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Tsubouchi H, Awaji T, Hirose R, Kishida K, Yamashita S, Furuya K, Chang Y, Shikado K, Kohta M, Ogita K. Preventive Effect of Hydrocolloid Dressings on Hypertrophic Scarring of Post-Cesarean Section Wounds: A Randomized Pilot Study. Adv Skin Wound Care 2024; 37:360-367. [PMID: 38899817 DOI: 10.1097/asw.0000000000000155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
OBJECTIVE To determine the prophylactic effect of hydrocolloid dressings on hypertrophic scarring in post-cesarean section wounds. METHODS Patients who underwent cesarean section (C/S) at the authors' hospital and provided informed consent to participate were randomly assigned to the intervention and control groups. The intervention group commenced applying hydrocolloid dressings to the wound on postoperative day 7 or 8 and continued with weekly dressing changes for 6 months. The control group refrained from any dressing application but was followed up. In each group, the condition of the wound was evaluated 6 and 12 months postoperatively using the Japan Scar Workshop Scar Scale 2015, the Patient and Observer Scar Assessment Scale version 2.0, the modified Vancouver Scar Scale, and patient-reported outcomes. RESULTS During this period, 135 patients underwent C/S at the authors' institution, and 47 (23 in the intervention group and 24 in the control group) were included in the analysis. In all assessment methods, the intervention group scored lower than the control group at 6 and 12 months after C/S. Twelve months after C/S, hypertrophic scarring (Japan Scar Workshop Scar Scale 2015 score of 6-15) was found in 14 of the 47 (29.8%) patients: 11 of 24 (45.8%) in the control group and 3 of 23 (13.0%) in the intervention group. The intervention's relative risk was 0.623 (95% CI, 0.417-0.930). The risk factor for hypertrophic scarring was midline vertical incision, with an odds ratio of 20.53 (95% CI, 4.18-100.92). CONCLUSIONS The study reveals that the application of hydrocolloid dressings to wounds reduces the risk of hypertrophic scarring after C/S.
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Affiliation(s)
- Hiroaki Tsubouchi
- In the Department of Obstetrics and Gynecology, Rinku General Medical Centre, Izumisano, Osaka, Japan, Hiroaki Tsubouchi, MD, PhD, is Deputy Chief; Takuya Awaji, MD, is Deputy Chief; Rikuto Hirose, MD, is Senior Resident; Kenji Kishida, MD, is Physician; Saya Yamashita, MD, PhD, is Deputy Head Physician; Kiichiro Furuya, MD, PhD, is Deputy Head Physician; Yangshil Chang, MD, is Deputy Head Physician; and Kayoko Shikado, MD, is Staff Doctor. Masushi Kohta, PhD, is Senior Assistant Professor, Research Center for Implementation Nursing Science Initiative, Fujita Health University, Toyoake, Aichi, Japan. Also in the Department of Obstetrics and Gynecology, Rinku General Medical Centre, Kazuhide Ogita, MD, PhD, is Chief Obstetrician
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Sangha MS, Deroide F, Meys R. Wound healing, scarring and management. Clin Exp Dermatol 2024; 49:325-336. [PMID: 38001053 DOI: 10.1093/ced/llad410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 11/03/2023] [Accepted: 11/16/2023] [Indexed: 11/26/2023]
Abstract
Understanding wound healing is imperative for the dermatological physician to optimize surgical outcomes. Poor healing may result in negative functional, cosmetic and psychological sequelae. This review briefly outlines the physiology of wound healing, with a view to improving the management of wounds and scars, and minimizing the long-term scarring complications.
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Affiliation(s)
| | - Florence Deroide
- Department of Dermatology, Royal Free London NHS Foundation Trust, London, UK
| | - Rhonda Meys
- Department of Dermatology, Royal Free London NHS Foundation Trust, London, UK
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Rimmer SN, Chandy RJ, Khan D, Feldman SR. Recurrence rates in the treatment of keloids and hypertrophic scars with intralesional triamcinolone combined with other intralesional agents. Arch Dermatol Res 2023; 315:2757-2767. [PMID: 37432467 DOI: 10.1007/s00403-023-02662-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/10/2023] [Accepted: 06/25/2023] [Indexed: 07/12/2023]
Abstract
Hypertrophic scars (HTS) and keloids are pathologic scars that are products of a wound healing pathway error attributed to genetic and inflammatory causes (Leventhal et al., Arch Facial Plast Surg 8(6):362-368. https://doi.org/10.1001/archfaci.8.6.362 , 2006). Methods of pathologic scar treatment include intralesional agents, cryotherapy, surgical excision, pressure dressings, topical agents, laser resurfacing, radiotherapy, and other investigational therapies (Leventhal et al. 2006). The recurrence of pathologic scar is high across all treatment modalities, including the use of intralesional agents (Trisliana Perdanasari et al., Arch Plast Surg 41(6):620-629. https://doi.org/10.5999/aps.2014.41.6.620 , 2014). In the treatment of pathologic scar, combination approaches using intralesional agents, such as triamcinolone (TAC), 5-fluorouracil (5FU), verapamil (VER), bleomycin (BLM), and botulinum toxin (BTX), are superior therapies when compared to monotherapy (Yosipovitch et al., J Dermatol Treat 12(2):87-90. https://doi.org/10.1080/095466301317085363 , 2001; Yang et al., Front Med 8:691628. https://doi.org/10.3389/fmed.2021.691628 , 2021; Sun et al., Aesthetic Plast Surg 45(2):791-805. https://doi.org/10.1007/s00266-019-01570-8 , 2021). This review assesses recurrence and the reporting of recurrence in pathologic scar after treatment with intralesional triamcinolone (TAC) in combination with another intralesional agent. A literature review was conducted using research journals from PubMed using the following search terms: [(keloid) AND (triamcinolone) AND (combination) AND (intralesional)], as well as [(keloid) AND (triamcinolone) AND (combination)]. Articles were reviewed and included if the article analyzed or compared intralesional agents for pathologic scar treatment within the last 10 years. The average follow-up period of included articles (n = 14) that utilized combination intralesional therapy (TAC-X) was approximately 11 months (range 1-24 months). Consistent recurrence rate reporting across studies was lacking. The combination agent with the highest recurrence rate was TAC-5FU (23.3%). The range of reported recurrence rates was 7.5-23.3%. Six studies using various intralesional combination regimens reported 0% recurrence over the follow-up period (TAC-5FU, TAC-BTX, TAC-BLM, TAC-CRY). Three studies did not report recurrence rates. While the efficacy of combination therapy is typically assessed via scar scales, the assessment of recurrence across studies of combination therapy is inconsistent and inadequate, with truncated follow-up periods. While scar recurrence can take place during 1-year post-treatment, long-term follow-up (18-24 months) is needed to characterize recurrence in the treatment of pathologic scar using various intralesional agents. Long-term follow-up periods allow patients to receive accurate prognostic information regarding recurrence after combination intralesional therapy. There are limitations to this review in that comparisons were made across studies with varying outcome variables, including scar size, injection concentration and interval, and follow-up period. Standardized follow-up periods and recurrence rate reporting are integral to furthering the understanding of these therapies and enhancing patient care.
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Affiliation(s)
- Sarah N Rimmer
- Department of Dermatology, Center for Dermatology Research, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
| | - Rithi J Chandy
- Department of Dermatology, Center for Dermatology Research, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Danyaal Khan
- Department of Dermatology, Center for Dermatology Research, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Steven R Feldman
- Department of Dermatology, Center for Dermatology Research, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Dermatology, University of Southern Denmark, Odense, Denmark
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Treatment of Keloids: A Meta-analysis of Intralesional Triamcinolone, Verapamil, and Their Combination. Plast Reconstr Surg Glob Open 2022; 10:e4075. [PMID: 35186630 PMCID: PMC8849409 DOI: 10.1097/gox.0000000000004075] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 11/29/2021] [Indexed: 11/26/2022]
Abstract
Keloids are skin lesions of abnormal and excessive scar proliferation that have no agreed upon gold standard of therapy. Extensive research in this area has shown that both intralesional triamcinolone and verapamil are effective in their treatment.
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Yang S, Luo YJ, Luo C. Network Meta-Analysis of Different Clinical Commonly Used Drugs for the Treatment of Hypertrophic Scar and Keloid. Front Med (Lausanne) 2021; 8:691628. [PMID: 34568361 PMCID: PMC8458741 DOI: 10.3389/fmed.2021.691628] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 07/29/2021] [Indexed: 11/24/2022] Open
Abstract
Background: There is no uniform treatment for pathological scars, including keloids and hypertrophic scars, in clinic currently. Previously, multiple randomized controlled trials have examined the clinical efficacy of different treatments. Nonetheless, the results are inconsistent, and many treatments have not been directly compared. This makes it difficult to conclude which approach is more favorable, in terms of efficacy and safety, for the treatment of pathological scarring. This study aimed at evaluating the efficacy of different injection and topical treatment strategies for hypertrophic scar and keloid. Methods: Relevant literature from PubMed, Medline, Embase, Scopus, the Cochrane Central Register of Controlled Trials (CCRCT), and WHO International Clinical Trials Registry Platform (WHO-ICTRP) were searched, from database inception through November 2020. Randomized clinical trials evaluating different treatment strategies of pathological scars, including triamcinolone acetonide (TAC), verapamil (VER), 5-fluorouracil (5-FU), botulinum toxin A (BTA), bleomycin (BLM), and silicone gels were included in the study. Results: The network meta-analysis included a total of 2,009 patients from 29 studies. A network meta-analysis of injection and topical treatment strategies showed that the efficacy of TAC combined with BTA was best in the treatment of pathological scars. Combination therapies of TAC with 5-FU and TAC with BTA significantly improved the clinical efficiency. However, there was no statistically significant difference between other treatment strategies. The order of efficacy predicted by the surface under the cumulative ranking (SUCRA) curve was as follows: TAC+BTA (82.2%) > TAC+5-FU (69.8%) > BTA (67.3%) > 5-FU+silicone (59.4%) > TAC+silicone (58.3%) > 5-FU (49.8%) > BLM (42.0%) > TAC (26.7%) > VER (26.2%) > silicone (18.3%). There was no publication bias revealed based on the funnel diagram. Conclusion: This study recommends intralesional injection of TAC-BTA and TAC-5-FU combined therapies. But for patients who cannot tolerate the side effects, the use of silicone gels in combination with TAC is recommended. However, these conclusions need to be further confirmed by more randomized controlled trials.
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Affiliation(s)
- Sha Yang
- Department of Orthopaedics, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Engineering Research Center of Stem Cell Therapy, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Yujia J Luo
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Engineering Research Center of Stem Cell Therapy, Children's Hospital of Chongqing Medical University, Chongqing, China.,Department of Neurosurgeons, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Cong Luo
- Department of Orthopaedics, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Engineering Research Center of Stem Cell Therapy, Children's Hospital of Chongqing Medical University, Chongqing, China
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Kuang J, An P, Li W. Comparative efficacy and safety of verapamil and triamcinolone in keloid and hypertrophic scar treatment: a meta-analysis. J COSMET LASER THER 2021; 23:26-34. [PMID: 34278918 DOI: 10.1080/14764172.2021.1950765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Keloids and hypertrophic scars are harmful to physical and psychological health. The study aims to compare the efficacy and safety of verapamil and triamcinolone in the treatment of keloids and hypertrophic scars. Relevant publications were searched from PubMed, Embase, Cochrane library, CNKI, Weipu, and Wanfang databases. Results were expressed as weighted mean differences (WMDs) or the relative ratios (RRs) with 95% confidence interval (CI). Pooled estimates were calculated using random-effects or fixed-effects models according to the heterogeneity among studies. The pooled results indicated that the triamcinolone treatment showed significantly better effectiveness in height (at 12, 15, 18, 21, and 24 weeks), pliability (at 3, 6, 9, 21, and 24 weeks) and vascularity (at 3, 6, 9, and 12 week) than that of verapamil (P < .05). Moreover, the side effects such as skin atrophy (RR = 0.13, 95% CI: 0.04 to 0.42, P = .001), telangiectasia (RR = 0.08, 95% CI: 0.02 to 0.28, P < .001), and hyperpigmentation (RR = 0.12, 95% CI: 0.03 to 0.44, P = .001) of verapamil were significantly less than those in triamcinolone. This meta-analysis showed that triamcinolone had a better therapeutic efficacy than verapamil, while verapamil was more safety.
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Affiliation(s)
- Jing Kuang
- Department of Plastic Surgery, Jinan Central Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Ping An
- Disinfection Supply Center, Jinan Fifth People's Hospital, Jinan, Shandong, China
| | - Wei Li
- Health Management Centre, Jinan Central Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
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Wang P, Gu L, Bi H, Wang Q, Qin Z. Comparing the Efficacy and Safety of Intralesional Verapamil With Intralesional Triamcinolone Acetonide in Treatment of Hypertrophic Scars and Keloids: A Meta-Analysis of Randomized Controlled Trials. Aesthet Surg J 2021; 41:NP567-NP575. [PMID: 33313652 DOI: 10.1093/asj/sjaa357] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Clinical treatment of hypertrophic scars (HSs) and keloids is often unsatisfactory. Intralesional injections of triamcinolone acetonide (TAC) and verapamil are widely used to treat HSs and keloids, but their efficacy and safety are controversial. OBJECTIVES The aim of this study was to conduct a meta-analysis of the effectiveness and safety of verapamil and TAC in the treatment of HSs and keloids. METHODS Embase, Google Scholar, and PubMed were searched for randomized controlled trials (RCTs) from inception to February 2020. RCTs that evaluated treatment effects with the Vancouver Scar Scale or reported adverse effects were included. The continuous data and the dichotomous variables were analyzed as mean difference (MD) and relative risk (RR), respectively. RESULTS Seven RCTs (461 patients) were included. Compared with verapamil, TAC rapidly changed the ∆height (MD = 0.07; P < 0.05) and ∆pliability (MD = 0.23; P < 0.05) after the first session, but subsequent treatments resulted in no significant differences in the ∆height, ∆pigmentation, ∆vascularity, and ∆pliability. Although total adverse effects (RR = 0.42; P = 0.1) were not significantly different, in the subgroup analysis the incidence of telangiectasia (RR = 0.04; P < 0.05) and skin atrophy (RR = 0.10; P < 0.05), but not pain (RR = 1.27; P = 0.77), was significantly lower with verapamil than with TAC. CONCLUSIONS Verapamil may be an effective substitute for TAC. Although total adverse effects did not change, the incidence of telangiectasia and skin atrophy was lower with verapamil than with TAC. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Pu Wang
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, People’s Republic of China
| | - Luosha Gu
- Department of Plastic Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People’s Republic of China
| | - Hongsen Bi
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, People’s Republic of China
| | - Qifei Wang
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, People’s Republic of China
| | - Zelian Qin
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, People’s Republic of China
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Sun P, Lu X, Zhang H, Hu Z. The Efficacy of Drug Injection in the Treatment of Pathological Scar: A Network Meta-analysis. Aesthetic Plast Surg 2021; 45:791-805. [PMID: 31853608 DOI: 10.1007/s00266-019-01570-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 12/01/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pathological scars mainly include hyperplastic scars and keloids, and there is no uniform treatment standard for the treatment of pathological scar in clinic now. Drug injection in the treatment of pathological scar is widely used because of its advantages of less trauma and simple operation. Therefore, we used a network meta-analysis to compare the curative effect of four kinds of drugs which are commonly used in the treatment of pathological scar such as botulinum toxin type A, corticosteroids (including diprospan and triamcinolone acetonide (TAC)), verapamil and 5-fluorouracil (5-FU), systematically. It is hoped that our study will provide evidence for the choice of drugs in the treatment of pathological scar by injection. METHODS Relevant articles from Wanfang, VIP, CNKI, PubMed, Cochrane Library and Embase databases were extracted by us. They were included into a network meta-analysis to compare the four kinds of drugs which are commonly used in the treatment of pathological scar. RESULTS The network meta-analysis included a total of 1513 patients from 23 studies. Through meta-analysis, we found that the efficacy of botulinum toxin type A combined with corticosteroid drugs was best in the treatment of pathological scar by injection. There was no significant difference between botulinum toxin type A, corticosteroids combined with 5 Fu, verapamil and 5-FU. The efficacy of corticosteroids combined with 5-FU was better than that of corticosteroids alone and verapamil alone, but there was no significant difference between them and 5-FU. Further, the order of efficacy predicted by the SUCRA curve was as follows: botulinum toxin type A combined with corticosteroids > corticosteroids combined with 5-FU > botulinum toxin type A > corticosteroids > 5-FU > verapamil. Moreover, no publication bias was found in the funnel diagram. CONCLUSION In the injection treatment of pathological scar, we recommend the combined injection of two drugs, especially botulinum toxin type A combined with corticosteroids. The effective treatment of botulinum toxin type A combined with corticosteroids in the treatment of pathological scar is as follows: Patients were treated once monthly with intralesional injection of TAC (0.1 ml/cm3) mixed with botulinum toxin type A (2.5 IU/cm3) for a total of 3 treatments. However, there are still limitations in this network meta-analysis, and its conclusion still needs to be further confirmed by more randomized controlled trials. 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)
- Pengfei Sun
- Department of Plastic Surgery, Zibo Central Hospital, No. 54 The Communist Youth League Road, Zibo, Shandong Province, People's Republic of China
| | - Xiaosheng Lu
- Department of Plastic Surgery, Affiliated Hospital of Weifang Medical University, No. 2428 Yuhe Road, Weifang, Shandong Province, People's Republic of China
| | - Huachang Zhang
- Department of Plastic Surgery, Zibo Central Hospital, No. 54 The Communist Youth League Road, Zibo, Shandong Province, People's Republic of China
| | - Zhensheng Hu
- Department of Plastic Surgery, Qilu Hospital of Shandong University, Jinan, People's Republic of China.
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Ekstein SF, Wyles SP, Moran SL, Meves A. Keloids: a review of therapeutic management. Int J Dermatol 2020; 60:661-671. [PMID: 32905614 DOI: 10.1111/ijd.15159] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/28/2020] [Accepted: 07/30/2020] [Indexed: 12/20/2022]
Abstract
Keloid scar formation arises from a disorganized fibroproliferative collagen response that extends beyond the original wound margins because of excessive production of extracellular matrix (ECM). Despite treatment options for keloid scars including medical and surgical therapies, such as intralesional steroid injection and surgical excision, the recurrence rate remains high. Herein we consolidate recently published narrative reviews, systematic reviews, and meta-analyses to provide an overview of updated treatment recommendations for keloidal scar formation. PubMed search engine was used to access the MEDLINE database to investigate updates regarding keloid incidence and treatment. More than 100 articles were reviewed. Keloid management remains a multimodal approach. There continues to be no gold standard of treatment that provides a consistently low recurrence rate; however, the increasing number of available treatments and synergistic combinations of these treatments (i.e., laser-based devices in combination with intralesional steroids, or 5-fluorouracil (5-FU) in combination with steroid therapy) is showing favorable results. Future studies could target the efficacy of novel treatment modalities (i.e., autologous fat grafting or stem cell-based therapies) for keloid management. This review article provides updated treatment guidelines for keloids and discusses insight into management to assist patient-focused, evidence-based clinical decision making.
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Affiliation(s)
- Samuel F Ekstein
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Steven L Moran
- Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA.,Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
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Liu R, Yang B, Deng Z, Liu L, Zhao X. Efficacy and safety of verapamil vs triamcinolone acetonide for keloids and hypertrophic scars: A systematic review and meta-analysis. Dermatol Ther 2020; 33:e13564. [PMID: 32400925 DOI: 10.1111/dth.13564] [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: 02/18/2020] [Revised: 04/28/2020] [Accepted: 05/10/2020] [Indexed: 11/30/2022]
Abstract
The treatment of keloids and hypertrophic scars remains a challenge. Although triamcinolone acetonide (TAC) is one of the most common and effective treatments for keloids and hypertrophic scars, TAC is not effective in some patients, and some may even experience adverse outcomes. Verapamil might be considered a safe alternative to TAC. The aim of this study was to compare the efficacy and safety of verapamil and TAC for the treatment of keloids and hypertrophic scars. Three databases (Medline, EMBASE, and CENTRAL database) were electronically searched from 1997 to December 2019. Article selection was limited to randomized controlled trials (RCTs) and controlled clinical trials (CCTs). Two authors independently assessed the selection of studies, risk of bias, and extracted the data. Mean differences (MDs) were computed for continuous variables, risk ratios (RRs) were computed for dichotomous variables, and 95% confidence intervals (CIs) were calculated for both assessments. Five RCTs were included, comprising a total of 215 patients (273 scars). Vancouver Scar Scale (VSS) parameters (such as height, vascularity, pliability, and pigmentation) were reported as the outcome measures and provided detailed values in four studies. No significant differences were observed between verapamil and TAC in the reduction of height (MD 0.57, 95% CI -0.94 to 2.08, P = .46), vascularity (MD 0.30, 95% CI -0.42 to 1.02, P = .41), pliability (MD 0.67, 95% CI -1.12 to 2.47, P = .46), and degree of pigmentation (MD 0.14, 95% CI -0.41 to 0.69, P = .61). Adverse outcomes were reported in four studies. The results showed that the incidence of telangiectasia and skin atrophy that used verapamil was significantly lower than that for TAC. Concerning the treatment of keloids and hypertrophic scars, even though verapamil was safer than TAC, TAC worked faster than verapamil. Furthermore, we did not find any clear evidence that verapamil was more or less effective than TAC. Considering the high degree of safety of verapamil, we suggest that verapamil might be used as an alternative treatment when TAC results in adverse outcomes.
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Affiliation(s)
- Ruiquan Liu
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Bin Yang
- Department of General Surgery, The First Affiliated Hospital, Kunming Medical University, Kunming, Yunnan, China
| | - Zhu Deng
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Liu Liu
- Department of Plastic Surgery, The First Affiliated Hospital, Kunming Medical University, Kunming, Yunnan, China
| | - Xian Zhao
- Department of Plastic Surgery, The First Affiliated Hospital, Kunming Medical University, Kunming, Yunnan, China
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11
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Abou-Taleb DAE, Badary DM. Intralesional verapamil in the treatment of keloids: A clinical, histopathological, and immunohistochemical study. J Cosmet Dermatol 2020; 20:267-273. [PMID: 32459066 DOI: 10.1111/jocd.13476] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/25/2020] [Accepted: 05/04/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The histopathological changes and immunohistochemical studies occurring in keloids in vivo after treatment by intralesional (IL) verapamil are not yet assessed. This study aimed to evaluate the efficacy and safety as well as the histological/immunohistochemical effects of intralesional verapamil on keloids. PATIENTS AND METHODS Thirty-one patients with 43 keloids were treated with IL verapamil at 3-week intervals until reaching complete flattening of the lesion or for a maximum of 6 sessions. Keloid biopsies were obtained before and after treatment for evaluation of histopathological changes and the immunohistochemical expression of VEGF and MMP9. RESULTS Of 43 keloids, 6 keloids (14%) and 17 (39.5%) showed excellent and good improvement, respectively, with no significant side effects except for pain at the site of injection. Histopathological and immunohistochemical evaluations were consistent with the clinical observations after treatment, and there was a statistically significant decrease in VEGF and MMP9 expressions after treatment. CONCLUSION IL verapamil is effective in the treatment of keloids which is possibly attributed to suppression of MMP9 and VEGF. It is a simple and relatively safe treatment method for keloids.
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Affiliation(s)
- Doaa A E Abou-Taleb
- Department of Dermatology, Venereology, and Andrology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Dalia M Badary
- Department of Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt
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12
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Tripathi S, Soni K, Agrawal P, Gour V, Mondal R, Soni V. Hypertrophic scars and keloids: a review and current treatment modalities. BIOMEDICAL DERMATOLOGY 2020. [DOI: 10.1186/s41702-020-00063-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
AbstractHypertrophic scars (HTS) are raised, red, rigid, inflexible cell-like, and cosmetic problems precipitated due to multiple underlying dermal injuries such as burn, surgery, and trauma during which aberrant wound healing with more pathological deposition of the extracellular matrix than degradation leads to their spawning. Till date, well established and specific treatments for HTS have not been reported; hence, the need of recent developments is thrusted with novel drug delivery vision. This review will try to encompass all the agogs to HTS, definition, pathophysiology, mechanism of hypertrophic scar formation, the role of growth factors in hypertrophic scarring, and their difference with keloids. Further, it will illuminate the available medicaments and recent advances in novel topical drug delivery systems such as ethosomes, transethosomes, liposomes, solid lipid nanoparticles, and microsponges for treatment of HTS.
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Johnson BZ, Stevenson AW, Prêle CM, Fear MW, Wood FM. The Role of IL-6 in Skin Fibrosis and Cutaneous Wound Healing. Biomedicines 2020; 8:biomedicines8050101. [PMID: 32365896 PMCID: PMC7277690 DOI: 10.3390/biomedicines8050101] [Citation(s) in RCA: 177] [Impact Index Per Article: 44.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/20/2020] [Accepted: 04/23/2020] [Indexed: 12/12/2022] Open
Abstract
The timely resolution of wound healing is critical for restoring the skin as a protective barrier. The switch from a proinflammatory to a reparative microenvironment must be tightly regulated. Interleukin (IL)-6 is a key modulator of the inflammatory and reparative process: it is involved in the differentiation, activation, and proliferation of leukocytes, endothelial cells, keratinocytes, and fibroblasts. This review examines the role of IL-6 in the healing of cutaneous wounds, and how dysregulation of IL-6 signaling can lead to either fibrosis or a failure to heal. The role of an IL-6/TGF-β feedback loop is discussed in the context of fibrogenesis, while IL-6 expression and responses in advanced age, diabetes, and obesity is outlined regarding the development of chronic wounds. Current research on therapies that modulate IL-6 is explored. Here, we consider IL-6′s diverse impact on cutaneous wound healing.
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Affiliation(s)
- Blair Z. Johnson
- School of Biomedical Sciences, University of Western Australia, Crawley, WA 6009, Australia; (A.W.S.); (C.M.P.); (M.W.F.); (F.M.W.)
- Correspondence:
| | - Andrew W. Stevenson
- School of Biomedical Sciences, University of Western Australia, Crawley, WA 6009, Australia; (A.W.S.); (C.M.P.); (M.W.F.); (F.M.W.)
| | - Cecilia M. Prêle
- School of Biomedical Sciences, University of Western Australia, Crawley, WA 6009, Australia; (A.W.S.); (C.M.P.); (M.W.F.); (F.M.W.)
- Institute for Respiratory Health, University of Western Australia, Crawley, WA 6009, Australia
| | - Mark W. Fear
- School of Biomedical Sciences, University of Western Australia, Crawley, WA 6009, Australia; (A.W.S.); (C.M.P.); (M.W.F.); (F.M.W.)
| | - Fiona M. Wood
- School of Biomedical Sciences, University of Western Australia, Crawley, WA 6009, Australia; (A.W.S.); (C.M.P.); (M.W.F.); (F.M.W.)
- WA Department of Health, 189 Royal St, East Perth, WA 6004, Australia
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Riccio M, Marchesini A, Senesi L, Skrami E, Gesuita R, De Francesco F. Managing Pathologic Scars by Injecting Auto-Cross-linked Hyaluronic Acid: A Preliminary Prospective Clinical Study. Aesthetic Plast Surg 2019; 43:480-489. [PMID: 30627811 DOI: 10.1007/s00266-018-01303-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 12/18/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Pathological scars are unattractive and may significantly impair the patient's quality of life. Current treatments provide inconsistent results, and none may be regarded as definitive. Recently, an auto-cross-linked hyaluronic acid (HA) formulation, IAL-SYSTEM ACP, featuring a long residence time and an enhanced safety profile, has been successfully used to prevent surgical adhesions, treat tendon lesions and rejuvenate the face and the décolletage. This study aims to preliminarily investigate whether IAL-SYSTEM ACP may also be effective in treating pathological scars resulting from burns, trauma or iatrogenic causes. METHODS Patients presenting one pathological scar were prospectively recruited and treated with two IAL-SYSTEM ACP injections carried out two weeks apart. Scar improvement was measured comparing the patient and observer scar assessment scale (POSAS) scores collected before treatment (T0) and 90 days after the second injection (T90) using nonparametric tests. The effect of age and scar type over score variation was investigated through quantile regression analysis. RESULTS Forty-one patients, 10 women and 31 men (median age, 34 years) were recruited. No patient dropped out, and no significant adverse event was observed. At T90, the median observer total score decreased by 11 units (- 77.5%) and the median patient total score decreased by 15 units (- 73.7%). The difference was significant (p < 0.001) in both cases. Traumatic injuries and young patient's age were the most significant predictors of a positive treatment outcome. CONCLUSIONS Treatment of pathological scars by two IAL-SYSTEM ACP injections, carried out two weeks apart, may provide significant clinical benefits. These findings should be the subject of further investigations. 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)
- Michele Riccio
- SOD Chirurgia Ricostruttiva e Chirurgia della Mano (Department of Reconstructive Surgery and Hand Surgery), AOU "Ospedali Riuniti", Via Conca, 71, 60126, Ancona, Italy
| | - Andrea Marchesini
- SOD Chirurgia Ricostruttiva e Chirurgia della Mano (Department of Reconstructive Surgery and Hand Surgery), AOU "Ospedali Riuniti", Via Conca, 71, 60126, Ancona, Italy
| | - Letizia Senesi
- SOD Chirurgia Ricostruttiva e Chirurgia della Mano (Department of Reconstructive Surgery and Hand Surgery), AOU "Ospedali Riuniti", Via Conca, 71, 60126, Ancona, Italy
| | - Edlira Skrami
- Centre of Epidemiology, Biostatistics and Medical Information Technology, "Politecnica delle Marche" University, Ancona, Italy
| | - Rosaria Gesuita
- Centre of Epidemiology, Biostatistics and Medical Information Technology, "Politecnica delle Marche" University, Ancona, Italy
| | - Francesco De Francesco
- SOD Chirurgia Ricostruttiva e Chirurgia della Mano (Department of Reconstructive Surgery and Hand Surgery), AOU "Ospedali Riuniti", Via Conca, 71, 60126, Ancona, Italy.
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The Efficacy of Combining Fractional Carbon Dioxide Laser With Verapamil Hydrochloride or 5-Fluorouracil in the Treatment of Hypertrophic Scars and Keloids: A Clinical and Immunohistochemical Study. Dermatol Surg 2019; 45:536-546. [DOI: 10.1097/dss.0000000000001726] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Onur Erol O, Agaoglu G, Jawad MA. Combined Non-Ablative Laser and Microfat Grafting for Burn Scar Treatment. Aesthet Surg J 2019; 39:NP55-NP67. [PMID: 30403775 DOI: 10.1093/asj/sjy291] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Burn scar treatment persists as an unsolved problem, involving thousands of affected patients disfigured for life. OBJECTIVES We sought to present our experience with the use of combined treatments for patients with burn scars. METHODS This was a case series report of the senior author's experience during 8 years utilizing the combined treatments of Fraxel Restore (fractional laser) and microfat graft injection for 288 patients with burn scars. RESULTS Laser treatment reduced scar intensity and attenuated skin irregularities and hyperpigmentation. All patients demonstrated marked improvement of skin texture and an increase in scar softness after 3 sessions of microfat grafting. However, the degree of improvement varied between patients and was related to the severity of the scar and the type of tissue. Overall, a 40% to 80% improvement was noted in our patients. All patients and their families expressed satisfaction with the results. CONCLUSIONS The combined treatment of Fraxel and microfat grafting is an effective technique for improving the appearance of a hypertrophic scar or keloid on burn patients. Fat tissue stem cells may have helped to repair the damaged skin. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- O Onur Erol
- ONEP Plastic Surgery Science Institute, Istanbul, Turkey
| | - Galip Agaoglu
- ONEP Plastic Surgery Science Institute, Istanbul, Turkey
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Li Y, Liang X, Wang P, Long X, Wang X, Meng Z. Long non-coding RNA CACNA1G-AS1 promotes calcium channel protein expression and positively affects human keloid fibroblast migration. Oncol Lett 2018; 16:891-897. [PMID: 29963160 PMCID: PMC6019917 DOI: 10.3892/ol.2018.8717] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 11/20/2017] [Indexed: 11/06/2022] Open
Abstract
Keloids are a type of benign hyperplasia that cause dermatologic dysfunction and esthetic deformity by invading adjacent normal tissues. Little is known about their etiology, therefore, they are a challenge to treat using plastic surgery. In a previous study, it was demonstrated that the expression of the long non-coding RNA CACNA1G-AS1 (CAS1) is high in keloid tissue, suggesting that CAS1 is involved in keloid formation. In the present study, the aim was to identify potential keloid target proteins by exploring CAS1 biological function during cell proliferation and migration, cytokine secretion, collagen secretion and the control of calcium channel protein expression in human keloid fibroblasts. Three biopsy samples were collected from each patient with keloids at The Peking Union Medical College Hospital, which were then used to investigate the role of CAS1 in cell proliferation and migration. CAS1 silencing was also carried out using small interfering RNA; cell factors, collagen and calcium channel protein levels were compared with control cells. The interference of CAS1 expression reached 50% compared with the control group. CACNA1G and type I collagen expression was significantly downregulated by CAS1 knockdown, while the expression of transforming growth factor-β and type III collagen was not affected. Wound healing time was longer in the CAS1-knockdown group, but there was no visible change in cell proliferation. In conclusion, CAS1 appeared to promote calcium channel protein and type I collagen expression, and to have a positive effect on cell migration in human keloid fibroblasts. Therefore it has potential as a novel therapeutic target for keloids.
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Affiliation(s)
- Ye Li
- Department of Integrative Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, P.R. China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, P.R. China
| | - Xuebing Liang
- Department of Plastic and Reconstructive Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, P.R. China
| | - Peng Wang
- Department of Integrative Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, P.R. China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, P.R. China
| | - Xiao Long
- Department of Plastic and Reconstructive Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, P.R. China
| | - Xiaojun Wang
- Department of Plastic and Reconstructive Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, P.R. China
| | - Zhiqiang Meng
- Department of Integrative Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, P.R. China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, P.R. China
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Comparing Efficacy and Tolerability of Triamcinolone and Verapamil in Treatment of Hypertrophic Scars and Keloids. ACTA ACUST UNITED AC 2017. [DOI: 10.5812/jssc.69390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Okhlopkov VA, Skalsky SV, Sokolova TF. EFFECTIVENESS OF CREAM CONTAINING VERAPAMIL HYDROCHLORIDE, IN THE THERAPY OF RUBTS IN EXPERIMENT. VESTNIK DERMATOLOGII I VENEROLOGII 2017. [DOI: 10.25208/0042-4609-2017-93-4-38-43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
The data in respect to efficacy of verapamil-containing scar cream for treatment of hypertrophic and keloid scars are presented in the article. Skin scars were simulated in rats by excision of a full-thickness skin flap size 5x4 cm2 in the center of the back. Upon wound healing and scar formation a daily twofold fomentation of verapamil-containing cream was carried out. Treatment efficacy was checked after 10, 30 and 60 days. The following indices were studied: an area of the scar, its type, consistence, color, sensitivity, and scar microcirculation according to biomicroscopy. The proposed novel method for treatment of hypertrophic and keloid scars with verapamil-containing cream allowed to obtain a sustained clinical result demonstrating a reducing area of the scar by 25%, a physiological scar formation, improving the consistence and scar colour changing to the normal skin colour, its softening and flattening, and pain disappearance. Due to the dermal application, the method was painless, safety and did not affect on the surrounding tissues. According to biomicroscopy a scar remodeling approximated the indices to the level of healthy skin in 93% of rats. The most significant clinical effect the cream with verapamil was observed in experimental animals in 60 days after treatment.
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Kant SB, van den Kerckhove E, Colla C, Tuinder S, van der Hulst RRWJ, Piatkowski de Grzymala AA. A new treatment of hypertrophic and keloid scars with combined triamcinolone and verapamil: a retrospective study. EUROPEAN JOURNAL OF PLASTIC SURGERY 2017; 41:69-80. [PMID: 29398785 PMCID: PMC5780547 DOI: 10.1007/s00238-017-1322-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Accepted: 05/01/2017] [Indexed: 11/13/2022]
Abstract
Background Since the management of keloid and hypertrophic scars still remains a difficult clinical problem, there is need for adequate, effective therapy. In this study, we explored for the first time the efficacy and the potential synergetic effect of combined triamcinolone and verapamil for the treatment of hypertrophic and keloid scars. The objective was to assess the efficacy of combined intralesional triamcinolone and verapamil therapy for hypertrophic and keloid scars. Methods Fifty-eight patients with hypertrophic scars (n = 31) and keloid scars (n = 27) were included. A specific injection therapy scheme was applied. Five follow-up moments were chosen, with a maximum follow-up of nearly 2 years. The effects of combination therapy on scar pliability, thickness, relief, vascularization, surface area, pain, and pruritus were examined by means of the Patient and Observer Scar Assessment Scale (POSAS). Results Our results reveal a fast and abiding improvement of both keloid and hypertrophic scars after treatment with the combination therapy. All POSAS components showed a reduction in scar score, while scar relief, pain, itchiness, and surface area improved significantly (P < 0.05) in keloids. Significant improvement in hypertrophic scars was found in scar pigmentation, vascularization, pliability, thickness, pain, and surface area. Overall POSAS scores revealed statistically significant decreases between baseline and 3–4 months, 4–6 months, and >12 months after start of therapy in both keloids and hypertrophic scars. Conclusions This study reveals that combined therapy of triamcinolone and verapamil results in overall significant scar improvement with a long-term stable result. Level of evidence: Level IV, therapeutic study.
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Affiliation(s)
- S B Kant
- 1Department of Plastic Surgery, Maastricht University Medical Center, P Debyelaan 25, 6229HX Maastricht, The Netherlands
| | - E van den Kerckhove
- 1Department of Plastic Surgery, Maastricht University Medical Center, P Debyelaan 25, 6229HX Maastricht, The Netherlands.,2KU Leuven, Department of Rehabilitation Sciences, Faber, Universitaire Ziekenhuizen Leuven, Leuven, Belgium.,3Department of Physical Medicine and Rehabilitation and Burns Center, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - C Colla
- 1Department of Plastic Surgery, Maastricht University Medical Center, P Debyelaan 25, 6229HX Maastricht, The Netherlands
| | - S Tuinder
- 1Department of Plastic Surgery, Maastricht University Medical Center, P Debyelaan 25, 6229HX Maastricht, The Netherlands
| | - R R W J van der Hulst
- 1Department of Plastic Surgery, Maastricht University Medical Center, P Debyelaan 25, 6229HX Maastricht, The Netherlands
| | - A A Piatkowski de Grzymala
- 1Department of Plastic Surgery, Maastricht University Medical Center, P Debyelaan 25, 6229HX Maastricht, The Netherlands
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β-Adrenergic Receptor Blockers Reduce the Occurrence of Keloids and Hypertrophic Scars after Cardiac Device Implantation. Plast Reconstr Surg 2017; 139:1248-1256. [DOI: 10.1097/prs.0000000000003239] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Li Z, Jin Z. Comparative effect and safety of verapamil in keloid and hypertrophic scar treatment: a meta-analysis. Ther Clin Risk Manag 2016; 12:1635-1641. [PMID: 27877046 PMCID: PMC5108599 DOI: 10.2147/tcrm.s118748] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Keloids and hypertrophic scars are the most common types of pathological scarring. Traditionally, keloids have been considered as a result of aberrant wound healing, involving excessive fibroblast participation that is characterized by hyalinized collagen bundles. However, the usefulness of this characterization has been questioned. In recent years, studies have reported the appropriate use of verapamil for keloids and hypertrophic scars. METHODS Searches were conducted on the databases Medline, Embase, Cochrane, PubMed, and China National Knowledge Infrastructure from 2006 to July 2016. State12.0 was used for literature review, data extraction, and meta-analysis. Treatment groups were divided into verapamil and nonverapamil group. Nonverapamil group includes steroids and intense pulsed light (IPL) therapy. Total effective rates include cure rate and effective rate. Cure: skin lesions were completely flattened, became soft and symptoms disappeared. Efficacy: skin lesions subsided, patient significantly reduced symptoms. Inefficient definition of skin was progression free or became worse. Random-effects model was used for the meta-analysis. RESULTS Six studies that included 331 patients with keloids and hypertrophic scars were analyzed. Analysis of the total effective rate of skin healing was performed. The total effective rates in the two groups were 54.07% (verapamil) and 53.18% (nonverapamil), respectively. The meta-analysis showed that there was no difference between the two groups. We also compared the adverse reactions between the verapamil treatment group and the steroids treatment group in two studies, and the result indicated that the verapamil group showed less adverse reactions. CONCLUSION There were no differences between the application of verapamil and nonverapamil group in keloids and hypertrophic scars treatment. Verapamil could act as an effective alternative modality in the prevention and treatment of keloid and hypertrophic scars. A larger number of studies are required to confirm our conclusion.
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Affiliation(s)
- Zhouna Li
- Department of Dermatology, Yanbian University Affiliated hospital, Yanji, Jilin, People’s Republic of China
| | - Zhehu Jin
- Department of Dermatology, Yanbian University Affiliated hospital, Yanji, Jilin, People’s Republic of China
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