 264:1497-508. [PMID: 17628822 DOI: 10.1007/s00405-007-0383-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2007] [Accepted: 06/14/2007] [Indexed: 11/27/2022]
Abstract
Keloids are abnormal wound reactions of connective tissue. Auricular keloids can develop as a result of, e.g., otoplasty, ear piercing, or skin trauma. A wide variety of therapeutic options exists, including surgery as primary treatment. Furthermore, there are medical, physical, radiotherapeutic and experimental options. The present paper focuses on the different techniques including the therapeutic outcome and quality rating for each chosen pathway. In addition to the experience of the university hospitals, a thorough review of the literature was performed in order to update and compare today's therapeutic options. Surgical techniques are customized to the lesion's specific localization and extent. They may include revision of otoplasty. With medical treatment, established modalities such as steroid injection have to be distinguished from experimental methods like interferon, 5-FU, verapamil, imiquimod, or mitomycin C. Radiation is generally accepted to be effective, especially applied accompanying surgery, but needs to be restricted due to possible side effects. Physical therapy, e.g., pressure in a variety of application modalities, has gained a profound position in the therapy of auricular keloids. The success rates of the different treatment modalities vary markedly, and the number of patients per study is considerably low. Resuming the results, a periodic follow-up and good patients' compliance are mandatory to early realize and treat auricular keloids. However, studies are needed to evaluate accepted and experimental therapies including larger number of patients.
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Affiliation(s)
- K Froelich
- Department of Otolaryngology, Head and Neck Surgery, University of Wuerzburg, Josef-Schneider-Strasse 11, 97080, Würzburg, Germany.
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