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Huang Y, Ren S, Yang Q. Efficacy and Safety of Excision Combination Therapies for Earlobe Keloids: A Systematic Review and Meta-analysis. Aesthetic Plast Surg 2024; 48:2757-2770. [PMID: 38789810 DOI: 10.1007/s00266-024-04092-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 04/15/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND Different combinations of excision and adjuvant therapies have been applied to improve outcomes for earlobe keloids, though evidence in this field is still lacking. OBJECTIVES This study sought to systematically investigate efficacy and safety of these treatments. METHODS We conducted a systematic search on PubMed, Embase, Web of Science, and Cochrane Library to find all relevant studies. Meta-analysis of recurrence rates (RRs) and adverse event rates with 95% confidence intervals, and individual participants data (IPD) were calculated for each intervention when possible. Otherwise, narrative syntheses were performed. RESULTS A total of 85 articles, covering 23 treatments for earlobe keloids, were included, indicating a preference for multiple combination therapy. The estimated RRs for 6 interventions (i.e., excision monotherapy, combinations of excision with imiquimod, pressure therapy, radiotherapy, steroids, and steroids with pressure therapy) appeared to be comparable. Electron radiotherapy was found to have potential advantages over X-ray treatment, contributing to the observed heterogeneity. Further meta-analysis using IPD revealed that both combination therapies of excision plus steroid therapy (p=0.003) and excision plus radiotherapy (p=0.003) yielded better recurrence-free survival compared to excision alone. The median recurrence-free interval for combination therapy was 10 months. Adverse event rates were similar among different intervention groups. CONCLUSIONS This study suggests that combining excision with radiotherapy or perioperative steroid therapy has the potential to improve prognosis of earlobe keloids without increasing the risk of adverse events. Overall evaluation of patients' conditions and further studies with sufficient follow-up are warranted for clinical practice. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Ying Huang
- Department of Comprehensive Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Badachu Road 33, Beijing, People's Republic of China
| | - Shuofang Ren
- Department of Cardiac Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Qinghua Yang
- Department of Comprehensive Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Badachu Road 33, Beijing, People's Republic of China.
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Tahir SM, Ihebom D, Simman R. Compression Therapy for Keloid Scars: A Systematic Review and Meta-analysis. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5864. [PMID: 38841536 PMCID: PMC11150022 DOI: 10.1097/gox.0000000000005864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 04/08/2024] [Indexed: 06/07/2024]
Abstract
Background Keloid scars have a multitude of treatments with varying success rates. The purpose of this systematic review and meta-analysis is to study the different types of compression therapies used following surgical excision and their recurrence rates. Methods A literature search was conducted using the following databases: PubMed, Embase, and Cochrane Reviews. The following keywords were used in the search: "keloid" and "compression." The following inclusion criteria were used: (1) identifying lesion must be a keloid and (2) use of any type of compression therapy for keloid scar. Results A total of 27 articles were included in the final analysis, grouped into three treatment modalities for comparison. The three treatment modalities are (1) surgical excision and compression earring, (2) surgical excision and silicone gel sheeting, and (3) surgical excision, compression earring, and silicone gel sheeting. Based on our analysis, combination treatment with compression earring device and silicone gel sheeting had the lowest recurrence rate when compared with compression earring device or silicone gel alone, but the difference in recurrence rates between the three treatment modalities was not statistically significant. Conclusions There were too few studies included in each treatment modality with even fewer sample sizes, and there is a need for a greater number of studies with increased sample size to evaluate which therapy is the most efficacious in preventing keloid recurrence following surgical excision.
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Affiliation(s)
- Sadia M. Tahir
- From the College of Medicine and Life Sciences, University of Toledo, Toledo, Ohio
| | - Diane Ihebom
- From the College of Medicine and Life Sciences, University of Toledo, Toledo, Ohio
| | - Richard Simman
- College of Medicine and Life Sciences, Department of Surgery, University of Toledo, Toledo, Ohio
- ProMedica Health Network, Wound Care Program, Jobst Vascular Institute, Toledo, Ohio
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Nejat AH, Hamdan S, Abrego I, Lindsey JT, Vitter R. Fully Digital Workflow for Fabrication of A 3D Printed Ear Stent for Auricular Keloids: A Technique Article. J Prosthodont 2021; 31:266-270. [PMID: 34811842 DOI: 10.1111/jopr.13455] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2021] [Indexed: 11/28/2022] Open
Abstract
Keloids are skin lesions which result from an aberration in the physiological healing process marked with overgrowth of collagen fibers. Keloid of the ear is cosmetically challenging and has an increased chance of re-growth. To minimize recurrence, pressure therapy in combination with other treatment forms has been used. Various techniques have been used to fabricate a passive or active stent. This report presents a fully digital workflow to fabricate an ear stent after intralesional excision and skin autografting of an extensive recurrence of a keloid lesion of the left ear involving the helix, antihelix, scapha and conchal bowl. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Amir H Nejat
- Assistant Professor, Prosthodontics Department, Louisiana State University Health Science Center, School of Dentistry, New Orleans, LA
| | - Suleiman Hamdan
- Associate Professor, Prosthodontics Department, Louisiana State University Health Science Center, School of Dentistry, New Orleans, LA
| | | | - John T Lindsey
- Clinical Associate Professor of Surgery, Division of Plastic and Reconstructive Surgery, Tulane University School of Dentistry
| | - Roger Vitter
- Assistant Professor, Prosthodontics Department, Louisiana State University Health Science Center, School of Dentistry, New Orleans, LA
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Chen J, Chen A, Zhang J, Wang F, Fang Q, He Z, Chen X, Ma W, Hu F. Efficacy and safety of laser combination therapy and laser alone therapy for keloid: a systematic review and meta-analysis. Lasers Med Sci 2021; 37:1127-1138. [PMID: 34283306 DOI: 10.1007/s10103-021-03364-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 06/17/2021] [Indexed: 11/26/2022]
Abstract
To evaluate the efficacy and safety of laser alone therapy and laser combination therapy (mainly combined with other kinds of laser or steroids) for keloid.PubMed, Embase and Web of Science were searched for relevant articles from inception to June 2020. Comprehensive Meta-Analysis software 2.0 (CMA) was used to perform the meta-analysis.A total of 29 articles were included in this meta-analysis. During the mean follow-up of 14 (1-84) months, the overall improvement rates of baseline Vancouver scar scale (VSS) score and itch were 0.454 (95%CI 0.351-0.561, I2 = 0) and 0.786 (95%CI 0.613-0.895, I2 = 0) in the laser combination therapy group. The improvement rates of scar height and flexibility in the laser combination therapy group were 0.629 (95%CI 0.519-0.727, I2 = 52.089) and 0.784 (95%CI 0.251-0.975, I2 = 89.420). The average improvement rate of the scar score in laser combination therapy was 0.338 (0.201-0.510); however, there were insufficient data for laser alone therapy comparison. The laser combination therapy had a greater pain improvement rate, 0.580 (0.389-0.750) versus 0.420 (0.224-0.645), compared to laser alone therapy, and a greater degree of good or excellent (> 50%) improvement in the overall scar, 0.636 (95%CI 0.347-0.852) versus 0.149 (95%CI 0.032-0.482), with laser alone therapy. Moreover, a lower regrowth rate of 0.187 (0.129-0.263) versus 0.249 (0.060-0.631), a lower post-treatment pigmentation rate of 0.125 (0.091-0.169) versus 0.135 (0.058-0.282), and a lower infection rate of 0.047 (0.009-0.209) versus 0.076 (0.012-0.351) were observed in the laser combination therapy compared with those rates in the laser alone therapy.The overall effect of laser combination therapy was better than that of laser alone therapy, and the incidence of adverse reactions was lower in laser combination therapy than in laser alone therapy.
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Affiliation(s)
- Jiahui Chen
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China
- 2017 Clinical Medicine, Shenzhen University Health Science Center, Shenzhen, Guandong, People's Republic of China
| | - Aiyue Chen
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China
- 2017 Clinical Medicine, Shenzhen University Health Science Center, Shenzhen, Guandong, People's Republic of China
| | - Jianhao Zhang
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China
- 2017 Clinical Medicine, Shenzhen University Health Science Center, Shenzhen, Guandong, People's Republic of China
| | - Feipeng Wang
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China
- 2017 Clinical Medicine, Shenzhen University Health Science Center, Shenzhen, Guandong, People's Republic of China
| | - Qiongfang Fang
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China
- 2017 Clinical Medicine, Shenzhen University Health Science Center, Shenzhen, Guandong, People's Republic of China
| | - Ziwei He
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China
- 2017 Clinical Medicine, Shenzhen University Health Science Center, Shenzhen, Guandong, People's Republic of China
| | - Xi Chen
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China
| | - Wancheng Ma
- Department of Non-Communicable Disease Prevention and Control, Shenzhen Luohu Center for Chronic Disease, Shenzhen, Guangdong, People's Republic of China
| | - Fulan Hu
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China.
- Department of Epidemiology and Health Statistics, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China.
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Zawadiuk LRR, Van Slyke AC, Bone J, Redfern B, Carr NJ, Arneja JS. What Do We Know About Treating Recalcitrant Auricular Keloids? A Systematic Review and Meta-Analysis. Plast Surg (Oakv) 2021; 30:49-58. [PMID: 35096693 PMCID: PMC8793758 DOI: 10.1177/2292550321995746] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Recalcitrant auricular keloids are keloids that have recurred after any previous treatment. They have been shown to have an increased likelihood of recurrence. There is no consensus on how best to treat recalcitrant auricular keloids. Here, we perform the first systematic review and meta-analysis investigating the evidence for treating recalcitrant auricular keloids. Methods: We searched MEDLINE, EMBASE, CINAHL, and EBM Reviews using specific keywords. Prespecified inclusion and exclusion criteria were used to assess article eligibility. Data were extracted for number of recalcitrant keloids, treatment modality, recurrence, and minimum follow-up time. Included articles were stratified by treatment and assigned a level of evidence (LOE) based on the Oxford Centre for Evidence-Based Medicine guidelines. A meta-analysis was performed to estimate recurrence rates with 95% confidence intervals for each treatment modality. Results: A total of 887 unique articles were identified and 13 included. Eleven were LOE III and 2 were LOE IV. Recurrence rates were found to be 9% (95% CI: 3%-25%) for excision with adjuvant brachytherapy, 14% (95% CI: 12%-17%) for excision with adjuvant compression therapy, 17% (95% CI: 3%-56%) for excision with adjuvant external beam radiation, and 18% (95% CI: 4%-53%) for excision with adjuvant steroid injections. No statistical significant difference was found. Conclusions: Data for treatment of auricular keloids are heterogeneous with few high-quality studies. Excision with adjuvant brachytherapy has the lowest recurrence rate in our analysis. Narrow confidence intervals reported here for brachytherapy and compression therapy may help surgeons more confidently recommend either of these treatment modalities to patients.
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Affiliation(s)
- Luke R. R. Zawadiuk
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Aaron C. Van Slyke
- Division of Plastic Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jeffrey Bone
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Baillie Redfern
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nicholas J. Carr
- Division of Plastic Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jugpal S. Arneja
- Division of Plastic Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
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Park TH, Rah DK. Successful eradication of helical rim keloids with surgical excision followed by pressure therapy using a combination of magnets and silicone gel sheeting. Int Wound J 2015; 14:302-306. [PMID: 26593457 DOI: 10.1111/iwj.12547] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Revised: 10/11/2015] [Accepted: 10/27/2015] [Indexed: 11/28/2022] Open
Abstract
Extremely limited data are available for the treatment of helical rim keloids. The purpose of the present study was to demonstrate the successful treatment of helical rim keloids using surgical exicison followed by a newly designed pressure therapy device. We treated 40 pure helical rim keloids in 36 patients with surgical excisions followed by pressure therapy using a combination of magnets and silicone gel sheeting for 12 hours over a period of 2 years, from May 2012 to February 2014, at tertiary medical centre. The follow-up period was 18 months. Primary outcome was recurrence of keloids. Secondary outcome was patient satisfaction as assessed by the Patient Observer Scar Assessment Scale (POSAS). The overall recurrence-free rate was 95·0% after a follow-up period of 18 months. Scores obtained from the POSAS showed that most items were reported to be improved. This adjuvant therapy protocol resulted in excellent outcomes in cases of helical rim keloids compared to previously published protocols.
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Affiliation(s)
- Tae Hwan Park
- Department of Plastic and Reconstructive Surgery, CHA Bundang Medical Center, CHA University, Seongnam, South Korea.,Department of Plastic and Reconstructive Surgery, Yonsei University college of Medicine, Seoul, South Korea
| | - Dong Kyun Rah
- Department of Plastic and Reconstructive Surgery, Yonsei University college of Medicine, Seoul, South Korea
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Ud-Din S, Bayat A. Strategic management of keloid disease in ethnic skin: a structured approach supported by the emerging literature. Br J Dermatol 2014; 169 Suppl 3:71-81. [PMID: 24098903 DOI: 10.1111/bjd.12588] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2013] [Indexed: 12/11/2022]
Abstract
Keloid disease (KD) is a common, benign, dermal fibroproliferative growth of unknown aetiology. Lesions tend to grow over time; they often recur following therapy and do not regress spontaneously. KD causes considerable discomfort due to pain, pruritus and inflammation, and a significant psychosocial impact with reduced quality of life. It is unique to humans and occurrence is higher in individuals with dark, pigmented, ethnic skin. There is a strong familial heritability, with a high ethnic predisposition in individuals of African, Asian and Hispanic descent. High recurrence rates and unknown resolution rates present a major problem for both the patient and clinician. Many treatment modalities exist; however, there is no single advocated therapy. Therefore, the aim of this review was to explore the most current literature regarding the range of treatment options for KD and to offer a structured approach in the management of KD, based on evidence and experience, to aid clinicians in their current practice. A focused history involving careful evaluation of the patient's symptoms, signs, quality of life and psychosocial well-being should direct targeted therapy, complemented with regular follow-up and re-evaluation. Many treatment modalities, such as intralesional steroid injection, silicone gel application, cryotherapy, lasers, 5-fluorouracil and, relatively recently, photodynamic therapy, are currently being used in clinical practice for the management of KD. Combination therapies have also been shown to be beneficial. However, there is a lack of robust, randomized, level-one, evidence-controlled trials evaluating these treatment options. Management of KD in ethnic pigmented skin remains a clinical challenge. Thus, a strategic approach with structured assessment, targeted therapy and focus on prevention of recurrence is highly recommended. Quality evidence is essential in order to tailor treatment effectively for the ethnic patient presenting with KD.
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Affiliation(s)
- S Ud-Din
- Plastic and Reconstructive Surgery Research, Bayat Research Group, Manchester Institute of Biotechnology, University of Manchester, 131 Princess Street, Manchester, M1 7DN, U.K; University Hospital of South Manchester NHS Foundation Trust, Institute of Inflammation and Repair, Dermatology Group, Faculty of Medical and Human Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, M23 9LT, U.K
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Tanaydin V, Colla C, Piatkowski A, Beugels J, Hendrix N, van den Kerckhove E, Hugenholtz GCG, van der Hulst RDWJ. Management of ear keloids using custom-molded pressure clips: a preliminary study. EUROPEAN JOURNAL OF PLASTIC SURGERY 2014. [DOI: 10.1007/s00238-014-0943-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Yüzbaşıoğlu E. Reverse activated hyrax pressure appliance for treatment of a keloid located at auricula helix. J Prosthodont 2013; 22:509-12. [PMID: 23551793 DOI: 10.1111/jopr.12034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2012] [Indexed: 11/29/2022] Open
Abstract
Keloids are considered aberrations of the wound healing process, and various treatment regimens are described depending on the morphology and size of the lesion. Compression therapy using custom-made pressure clips or splints is widely used for the treatment of keloids. The most common complication of this therapy is ulceration due to excessive soft tissue pressure, resulting in delays and prolonged treatment time. This article describes the fabrication of a custom-made pressure appliance for the treatment of a keloid located at the auricle helix. The pressure appliance can be modified to fit the auricle helix and covers the area needing pressure.
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Affiliation(s)
- Emir Yüzbaşıoğlu
- Department of Prosthodontics, School of Dentistry, Istanbul Medipol University, Turkey.
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10
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Abstract
Keloid disorder (KD) is a fibroproliferative ailment of the cutaneous connective tissue secondary to dysregulation in various skin repair and healing processes. This disorder is characterized by excess collagen and/or glycoprotein depositions in the dermis. Age of onset of KD is not well documented. Based on clinical observations, various authors have reported the onset of KD to be between the ages of 10 and 30 years. We report on an African American female who developed bilateral auricular keloids at the age of 9 months. To our knowledge, this is the youngest age at which a patient has been documented to have developed KD.
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Park TH, Seo SW, Kim JK, Chang CH. Outcomes of surgical excision with pressure therapy using magnets and identification of risk factors for recurrent keloids. Plast Reconstr Surg 2011; 128:431-439. [PMID: 21788835 DOI: 10.1097/prs.0b013e31821e7006] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND In a previous study, the authors described an adjuvant pressure therapy using magnets for the management of ear keloids. The purpose of the present study was to build on this previous study by expanding the cohort of patients, evaluating treatment outcomes by means of a prospective study and identifying risk factors for recurrent ear keloids. METHODS The authors treated 1436 ear keloids in 883 patients with surgical excision followed by pressure therapy using magnets at Kangbuk Samsung Hospital over the 7.25-year period from December of 2002 to February of 2010. Six hundred eighteen of 883 patients (70 percent) had histories of treatment failure at other hospitals. The follow-up period was 18 months. Therapeutic outcomes were evaluated as recurrence or nonrecurrence. Comparisons between the two groups (recurrence versus nonrecurrence) were made using Mann-Whitney tests for continuous variables, the chi-square test and the Fisher's exact test for categorical variables, and multivariate logistic regression for investigating associations between possible risk factors and keloid recurrence. RESULTS The overall recurrence-free rate was 89.4 percent after a follow-up period of 18 months. Keloid recurrence was significantly associated with the presence of prior treatment history, keloid low growth rate, and high patient body mass index. CONCLUSIONS The authors' protocol results in excellent outcomes in cases of ear keloids. Patients with prior treatment history, low growth rates of keloids because of longer duration of disease, and high body mass index should be monitored closely for signs of recurrence and managed cautiously during ear keloid treatment. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, III.
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Affiliation(s)
- Tae Hwan Park
- Seoul, Korea From the Department of Plastic and Reconstructive Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine
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Recalcati S, Caccialanza M, Piccinno R. Postoperative radiotherapy of auricular keloids: A 26-year experience. J DERMATOL TREAT 2010; 22:38-42. [DOI: 10.3109/09546630903460278] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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KADOUCH DANIELJ, VAN DER VEER WILLEMM, KERKDIJK DESIREE, DELAVARY BABAKMAHDAVIAN, NIESSEN FRANKB. Postoperative Pressure Therapy of Ear Keloids Using a Custom-Made Methyl Methacrylate Stent. Dermatol Surg 2010; 36:383-5. [DOI: 10.1111/j.1524-4725.2009.01449.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Intralesional Botulinum Toxin Type A Injection as a New Treatment Measure for Keloids. Plast Reconstr Surg 2009; 124:275e-277e. [DOI: 10.1097/prs.0b013e3181b98ee7] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bermueller C, Rettinger G, Keck T. Auricular keloids: treatment and results. Eur Arch Otorhinolaryngol 2009; 267:575-80. [DOI: 10.1007/s00405-009-1059-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2009] [Accepted: 07/21/2009] [Indexed: 01/19/2023]
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Savion Y, Sela M, Sharon-Buller A. Pressure earring as an adjunct to surgical removal of earlobe keloids. Dermatol Surg 2009; 35:490-2. [PMID: 19250308 DOI: 10.1111/j.1524-4725.2009.01074.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Yigal Savion
- Department of Maxillofacial Prosthetics, Hadassah Hospital, Jerusalem, Israel.
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Zhibo X, Miaobo Z. Potential therapeutical effects of botulinum toxin type A in keloid management. Med Hypotheses 2008; 71:623. [PMID: 18534768 DOI: 10.1016/j.mehy.2008.04.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2008] [Revised: 04/16/2008] [Accepted: 04/18/2008] [Indexed: 11/26/2022]
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Savion Y, Sela M, Sharon-Buller A. Prefabricated pressure earring for earlobe keloids. J Prosthet Dent 2008; 99:406-7. [DOI: 10.1016/s0022-3913(08)60091-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Quarles FN, Brody H, Johnson BA, Badreshia S, Vause SE, Brauner G, Breadon JY, Swinehart J. Keloids. Dermatol Ther 2007; 20:142-6. [PMID: 17803608 DOI: 10.1111/j.1529-8019.2007.00126.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Frederick N Quarles
- Quarles Dermatology, 291 Independence Boulevard, Virginia Beach, VA 23462, USA.
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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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