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Zhang Z, Fan C, Xu Q, Guo F, Li W, Zeng Z, Xu Y, Yu J, Ge H, Yang C, Chang J. A New Strategy to Inhibit Scar Formation by Accelerating Normal Healing Using Silicate Bioactive Materials. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024:e2407718. [PMID: 39340818 DOI: 10.1002/advs.202407718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Revised: 08/28/2024] [Indexed: 09/30/2024]
Abstract
Inspired by the scar-free wound healing in infants, an anti-scar strategy is proposed by accelerating wound healing using silicate bioactive materials. Bioglass/alginate composite hydrogels are applied, which significantly inhibit scar formation in rabbit ear scar models. The underlining mechanisms include stimulation of Integrin Subunit Alpha 2 expression in dermal fibroblasts to accelerate wound healing, and induction of apoptosis of hypertrophic scar fibroblasts by directly stimulating the N-Acylsphingosine Amidohydrolase 2 expression in hypertrophic scar fibroblasts, and indirectly upregulating the secretion of Cathepsin K in dermal fibroblasts. Considering specific functions of the bioactive silicate materials, two scar treatment regimes are tested. For severe scars, a regenerative intervention is applied by surgical removal of the scar followed by the treatment with bioactive hydrogels to reduce the formation of scars by activating dermal fibroblasts. For mild scars, the bioactive dressing is applied on the formed scar and reduces scar by inducing scar fibroblasts apoptosis.
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Affiliation(s)
- Zhaowenbin Zhang
- Joint Centre of Translational Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, P. R. China
- Zhejiang Engineering Research Center for Tissue Repair Materials, Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou, 325000, P. R. China
- State Key Laboratory of High-Performance Ceramics and Superfine Microstructure, Shanghai Institute of Ceramics, Chinese Academy of Sciences, Shanghai, 200050, P. R. China
| | - Chen Fan
- Joint Centre of Translational Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, P. R. China
- Zhejiang Engineering Research Center for Tissue Repair Materials, Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou, 325000, P. R. China
| | - Qing Xu
- State Key Laboratory of High-Performance Ceramics and Superfine Microstructure, Shanghai Institute of Ceramics, Chinese Academy of Sciences, Shanghai, 200050, P. R. China
| | - Feng Guo
- Department of Plastic Surgery, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, 200050, P. R. China
| | - Wenbo Li
- Department of Plastic Surgery, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, 200050, P. R. China
| | - Zhen Zeng
- Joint Centre of Translational Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, P. R. China
- Zhejiang Engineering Research Center for Tissue Repair Materials, Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou, 325000, P. R. China
| | - Yuze Xu
- Joint Centre of Translational Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, P. R. China
- Zhejiang Engineering Research Center for Tissue Repair Materials, Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou, 325000, P. R. China
- State Key Laboratory of High-Performance Ceramics and Superfine Microstructure, Shanghai Institute of Ceramics, Chinese Academy of Sciences, Shanghai, 200050, P. R. China
| | - Jing Yu
- Joint Centre of Translational Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, P. R. China
- Zhejiang Engineering Research Center for Tissue Repair Materials, Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou, 325000, P. R. China
| | - Hongping Ge
- Joint Centre of Translational Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, P. R. China
- Zhejiang Engineering Research Center for Tissue Repair Materials, Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou, 325000, P. R. China
| | - Chen Yang
- Joint Centre of Translational Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, P. R. China
- Zhejiang Engineering Research Center for Tissue Repair Materials, Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou, 325000, P. R. China
| | - Jiang Chang
- Joint Centre of Translational Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, P. R. China
- Zhejiang Engineering Research Center for Tissue Repair Materials, Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou, 325000, P. R. China
- State Key Laboratory of High-Performance Ceramics and Superfine Microstructure, Shanghai Institute of Ceramics, Chinese Academy of Sciences, Shanghai, 200050, P. R. China
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You SJ, Li S, Hu CM, Zhong FY, Gan SH, Cai Y, Xiang XY. Safety and efficacy of intralesional bleomycin for keloids and hypertrophic scars: A systematic review and meta-analysis. J Cosmet Dermatol 2024. [PMID: 39205503 DOI: 10.1111/jocd.16447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 05/29/2024] [Accepted: 06/25/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Bleomycin, originally an antitumor drug, was explored as a pathological scar treatment in the mid-1990s. However, its efficacy and safety profile varies among individuals. AIMS This study aimed to assess topical bleomycin's efficacy and safety in treating hypertrophic scars and keloids. METHODS We reviewed randomized controlled trials (RCTs) and controlled clinical trials (CCTs) published in English, comparing intralesional bleomycin to placebos or common intralesional scar treatments. Primary outcomes included percentage change in scar improvement, pigmentation, recurrence, atrophy, pain, telangiectasia, ulceration, patient self-assessment, and observer assessment (>50%). RESULTS Six trials met the criteria. Bleomycin significantly improved scar reduction compared to triamcinolone (p < 0.05). There was no significant difference in pigmentation (p = 0.05) and recurrence (p = 0.21) compared to other treatments. In terms of safety, bleomycin caused less skin atrophy (p < 0.01) and telangiectasia (p < 0.01) but more pain (p = 0.03) than other treatments. CONCLUSIONS Bleomycin was more effective than TAC, 5-FU, or TAC combined with 5-FU for treating keloids and hypertrophic scars with lower skin atrophy and telangiectasia risks. However, it may cause more pain than 5-FU or TAC. Further comprehensive studies, including RCTs, are required for objective analysis.
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Affiliation(s)
- Shun Jie You
- Plastic and Reconstructive Surgery & Burns, Affiliated Hospital of North Sichuan Medical College, Sichuan, Nanchong, China
| | - Si Li
- Dermatology, Affiliated Hospital of North Sichuan Medical College, Sichuan, Nanchong, China
| | - Chen Ming Hu
- Department of Vascular Surgery Dazhou, Sichuan, Nanchong, China
| | - Fang Yu Zhong
- Plastic and Reconstructive Surgery & Burns, Affiliated Hospital of North Sichuan Medical College, Sichuan, Nanchong, China
| | - Shi Han Gan
- Plastic and Reconstructive Surgery & Burns, Affiliated Hospital of North Sichuan Medical College, Sichuan, Nanchong, China
| | - Yan Cai
- Genetics and Prenatal Diagnosis Center, Affiliated Hospital of North Sichuan Medical College, Sichuan, Nanchong, China
| | - Xiao Yan Xiang
- Plastic and Reconstructive Surgery & Burns, Affiliated Hospital of North Sichuan Medical College, Sichuan, Nanchong, China
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Khattab FM, Bessar H, Khater EM. Keloid Therapy: A Neoteric Comparative Study. J Cosmet Dermatol 2022; 21:3962-3969. [PMID: 35842750 DOI: 10.1111/jocd.15247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/24/2022] [Accepted: 07/20/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Keloids are considered disorders of fibroproliferation characterized by accumulation of collagen fibers in hypodermis and dermis, caused by inflammation, surgery, and trauma. OBJECTIVES The main goal of the study was to approach a better modality for the treatment of keloids by comparing the effects and the side effects of intralesional cryotherapy and intralesional injection of bleomycin. METHODS This interventional, comparative clinical trial was conducted on 60 cases and were divided equally into the group (A) combined group where who were subjected to intralesional bleomycin followed by cryotherapy in the same session, group (B) who were subjected to intralesional injection of bleomycin, and group (C) intralesional cryotherapy. All cases were subjected to clinical examination, complete history taking, dermatological examination, examination, and evaluation of scar lesion using the Vancouver scar scale. RESULTS There was a statistically significant decrease in pliability among the combined group. Also, pliability decreased in the bleomycin group and cryotherapy, but this decrease wasn't statistically significant. Our results revealed that there was a statistically significant decrease in lesion height among all the studied groups, but the decrease was more among the combined group. CONCLUSION Intralesional cryotherapy was effective as Intralesional bleomycin. Combined therapy was a valid and more effective technique with few adverse effects than either alone for keloids as it achieved a decrease in volumes of scars or accompanied symptoms.
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Affiliation(s)
- Fathia M Khattab
- Dermatology, Venereology, and Andrology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Hagar Bessar
- Dermatology, Venereology, and Andrology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Elsayed M Khater
- Dermatology, Venereology, and Andrology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Vanhooteghem O. Remarkable efficiency of surgical shave excision of keloids followed by intralesional injection of Bleomycin. A retrospective study of 314 cases. Dermatol Ther 2022; 35:e15425. [PMID: 35261136 PMCID: PMC9285601 DOI: 10.1111/dth.15425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/19/2022] [Accepted: 03/06/2022] [Indexed: 11/28/2022]
Abstract
The aim of this study was to determine the efficiency of a keloid treatment consisting of intradermal surgical shave excision followed by intralesional injections of Bleomycin. A retrospective study performed in the Department of Dermatology, CHU UCL Namur Sainte Elisabeth Clinic, Belgium between 2018 and 2019, on 314 patients with keloids—average age: 32 years (range 19–62). Patients were treated first by surgical shave excision and then after reepithelialization, monthly Bleomycin injections were used until the itching and/or pain ceased and the keloid disappeared. The satisfaction index based on Vancouver Scar Scale on the 314 patients was as follows: 87% of the patients were very satisfied with complete flattening (276 patients), 11% were moderated satisfied with significant flattening (32 patients), and 2% show recurrences (6 patients). Pain and itching disappear totally (100% of patients) based on Visual Analogue Scale. The absence of recurrence within 24 months of the last injection, leads us to believe that this can be a first choice and low‐cost treatment, whatever the phototype and the size of the lesion. This treatment can be given in all regions of the world, including in non‐industrialized or developing countries.
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Ramadan H, Saber M, Salah M, Samy N. The effectiveness of long Pulsed Nd:YAG Laser alone for treatment of keloids and hypertrophic scars versus its combination with bleomycin. J Cosmet Dermatol 2021; 20:3899-3906. [PMID: 34658151 DOI: 10.1111/jocd.14509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 09/16/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND OBJECTIVES Pathological scars are benign hyper-proliferative growths of dermal collagen that causes severe psychological and physical problems. This study was performed to assess and compare safety and clinical efficiency of combined pulsed Nd-YAG laser and intralesional bleomycin versus pulsed Nd-YAG laser alone to treat the hypertrophic scars and keloids. PATIENTS AND METHODS Randomly, 40 patients with hypertrophic scars or keloids were divided into two groups A and B. Group A were handled by pulsed Nd:YAG laser and intralesional bleomycin while group B were handled by pulsed Nd:YAG laser only. Response was assessed subjectively by clinical imaging and modified Vancouver Scar Scale (mVSS). While for objective evaluation, skin biopsies were taken from volunteer patients before and after treatment, and were examined by Hematoxylin and eosin staining (H&E) and Masson trichrome staining. RESULTS Our study demonstrated almost complete improvement in 4 (20%) patients, partial improvement in 16 (80%) patients and 0 patient with no improvement in group A. Furthermore, in group B, we demonstrated almost complete improvement in 2 (10%) patients, partial in 14 (70%) patients and no improvement in 4 (20%) patients. Modified Vancouver Scar Scale reduced from 10.15 to 3.5 in group A and from 11.05 to 4.95 in group B. Elastica Masson-Goldner staining and Hematoxylin and eosin staining showed that treatment in both groups structurally changed tissue collagen. CONCLUSION Long-pulsed Nd-YAG laser combined with intralesional bleomycin could be a promising way for treatment of keloids or hypertrophic scars.
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Affiliation(s)
| | - Mahmoud Saber
- Surgery Unit, Medical Application Of Laser (MAL) Department, National Institute of laser and Enhanced Sciences, Cairo University, Giza, Egypt
| | - Manal Salah
- Dermatology Unit, Medical Application Of Laser (MAL) Department, National Institute of laser and Enhanced Sciences, Cairo University, Giza, Egypt
| | - Nevien Samy
- Dermatology Unit, Medical Application Of Laser (MAL) Department, National Institute of laser and Enhanced Sciences, Cairo University, Giza, Egypt
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Arbache S, Arbache ST, Hirata SH. Is it possible to repigment iatrogenic and traumatic hypochromic lesions? A case series using the MMP ® drug delivery technique with 5-fluorouracil and bleomycin. Int J Dermatol 2021; 61:71-83. [PMID: 34173672 DOI: 10.1111/ijd.15725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 05/06/2021] [Accepted: 05/27/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES We present the results of 11 patients with hypochromic lesions treated with antifibrotic agents delivered through the MMP® technique. METHODS Eleven patients with hypochromic lesions because of external injuries were treated at a single clinic with 5-fluorouracil (5-FU) and/or bleomycin using the MMP® drug delivery technique. Treatment sessions were repeated at 30-day intervals until patient satisfaction. The primary outcome was repigmentation of the lesions, assessed independently by two dermatologists and by the patient. RESULTS The MMP® technique injected 0.048 mg/cm2 of 5-FU or 0.0028 U/cm2 of bleomycin. The accumulated 5-FU and bleomycin density per patient ranged from 0.02 to 0.77 mg and 0.0022 to 0.2800 U/ml, respectively. Patients were treated with 1 to 6 MMP® sessions with 5-FU (3 patients), bleomycin (6 patients), or both drugs (2 patients). After the last session, all patients had a significant improvement (>75%) of the lesions compared to baseline. There were no procedure-related short- or long-term adverse effects in any of the participants up to their last follow-up visit. CONCLUSIONS The injection of antifibrotic agents using the MMP® technique was effective and safe in the treatment of hypochromic lesions. This can be a new therapeutic option for these lesions.
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Affiliation(s)
- Samir Arbache
- Department of Medicine, Evidence Based Post Graduate Program, São Paulo Federal University (Universidade Federal de São Paulo - UNIFESP), São Paulo, SP, Brazil
| | | | - Sergio H Hirata
- Department of Dermatology, São Paulo Federal University (Universidade Federal de São Paulo - UNIFESP), São Paulo, SP, Brazil
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Kim WI, Kim S, Cho SW, Cho MK. The efficacy of bleomycin for treating keloid and hypertrophic scar: A systematic review and meta-analysis. J Cosmet Dermatol 2020; 19:3357-3366. [PMID: 32243056 DOI: 10.1111/jocd.13390] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 03/10/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Pathologic scars can lead to itching, erythema, and psychological stress due to cosmetic problems. Bleomycin, one of anticancer agents, has been used for treating keloid or hypertrophic scar. Some studies have shown that bleomycin can induce markedly scar improvement. AIMS To evaluate the efficacy of bleomycin compared to corticosteroid as well as other treatments for keloid or hypertrophic scar using meta-analysis methods. METHODS A computerized search was performed in different databases including Cochrane, Embase, and PubMed. Three randomized controlled trials (RCTs) and two controlled clinical trials (CCTs) were included. Then, statistical analyses of extracted outcome data from the studies were calculated using Rex (version 3.0.1; RexSoft Inc). RESULTS Scar improvement was significantly increased in the bleomycin group compared to the triamcinolone acetonide (TAC) group (SMD: 0.59, 95% CI: 0.30-0.88, P < .0001). In addition, there was also statistically significant difference between the bleomycin group and the 5-FU group (SMD: 1.37, 95% CI: 0.88-1.85, P < .0001). Bleomycin increased relatively scar improvement compared to TAC combined with 5-FU, although there was no statistical difference (SMD: 0.63, 95% CI: -0.59-1.84, P = .3108). Furthermore, bleomycin demonstrated significantly increased improvement of scar compared to TAC combined with cryotherapy (SMD: 1.11, 95% CI: 0.48-1.74, P = .0006). CONCLUSIONS This meta-analysis found that bleomycin was more effective for treating keloid or hypertrophic scar than other treatments including TAC, 5-FU, TAC combined with 5-FU, and TAC combined with cryotherapy. However, further comprehensive studies, including randomized controlled trials, are needed to perform objective analysis.
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Affiliation(s)
- Woo Il Kim
- Department of Dermatology, Soonchunhyang University Hospital, Seoul, Korea
| | - Sooyoung Kim
- Department of Dermatology, Soonchunhyang University Hospital, Seoul, Korea
| | - Sung Woo Cho
- Department of Surgery, Soonchunhyang University Hospital, Seoul, Korea
| | - Moon Kyun Cho
- Department of Dermatology, Soonchunhyang University Hospital, Seoul, Korea
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Treatment of Keloids and Hypertrophic Scars with Bleomycin and Electroporation. Plast Reconstr Surg 2013; 132:621e-630e. [DOI: 10.1097/prs.0b013e3182a053c8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Kim SK, Park JY, Song HS, Kim YS, Kim YC. Photodynamic therapy with ablative carbon dioxide fractional laser for treating Bowen disease. Ann Dermatol 2013; 25:335-9. [PMID: 24003277 PMCID: PMC3756199 DOI: 10.5021/ad.2013.25.3.335] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Revised: 07/05/2012] [Accepted: 08/26/2012] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Topical photodynamic therapy (PDT) has been increasingly used to treat malignant skin tumors including the Bowen disease. However, patients could be displeased with the long incubation time required for conventional PDT. OBJECTIVE We evaluated the efficacy and safety of PDT with a short incubation time of ablative CO2 fractional laser pretreatment for treating Bowen disease. METHODS Ten patients were included. Just before applying the topical photosensitizer, all lesions were treated with ablative CO2 fractional laser, following the application of methyl aminolevulinate and irradiation with red light (Aktilite CL 128). Histological confirmation, rebiopsy, and clinical assessments were performed. Adverse events were also recorded. RESULTS Five of the ten (50%) lesions showed a complete response (CR) within three PDT sessions. After four treatment sessions, all lesions except one penile shaft lesion (90%) achieved clinical and histological CR or clinical CR only. The average number of treatments to CR was 3.70±1.70. The treatments showed favorable cosmetic outcomes and no serious adverse events. CONCLUSION The results suggest that pretreatment with an ablative fractional CO2 laser before PDT has similar treatment efficacy and requires a shorter photosensitizer incubation time compared with the conventional PDT method.
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Affiliation(s)
- Sue Kyung Kim
- Department of Dermatology, Ajou University School of Medicine, Suwon, Korea
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Kim WS, Lee JS, Bae GY, Kim JJ, Chin YW, Bahk YY, Min HG, Cha HJ. Extract ofAneilema keisakinhibits transforming growth factor-β-dependent signalling by inducing Smad2 downregulation in keloid fibroblasts. Exp Dermatol 2012; 22:69-71. [DOI: 10.1111/exd.12063] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2012] [Indexed: 12/12/2022]
Affiliation(s)
- Won-Serk Kim
- Department of Dermatology; Kangbuk Samsung Hospital; Sungkyunkwan University School of Medicine; Seoul; Korea
| | - Ji-Seon Lee
- Department of Life Science; College of Natural Science; Sogang University; Seoul; Korea
| | - Gab-Yong Bae
- Department of Life Science; College of Natural Science; Sogang University; Seoul; Korea
| | - Jin-Ju Kim
- Department of Life Science; College of Natural Science; Sogang University; Seoul; Korea
| | | | | | - Hyung Geun Min
- Department of Biotechnology; College of Biomedical and Health Science; Konkuk University, Chungju-City, Korea
| | - Hyuk-Jin Cha
- Department of Life Science; College of Natural Science; Sogang University; Seoul; Korea
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Levy LL, Zeichner JA. Management of acne scarring, part II: a comparative review of non-laser-based, minimally invasive approaches. Am J Clin Dermatol 2012; 13:331-40. [PMID: 22849351 DOI: 10.2165/11631410-000000000-00000] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Acne scarring is a commonly encountered yet extremely challenging problem to treat for the dermatologist. As acne scarring can lead to significant psychological distress and low self-esteem, it is of utmost importance to have effective and satisfying treatments in the physician's armamentarium. However, many treatments are unsatisfying, leading to patient disappointment and frustration. Although early treatment of acne lesions and inflammation with isotretinoin is beneficial in preventing acne scarring, many patients still present with troubling noticeable scars. Despite the advances in pharmacology and technology, scar treatment still remains suboptimal and is tainted with several adverse effects. However, some treatments can provide benefits. This review article exhaustively discusses and analyzes the various minimally invasive approaches to the treatment of acne scarring with an emphasis on pharmacologic agents, such as isotretinoin for atrophic acne scars and corticosteroids and chemotherapeutic drugs for hypertrophic scars. Intralesional injections of corticosteroids are efficacious in reducing keloid scar formation in addition to preventing recurrence following surgical excision. In-office and minimally invasive procedural management, including chemical peels, dermabrasion, tissue augmentation, and punch excision is also discussed. Superficial chemical peels are efficacious in treating atrophic scars with relatively few adverse effects and complications. Although dermabrasion is used less often with the advent of laser resurfacing, this technique remains as a viable option for those with atrophic scars. Post-inflammatory hyperpigmentation can be managed successfully with topical agents such as azelaic acid and hydroquinone. The efficacy of various treatment modalities is highlighted with a focus on choosing the correct modalities for specific scar types.
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Farrugia BL, Keddie DJ, George GA, Lynam EC, Brook MA, Upton Z, Dargaville TR. An investigation into the effect of amphiphilic siloxane oligomers on dermal fibroblasts. J Biomed Mater Res A 2012; 100:1919-27. [DOI: 10.1002/jbm.a.33310] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2011] [Revised: 10/01/2011] [Accepted: 10/21/2011] [Indexed: 11/10/2022]
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Cutaneous scarring: Pathophysiology, molecular mechanisms, and scar reduction therapeutics. J Am Acad Dermatol 2012; 66:13-24; quiz 25-6. [DOI: 10.1016/j.jaad.2011.08.035] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Revised: 08/13/2011] [Accepted: 08/17/2011] [Indexed: 02/08/2023]
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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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Gauglitz G, Kunte C. Empfehlungen zur Prävention und Therapie hypertropher Narben und Keloide. Hautarzt 2011; 62:337-46. [DOI: 10.1007/s00105-010-2087-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Hsu YC, Chen MJ, Yu YM, Ko SY, Chang CC. Suppression of TGF-β1/SMAD pathway and extracellular matrix production in primary keloid fibroblasts by curcuminoids: its potential therapeutic use in the chemoprevention of keloid. Arch Dermatol Res 2010; 302:717-24. [PMID: 20717830 DOI: 10.1007/s00403-010-1075-y] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2010] [Revised: 07/23/2010] [Accepted: 07/31/2010] [Indexed: 11/25/2022]
Abstract
Keloid is a fibrotic disease characterized by abnormal accumulation of extracellular matrix (ECM) in the dermis. It is a late spreading skin overgrowth and may be considered a plastic surgeon's nightmare. In nature, curcuminoid is composed of curcumin, demethoxycurcumin (DMC) and bisdemethoxycurcumin (bDMC). Curcuminoids have been found to inhibit fibrosis. However, their role in the synthesis of ECM in the keloid fibroblasts (KFs) has remained unclear. In this series of studies, a total of seven primary KFs cultures were used as the KFs model for investigating the inhibitory effect of curcuminoids on the expression of ECM and TGF-β1. A sensitive and reproducible HPLC method was developed to provide a quantitative analysis on the cellular uptake of curcuminoids onto the KF cells. The level of ECM in the primary KFs was elevated. The elevation of ECM and TGF-β1/p-SMAD-2 level was substantially blocked by the cellular uptake of curcumin in a dose-dependent manner in all the seven primary KFs. The results have led to the conclusion that the excessive production of ECM in the KF cells could be blocked and/or rapidly decreased by curcumin.
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Affiliation(s)
- Yi-Chiang Hsu
- Graduate Institute of Medical Science and Innovative Research Center of Medicine, College of Health Sciences, Chang Jung Christian University, No. 396. Sec. 1, Changrong Rd., Gueiren Township, Tainan 71101, Taiwan.
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Sainsbury DCG, Allison KP, Muir T. Electrochemotherapy treatment of a recalcitrant earlobe keloid scar with chronic lymphocytic leukaemia infiltration. J Plast Reconstr Aesthet Surg 2010; 63:e733-6. [PMID: 20627836 DOI: 10.1016/j.bjps.2010.05.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2010] [Revised: 04/14/2010] [Accepted: 05/07/2010] [Indexed: 02/08/2023]
Abstract
Electrochemotherapy, a tumour ablation modality, which facilitates intracellular delivery of poorly-permeable cytotoxic drugs, such as bleomycin, has shown promising results in the treatment of cutaneous and subcutaneous melanomatous and non-melanomatous metastases. We report the case of a 52-year-old Caucasian gentleman with a keloid scar to his left earlobe that developed following a piercing. Despite multiple intralesional steroidal injections, five intralesional excisions and a course of superficial radiotherapy the keloid scar remained over nine years later. For 15 years the patient had also suffered chronic lymphocytic leukaemia with no nodal disease or systemic involvement. However, histological analysis of the final surgical excision specimen showed chronic lymphocytic leukaemia infiltration of the keloid scar. Further surgical excision seemed unwise considering the recalcitrance of the keloid scar. Additionally, no systemic chemotherapy treatment options were feasible. Electrochemotherapy was performed under local anaesthesia with the aim of eradicating the chronic lymphocytic leukaemia deposit within the keloid lesion. Four sessions of electrochemotherapy using bleomycin were deployed over 11 months. A deep core biopsy of the treated keloid performed three months following the last electrochemotherapy session showed no evidence of chronic lymphocytic leukaemia. Serendipitously, following the initial electrochemotherapy treatment no further growth of the keloid scar was observed. Furthermore, subsequent electrochemotherapy led to a substantial reduction in size of the keloid sustained for 14 months at last follow-up. This report highlights the exciting potential of electrochemotherapy and bleomycin in the treatment of recalcitrant scars. Larger, well-designed clinical and in-vitro studies are required to further elucidate the exact role, mechanism and cost-effectiveness of electrochemotherapy in this area.
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Affiliation(s)
- D C G Sainsbury
- Department of Plastic & Reconstructive Surgery, James Cook University Hospital, Middlesbrough, UK.
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Bloemen MC, van der Veer WM, Ulrich MM, van Zuijlen PP, Niessen FB, Middelkoop E. Prevention and curative management of hypertrophic scar formation. Burns 2009; 35:463-75. [DOI: 10.1016/j.burns.2008.07.016] [Citation(s) in RCA: 185] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2008] [Accepted: 07/08/2008] [Indexed: 12/26/2022]
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Aggarwal H, Saxena A, Lubana PS, Mathur RK, Jain DK. Treatment of keloids and hypertrophic scars using bleom. J Cosmet Dermatol 2008; 7:43-9. [DOI: 10.1111/j.1473-2165.2008.00360.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Abstract
BACKGROUND Therapeutic intervention for postacne scarring has historically been limited by the considerable morbidity of most treatments for only marginal disease improvement. Within the past decade, however, a greater understanding of the pathogenesis of acne scarring has led to the development of techniques that offer more favorable risk-benefit profiles. OBJECTIVE The aims of this article are to highlight a number of newer techniques and to assign their appropriateness to particular grades of acne scarring. MATERIALS AND METHODS Current modalities are discussed as they relate to disease process and specific acne scar types. Techniques are presented in order of most effectual therapeutic interventions for defined grades of acne scarring. Acne scarring grades have been described previously in terms of disease load, severity, and lesion morphologies. RESULTS A comprehensive discussion of updated therapeutic techniques and their biologic rationales in the treatment of acne scarring is presented. These include targeted interventions of inflammatory and postinflammatory processes, angiogenesis, immunologic processes, dermal and subcutaneous fibrosis, hypertrophy, and keloid scarring. DISCUSSION A requirement for developing successful treatments for postacne scarring is a greater understanding of its pathogenesis, variability among afflicted individuals, and the inflammatory mediators and immunology of the scarring process. Many innovative techniques introduced in the past decade attempt to counteract these pathologic processes while keeping the procedural and postoperative risks to a minimum.
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Affiliation(s)
- Greg J Goodman
- Skin and Cancer Foundation of Victoria and Monash University Department of Community Medicine, Victoria, Australia.
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Durani P, Bayat A. Levels of evidence for the treatment of keloid disease. J Plast Reconstr Aesthet Surg 2007; 61:4-17. [PMID: 17644502 DOI: 10.1016/j.bjps.2007.05.007] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2006] [Revised: 11/18/2006] [Accepted: 05/15/2007] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Keloid disease presents a significant burden for patients and a significant therapeutic challenge for clinicians. Multiple treatments have been proposed, but with the increasing drive towards effective use of resources, therapeutic options need to be evaluated in terms of the levels of evidence supporting their use. AIM To retrieve and review the primary clinical studies evaluating keloid disease therapy over the last 25 years and assign levels of evidence for the treatment modalities evaluated. METHOD A Medline search was conducted to identify all primary clinical studies evaluating the treatment of keloid disease, published in English since 1980 (excluding single case reports). Studies were assigned a level of evidence (LOE-1, highest quality to LOE-5, lowest) adapted from the Oxford Centre for Evidence-based Medicine. RESULTS 13 (12%) of 112 studies retrieved were assigned LOE-2, 99 (88%) assigned LOE-4. There were no LOE-1 studies. Ten of the LOE-2 studies evaluated silicone-based therapy or laser therapy. Most studies evaluating steroids, cryosurgery, laser therapy and post-surgical adjuvant therapy provide level 4 evidence. CONCLUSION High quality research in evaluating keloid therapy is lacking. There is a definite need for well designed and properly reported randomised controlled trials, to provide clinicians with a sound body of evidence on which to inform decision making.
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Affiliation(s)
- P Durani
- Renovo, Manchester Incubator Building, 48 Grafton Street, Manchester M13 9XX, UK
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Abstract
Wound healing is a complex and carefully regulated physiologic response to a traumatic injury. Deregulation of this coordinated process can lead to exuberant scar formation as seen in keloids and hypertrophic scars. Despite their common occurrence, keloids remain one of the most challenging dermatologic conditions to successfully treat and may have significant psychosocial impact for the patient. In this review, we discuss the clinical features, genetics, epidemiology, and treatment of keloids.
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Affiliation(s)
- David T Robles
- Division of Dermatology, Department of Medicine, University of Washington Medical Center, PO Box 356524, Seattle, WA 98105-6920, USA
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Exogenous nitric oxide stimulated collagen type I expression and TGF-beta1 production in keloid fibroblasts by a cGMP-dependent manner. Nitric Oxide 2006; 16:258-65. [PMID: 17052928 DOI: 10.1016/j.niox.2006.09.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2006] [Revised: 09/04/2006] [Accepted: 09/05/2006] [Indexed: 10/24/2022]
Abstract
Keloids arise from the aberrant wound healing process and nitric oxide (NO) plays an important role in the inflammation stage of wound healing. In order to better define the potential effect of NO/cGMP signal pathway in the keloid pathogenesis, the enhancing effect of exogenous NO (released from NO donor) on collagen expression in the keloid fibroblast (KF) as well as on the induction of collagen type I protein and TGF-beta1 expression in the KF were studied in this investigation. The DETA NONOate, an NO donor, was added to the KF, as the exogenous NO, to release NO in the culture medium. The expression of collagens was then determined by assaying the total soluble collagens and collagen type I in the KF. The cellular concentration of cGMP was measured by EIA in the KF. Exogenous NO was found to enhance the expression of collagens and elevate the cellular levels of cGMP. Moreover, to evaluate the effect of the elevated cellular cGMP levels on the expression of collagen and TGF-beta1, both cGMP and TGF-beta1 were measured by ELISA. The inhibitors for phosphodiesterase (PDE), such as IBMX (3-isobutyl-1-methylxanthine), Vinpocetine, EHNA, Milrinone and Zapriast, which have been reported to reduce the ability of PDE and subsequently produce an increase of cellular cGMP, induce the production of autocrine TGF-beta1 as well as the synthesis of collagen in the KF. In this investigation, the inhibition of the PDE enzyme activity was observed to enhance the effect on the collagen synthesis, and was induced by exogenous NO. Taken together, these results have suggested that the NO/cGMP pathway could positively influence the progression of keloid formation, via the TGF-beta1 expression in the KF.
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Affiliation(s)
- Luc Téot
- Montpellier University Hospital, Montpellier, France
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Kontochristopoulos G, Stefanaki C, Panagiotopoulos A, Stefanaki K, Argyrakos T, Petridis A, Katsambas A. Intralesional 5-fluorouracil in the treatment of keloids: an open clinical and histopathologic study. J Am Acad Dermatol 2005; 52:474-9. [PMID: 15761426 DOI: 10.1016/j.jaad.2004.09.018] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND The treatment of keloids remains unsatisfactory. Intralesional 5-fluorouracil (FU) has not been much investigated as a monotherapy in the treatment of keloids. OBJECTIVE We sought to evaluate the use of intralesional injections of 5-FU in the treatment of keloids. METHODS A total of 20 patients (11 male and 9 female) were treated once weekly with intralesional injections of 5-FU (50 mg/mL). Patients received an average of 7 treatments. Average injection volumes were 0.2 to 0.4 mL/cm2. All patients had full blood cell count, liver function tests, and renal function tests before and after treatment was commenced. A total of 10 patients had biopsy specimens taken before starting treatment as a baseline and after 6 sessions. Routine hematoxylin-eosin and immunohistochemical analysis detecting Ki-67 and transforming growth factor-beta were performed on paraffin sections. All patients were followed up for 12 months, or until recurrence was noted. RESULTS Of 20 patients, 17 (85%) showed more than 50% improvement. Only one did not respond favorably. Small and previously untreated lesions improved the most. Pain (20 of 20), hyperpigmentation (20 of 20), and tissue sloughing (6 of 20) were the main adverse effects. Histopathologic and immunohistochemical evaluation were consistent with the clinical observations. Ki-67 proliferative index was significantly reduced (P = .0001) after treatment. Transforming growth factor-beta was reduced less significantly. Recurrence was noted in 47% (9 of 19) of patients who responded to treatment within 1 year. A correlation was found ( P = .028) between the duration of the lesions and recurrence. CONCLUSION Our study demonstrates that intralesional 5-FU may be effective in the treatment of keloids, but recurrence is common and further investigation is required.
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Abstract
Acne is a common disease affecting a significant proportion of the population.(1-3) It causes considerable morbidity through soreness, disfigurement, and social handicap due to inflammatory lesions.(4,5) Modern therapy ensures that a considerable proportion of all patients can be offered effective treatment of their disease, but the morbidity is not restricted solely to the inflammatory lesions of acne.(6,7) Despite appropriate and effective primary prevention of scarring, scarring occurs in some degree in 95% of all patients irrespective of the severity of inflammatory acne (although severe acne causes more scarring than the milder forms). The scarring causes long-term morbidity that requires specific therapy.(7)
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Affiliation(s)
- Gregor B E Jemec
- Division of Dermatology, Department of Medicine, Roskilde Hospital, University of Copenhagen, DK-4000 Roskilde, Denmark.
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Abstract
Artecoll was developed about 20 years ago and underwent a number of production changes until it recently became FDA approved under the new name of Artefill. This product contains 20% polymethyl methacrylate (PMMA) microspheres with a diameter of 30 to 40 microm, which are suspended in a 3.5% atelo-collagen solution. The PMMA microspheres are now purified and no longer have an electrostatic charge, which in part was the cause for the early granulomatous reactions. Further, PMMA has long been known as bone cement and has been used in cosmetic surgery with a very good safety record. PMMA microspheres are biologically inert and nondegradable. The treatment results are therefore permanent and technical errors as well as incorrect injections will last. Due to the early record of granuloma formation, there is still a debate as to whether this product-as well as all other permanent fillers-should be injected for cosmetic reasons or not. With proper indications, excellent injection techniques, and realistic expectations as to what can be expected, this product has now proved to be one of the superior permanent filler substances.
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Affiliation(s)
- Eckart Haneke
- Department of Dermatology, University Medical Centre, St. Radboud Nijmegen, The Netherlands.
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Mustoe TA, Cooter RD, Gold MH, Hobbs FDR, Ramelet AA, Shakespeare PG, Stella M, Téot L, Wood FM, Ziegler UE. International clinical recommendations on scar management. Plast Reconstr Surg 2002; 110:560-71. [PMID: 12142678 DOI: 10.1097/00006534-200208000-00031] [Citation(s) in RCA: 632] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Many techniques for management of hypertrophic scars and keloids have been proven through extensive use, but few have been supported by prospective studies with adequate control groups. Several new therapies showed good results in small-scale trials, but these have not been repeated in larger trials with long-term follow-up. This article reports a qualitative overview of the available clinical literature by an international panel of experts using standard methods of appraisal. The article provides evidence-based recommendations on prevention and treatment of abnormal scarring and, where studies are insufficient, consensus on best practice. The recommendations focus on the management of hypertrophic scars and keloids, and are internationally applicable in a range of clinical situations. These recommendations support a move to a more evidence-based approach in scar management. This approach highlights a primary role for silicone gel sheeting and intralesional corticosteroids in the management of a wide variety of abnormal scars. The authors concluded that these are the only treatments for which sufficient evidence exists to make evidence-based recommendations. A number of other therapies that are in common use have achieved acceptance by the authors as standard practice. However, it is highly desirable that many standard practices and new emerging therapies undergo large-scale studies with long-term follow-up before being recommended conclusively as alternative therapies for scar management.
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Affiliation(s)
- Thomas A Mustoe
- Division of Plastic and Reconstructive Surgery, Northwestern University School of Medicine, Chicago, Ill. 60611, USA.
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Novedades en Dermatología quirúrgica. ACTAS DERMO-SIFILIOGRAFICAS 2002. [DOI: 10.1016/s0001-7310(02)76559-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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