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Hahn JM, Combs KA, Powell HM, Supp DM. A role for vitamin D and the vitamin D receptor in keloid disorder. Wound Repair Regen 2023; 31:563-575. [PMID: 37458255 DOI: 10.1111/wrr.13109] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/28/2023] [Accepted: 07/06/2023] [Indexed: 07/28/2023]
Abstract
Keloids are disfiguring fibroproliferative lesions that can occur in susceptible individuals following any skin injury. They are extremely challenging to treat, with relatively low response rates to current therapies and high rates of recurrence after treatment. Although several distinct genetic loci have been associated with keloid formation in different populations, there has been no single causative gene yet identified and the molecular mechanisms guiding keloid development are incompletely understood. Further, although it is well known that keloids are more commonly observed in populations with dark skin pigmentation, the basis for increased keloid risk in skin of colour is not yet known. Because individuals with dark skin pigmentation are at higher risk for vitamin D deficiency, the role of vitamin D in keloid pathology has gained interest in the keloid research community. A limited number of studies have found lower serum vitamin D levels in patients with keloids, and reduced expression of the vitamin D receptor (VDR) in keloid lesions compared with uninjured skin. Vitamin D has documented anti-inflammatory, anti-proliferative and pro-differentiation activities, suggesting it may have a therapeutic role in suppression of keloid fibrosis. Here we review the evidence supporting a role for vitamin D and VDR in keloid pathology.
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Affiliation(s)
- Jennifer M Hahn
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Kelly A Combs
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Heather M Powell
- Departments of Materials Science and Engineering and Biomedical Engineering, The Ohio State University, Columbus, Ohio, USA
- Scientific Staff, Shriners Children's Ohio, Dayton, Ohio, USA
| | - Dorothy M Supp
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Scientific Staff, Shriners Children's Ohio, Dayton, Ohio, USA
- Center for Stem Cell & Organoid Medicine (CuSTOM), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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Kim M, Mirsky N, Spielman A, Mathew P, Yechieli R, Tang JC, Thaller SR. Evaluating Symptomatic and Psychosocial Well-being After Keloid Treatment With SCAR-Q. Aesthet Surg J 2022; 42:NP416-NP422. [PMID: 35224618 DOI: 10.1093/asj/sjac043] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Many patients with keloids experience symptoms, such as pain and pruritus, and may present with significant psychosocial burdens. However, no single therapeutic regimen has been firmly established for treatment of keloids. OBJECTIVES The aim of this study was to assess patients' perspectives on their keloids after treatment by comparing preoperative and postoperative surveys. METHODS All patients seen at the keloid clinic, both preoperatively and postoperatively, were contacted by telephone call. Information about demographics, keloid characteristics, and levels of pain and pruritus were recorded. Participants also completed all 3 parts (appearance, symptoms, and psychosocial impact) of the SCAR-Q, a validated patient-reported outcome measure questionnaire. Statistical analysis was performed with SPSS version 23 (IBM Corp., Armonk, NY). RESULTS Of the 60 patients who participated in the study, 35 preoperative and 34 postoperative surveys were completed. Patients experienced significant reductions in mean [standard deviation] pain levels (from 5.6 [4.0] to 0.1 [0.4], P < 0.001) and pruritus (from 6.5 [3.0] to 0.8 [1.5], P < 0.001) postintervention. Significant improvements in all 3 parts of the SCAR-Q were noted. Appearance improved from 26.5 [22.3] to 73.4 [23.0] (P < 0.001); symptoms from 44.0 [15.7] to 81.4 [16.7] (P < 0.001); and psychosocial impact from 27.7 [30.7] to 82.6 [26.3] (P < 0.001). CONCLUSIONS Patients with keloids experience significant improvement in their symptomatic and psychosocial burden after treatment. Although management modalities are not well established, it is essential that plastic surgeons do not overlook the therapeutic benefits for their patients' well-being.
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Affiliation(s)
- Minji Kim
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Nicholas Mirsky
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Amanda Spielman
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Prakash Mathew
- Division of Plastic Surgery, University of Pennsylvania, Pennsylvania, PA, USA
| | - Raphael Yechieli
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jennifer C Tang
- Dr Philip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Seth R Thaller
- Division of Plastic, Aesthetic, and Reconstructive Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
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Sitaniya S, Jadhav A, Sharma YK, Subramani D, Deora MS, Gupta A. Quality-of-life of people with keloids and its correlation with clinical severity and demographic profiles. Wound Repair Regen 2022; 30:409-416. [PMID: 35388938 DOI: 10.1111/wrr.13015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 02/25/2022] [Accepted: 03/31/2022] [Indexed: 11/29/2022]
Abstract
Though the impairment of quality of life in individuals with keloids is profound, it has neither been well quantified nor correlated with severity in people with skin of colour. This cross-sectional, questionnaire-based study comprised 110 patients with keloid(s). A physician measured the severity of keloids using the Vancouver Scar scale and impairment of quality of life using the patient-filled Hindi version of Dermatology Life Quality Index questionnaire. The relationship among QoL and severity score as well as with components of demographic data was analysed using SPSS. Our study found the severity of keloid(s) to be moderately but significantly correlated with the quality of life of its sufferers. Individuals with multiple keloids were found to be significantly younger than those with solitary ones. Itching, pain, along with restricted mobility significantly impacted the quality of life as well as severity of keloids. Individuals who had undergone prior treatment were found to have a worse quality of life than the treatment naive. Recurrence was found to be associated with lower scar severity, multiple keloids, and younger age. Increasing age, though associated with greater scar severity, lacked any relationship with the quality of life. Our study also found that individuals with bigger keloids sought treatment earlier and more often. Hyperpigmented keloid(s), more common in individuals with skin of colour, were associated with a significantly worse quality of life as well as a higher scar severity.
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Affiliation(s)
- Sakshi Sitaniya
- Department of Dermatology, Dr. D.Y. Patil Medical College, Hospital and research centre, Dr. D.Y. Patil University, Pimpri, Pune, India
| | - Avinash Jadhav
- Department of Dermatology, Dr. D.Y. Patil Medical College, Hospital and research centre, Dr. D.Y. Patil University, Pimpri, Pune, India
| | - Yugal K Sharma
- Department of Dermatology, Dr. D.Y. Patil Medical College, Hospital and research centre, Dr. D.Y. Patil University, Pimpri, Pune, India
| | - Dharshini Subramani
- Department of Dermatology, Dr. D.Y. Patil Medical College, Hospital and research centre, Dr. D.Y. Patil University, Pimpri, Pune, India
| | - Mahendra S Deora
- Department of Dermatology, Dr. D.Y. Patil Medical College, Hospital and research centre, Dr. D.Y. Patil University, Pimpri, Pune, India
| | - Aayush Gupta
- Department of Dermatology, Dr. D.Y. Patil Medical College, Hospital and research centre, Dr. D.Y. Patil University, Pimpri, Pune, India
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Hahn JM, McFarland KL, Combs KA, Anness MC, Supp DM. Analysis of HOX gene expression and the effects of HOXA9 overexpression in fibroblasts derived from keloid lesions and normal skin. Wound Repair Regen 2021; 29:777-791. [PMID: 33811779 DOI: 10.1111/wrr.12917] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/24/2021] [Accepted: 03/18/2021] [Indexed: 12/20/2022]
Abstract
Keloids are fibroproliferative lesions resulting from an abnormal wound healing process due to pathological mechanisms that remain incompletely understood. Keloids tend to occur more frequently in anterior versus posterior body regions (e.g., ears, face, upper torso); this has been attributed to higher skin tension in those areas, although this has not yet been conclusively proven. Previous studies reported reduced expression of multiple homeobox (HOX) genes in keloid versus normal fibroblasts, suggesting a role for HOX genes in keloid pathology. However, HOX genes are differentially expressed along the anterior-posterior axis. Hypothetically, differential HOX expression may be due to differences in body sites, as matched donor sites are often unavailable for keloids and normal skin. To better understand the basis for differential HOX gene expression in cells from keloids compared with normal skin, we compared HOXA7, HOXA9, HOXC8 and HOXC11 expression in keloid and normal skin-derived fibroblasts from various body sites. When keloid (N = 20) and normal (N = 12) fibroblast cell strains were evaluated, expression of HOXA7, HOXA9 and HOXC8 was significantly lower in keloid versus normal fibroblasts. However, HOX gene expression was lower in fibroblasts from more anterior versus posterior body sites. When keloid and normal cells from similar body sites were compared, differential HOX expression was not observed. To investigate the phenotypic relevance of HOX expression, HOXA9 was overexpressed in keloid and normal fibroblasts. HOXA9 overexpression did not affect proliferation but significantly reduced fibroblast migration and altered gene expression. The results suggest that differential HOX expression may be due to differences in positional identity between keloid and normal fibroblasts. However, HOX genes can potentially regulate fibroblast phenotype, suggesting that differential HOX gene expression may play a role in keloid development in anterior body sites.
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Affiliation(s)
- Jennifer M Hahn
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Kevin L McFarland
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Kelly A Combs
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Meridith C Anness
- Women in Science and Engineering Program and Undergraduate Program in Medical Sciences, University of Cincinnati, Cincinnati, Ohio, USA.,Michigan State University College of Human Medicine, East Lansing, Michigan, USA
| | - Dorothy M Supp
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Scientific Staff, Shriners Children's Ohio, Dayton, Ohio, USA
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Zhu J, Zheng Z, Shen J, Lian X, Miao Z, Shen J, Zhang F. Efficacy of adjuvant radiotherapy for treatment of adrenocortical carcinoma: a retrospective study and an updated meta-analysis. Radiat Oncol 2020; 15:118. [PMID: 32448148 PMCID: PMC7245885 DOI: 10.1186/s13014-020-01533-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 04/07/2020] [Indexed: 12/21/2022] Open
Abstract
Background Adrenocortical carcinoma (ACC) is a rare and highly aggressive malignancy. Surgical resection is the standard treatment for localized ACC, but the local recurrence remains high. Adjuvant radiation (ART) has been proposed as a means to reduce recurrence rates in ACC after surgery with conflicting results from nonrandomized studies. We performed a retrospective study and a meta-analysis to determine the impact of ART on survival outcomes. Methods A retrospective study of the adrenocortical cancer database in Peking Union Medical College was conducted. We selected postoperative ACC patients with or without ART. A meta-analysis is also performed to compare the outcomes between ART and only surgical resection in ACC patients. The obtained data were analyzed using SPSS 23.0 and Stata 15.0 statistical software. Differences between two groups were compared using the log-rank test for retrospective analysis and estimated by calculating the odds ratio (OR) and 95% confidence interval (CI) for meta-analysis. Results Of a total of 75 patients available in the database, 12 patients underwent postoperative ART and were matched one to one to patients with only surgical resection. There was no significant difference on overall survival between ART group and control group (log-rank P = 0.149). Locoregional recurrence was diagnosed in 2 of the ART group, and in 4 of the control group (P = 0.64). A total of 238 participants were selected for the meta-analysis, of which 111 and 127 patients underwent ART after surgical resection and only surgical resection, respectively. Overall survival is significantly higher in ART group, with an odds ratio (OR) of 2.41 (95% CI of 1.33, 4.38; P = 0.004). Besides, meta-analysis significantly favored ART for locoregional recurrence-free survival and disease-free survival, with an OR of 4.08 and 2.27, respectively. Conclusions Our results show that compared to only surgical resection, ART is an effective postoperative treatment for ACC.
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Affiliation(s)
- Jiawei Zhu
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academe of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Ziye Zheng
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academe of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Jing Shen
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academe of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Xin Lian
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academe of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Zheng Miao
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academe of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Jie Shen
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academe of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.
| | - Fuquan Zhang
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academe of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
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Affiliation(s)
- Pengfei Sun
- Department of Plastic Surgery, Zibo Central Hospital, Zibo, China
| | - Zhensheng Hu
- Department of Plastic Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Bo Pan
- Department of Plastic Surgery, Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaosheng Lu
- Department of Plastic Surgery, Affiliated Hospital of Weifang Medical University, Weifang, China
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