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Wen J, Li Z, Liu W, Yu N, Wang X. Dual-wavelength dye laser combined with betamethasone injection for treatment of keloids: protocol of a randomised controlled trial. BMJ Open 2024; 14:e084939. [PMID: 38986560 PMCID: PMC11268050 DOI: 10.1136/bmjopen-2024-084939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 06/27/2024] [Indexed: 07/12/2024] Open
Abstract
INTRODUCTION Keloids, benign fibroproliferative tumours characterised by excessive fibroblast proliferation and over-deposition of extracellular matrix, pose a therapeutic challenge with high recurrence rates. Betamethasone (diprospan) injection (BI) is one of the most common non-invasive therapies for keloids. Pulsed dye laser (PDL) has the function of closing microvessels, which may become one of the auxiliary treatment methods of BI and may enhance its curative effect. Some studies suggest that the combination of a dual-wavelength dye laser (DWL) and BI may offer superior efficacy. This randomised controlled trial aims to evaluate whether the combined therapy of DWL+BI outperforms BI alone in treating keloids. METHODS AND ANALYSIS This single-centre, parallel positive control, randomised trial evaluates the efficacy and safety of DWL (585 nm PDL+1064 nm neodymium-doped yttrium aluminium garnet) combined with BI for keloid treatment. Enrolling 66 adult patients, participants are randomised into DWL+BI or BI groups in a 1:1 ratio. Over 12 weeks, each group undergoes four treatment sessions, ensuring blinding for outcome assessors. Data collection occurs at multiple time points (4, 12, 24 and 52 weeks), with primary outcomes assessing the Vancouver Scar Scale (VSS) improvement rate 24 weeks after the last intervention. Secondary outcomes include VSS improvement rates, changes in keloid volume, changes in relative perfusion index measured by laser speckle contrast imaging, Patient and Observer Scar Assessment Scale results and patient satisfaction. Safety assessments include vital signs, laboratory tests, pregnancy tests and self-reports of adverse reactions. ETHICS AND DISSEMINATION The results will be presented in peer-reviewed journals and at international conferences. This study is approved by the Ethics Committee of Peking Union Medical College Hospital, Chinese Academy of Medical Sciences. TRIAL REGISTRATION NUMBER Chinese Clinical Trial Register (ChiCTR2400080148).
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Affiliation(s)
- Junxian Wen
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Zhijin Li
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Weida Liu
- State Key Laboratory for Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Nanze Yu
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
- Department of International Medical Service, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Xiaojun Wang
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
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Ramelyte E, Welti M, Gardin F, Maul JT, Dummer R, Imhof L. Post-Excision Soft X-Ray Radiotherapy for Keloids: Experience in a Tertiary Referral Center. Dermatology 2024; 240:572-580. [PMID: 38897192 PMCID: PMC11309064 DOI: 10.1159/000539782] [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: 07/21/2023] [Accepted: 06/02/2024] [Indexed: 06/21/2024] Open
Abstract
INTRODUCTION Keloid is an abnormal proliferation of scar tissue that grows beyond the original margins of the injury. Even after complete resection, recurrences are common and pose a poorly understood challenge in dermatology. There is lack of large prospective clinical trials; thus, treatment recommendations are based on retrospective analyses and small cohort studies. Superficial radiotherapy is recommended in recurrent keloids; however, the successful treatment rates vary greatly. The aim of this study was to evaluate the keloid recurrence rate after post-excision soft X-ray radiotherapy and the associated factors. METHODS We reviewed retrospective data of all patients, treated with adjuvant post-excision soft X-ray radiotherapy with 12 Gy in 6 sessions at the tertiary referral center, Department of Dermatology, University Hospital Zurich, Switzerland, between 2005 and 2018. We analyzed individual keloids as separate cases. Successful treatment was defined as no sign of recurrence within 2 years. RESULTS Of the 200 identified patients, 90 met the inclusion criteria and were included in the final analysis. In 90 patients, 104 cases of treated keloids were analyzed. Keloids were mainly located on the trunk (49%) and were mostly caused by previous surgery (52.2%). 50% of the keloids did not relapse within 2 years after therapy. A significant factor leading to recurrence was the presence of previous therapy, with prior topical therapies, such as steroid injections or 5-fluorouracil, leading to most relapses. 69.2% of keloid cases who relapsed were pretreated. Soft X-ray radiotherapy was well tolerated, with posttreatment hyperpigmentation noted in 34% of patients, particularly in patients with non-Caucasian origin (61.3%). CONCLUSION Treatment of refractory keloids is difficult. Post-excision radiotherapy is an established adjuvant treatment option; nevertheless, recurrence rates are high, especially in pretreated keloids. Prospective studies determining the exact dosage and fraction of post-excisional radiotherapy are needed to determine the optimal radiation parameters.
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Affiliation(s)
- Egle Ramelyte
- Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Medical Faculty, University of Zurich, Zurich, Switzerland
| | - Michèle Welti
- Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Medical Faculty, University of Zurich, Zurich, Switzerland
| | - Fabian Gardin
- Medical Faculty, University of Zurich, Zurich, Switzerland
| | - Julia-Tatjana Maul
- Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Medical Faculty, University of Zurich, Zurich, Switzerland
| | - Reinhard Dummer
- Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Medical Faculty, University of Zurich, Zurich, Switzerland
| | - Laurence Imhof
- Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Medical Faculty, University of Zurich, Zurich, Switzerland
- Swiss Federal Institute of Technology (ETH) Zurich, Zurich, Switzerland
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Keloid treatments: an evidence-based systematic review of recent advances. Syst Rev 2023; 12:42. [PMID: 36918908 PMCID: PMC10012475 DOI: 10.1186/s13643-023-02192-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 02/15/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Keloids are pathologic scars that pose a significant functional and cosmetic burden. They are challenging to treat, despite the multitude of treatment modalities currently available. OBJECTIVE The aim of this study was to conduct an evidence-based review of all prospective data regarding keloid treatments published between 2010 and 2020. METHODS A systematic literature search of PubMed (National Library of Medicine), Embase (Elsevier), and Cochrane Library (Wiley) was performed in November of 2020. Search strategies with the keywords "keloid" and "treatment" were performed by a medical librarian. The search was limited to prospective studies that were peer-reviewed, reported on clinical outcomes of keloid therapies, and were published in the English language between January 1, 2010, and November 24, 2020. RESULTS A total of 3462 unique citations were identified, of which 108 studies met inclusion criteria. Current literature supports silicone gel or sheeting with corticosteroid injections as first-line therapy for keloids. Adjuvant intralesional 5-fluorouracil (5-FU), bleomycin, or verapamil can be considered, although mixed results have been reported with each. Laser therapy can be used in combination with intralesional corticosteroids or topical steroids with occlusion to improve drug penetration. Excision of keloids with immediate post-excision radiation therapy is an effective option for recalcitrant lesions. Finally, silicone sheeting and pressure therapy have evidence for reducing keloid recurrence. CONCLUSIONS This review was limited by heterogeneity of subject characteristics and study outcome measures, small sample sizes, and inconsistent study designs. Larger and more robust controlled studies are necessary to further understand the variety of existing and emerging keloid treatments, including corticosteroids, cryotherapy, intralesional injections, lasers, photodynamic therapy, excision and radiation, pressure dressings, and others.
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Schaffrick L, Ding J, Kwan P, Tredget EE. Molecular Features of Hypertrophic Scars After Thermal Injury: Is There a Biologic Basis for Laser Therapy? Adv Wound Care (New Rochelle) 2022; 11:163-178. [PMID: 34663086 DOI: 10.1089/wound.2021.0060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Significance: Hypertrophic scars (HTS) and keloids are common after thermal injuries and other trauma to deep regions of dermis of the skin. These abnormal scars can cause contractures and the thick masses of scar tissue that result in functional and cosmetic impairment. Management of these dermal fibrotic conditions includes a wide range of medical and surgical treatments, which can be time consuming, only partially effective, and often uncomfortable for patients. Recent Advances: The molecular pathophysiology of HTS has become more understood over the past two decades, where thermal injury to the reticular dermis results in an inflammatory response, fibrogenic growth factor release, and the formation of a dermal scar with increased collagen and proteoglycan composition in an abnormal morphology. Lasers are becoming a widely used form of treatment for these types of scars; however, the evidence for the beneficial effects of laser treatments and the understanding of their mechanism of action are still evolving. Critical Issues: Paradoxically, laser delivery of thermal energy to the skin is suggested to improve scar remodeling and wound healing, yet HTS is a well-recognized complication of excessive thermal energy delivered by laser treatments. This review aims to examine the current evidence for the use of lasers for HTS, and to investigate the molecular mechanisms where re-injury of a burn scar from laser treatment could result in overall improvements in scar quality. Future Directions: Improved design of clinical trials for the treatment of scarring in the future will evolve from new methodology and models of HTS in animals and humans.
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Affiliation(s)
- Lindy Schaffrick
- Wound Healing Research Group, Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Alberta, Edmonton, Canada
| | - Jie Ding
- Wound Healing Research Group, Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Alberta, Edmonton, Canada
| | - Peter Kwan
- Wound Healing Research Group, Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Alberta, Edmonton, Canada
| | - Edward E. Tredget
- Wound Healing Research Group, Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Alberta, Edmonton, Canada
- Department of Surgery, Division of Critical Care, University of Alberta, Edmonton, Canada
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Pan L, Qin H, Li C, Zhang G, Yang L, Zhang L. Efficacy of the Neodymium-Doped Yttrium Aluminum Garnet Laser in the Treatment of Keloid and Hypertrophic Scars: A Systematic Review and Meta-analysis. Aesthetic Plast Surg 2022; 46:1997-2005. [PMID: 35059813 DOI: 10.1007/s00266-021-02716-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 12/06/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Keloid and hypertrophic scars are the most common types of pathological scars. They can cause itching, pain, erythema, and psychological stress due to cosmetic problems, decreasing the quality of life for affected individuals. The neodymium-doped yttrium aluminum garnet (Nd:YAG) multipurpose laser is used to treat pathological scars, and studies have shown that the Nd:YAG laser can markedly improve scarring. AIMS We performed a meta-analysis to evaluate the efficacy of the Nd:YAG laser in the treatment of keloid and hypertrophic scars. METHODS A literature search of PubMed, Web of Science, Scopus, Cochrane, Embase, CNKI, and Wanfang was performed between January 1st, 2010, and July 14th, 2021. The Vancouver Scar Scale (VSS) was used to evaluate treatment outcomes. We used the R version 4.0.0 software for statistical analysis. RESULTS The Nd:YAG laser improved the condition of keloid and hypertrophic scars and reduced VSS score (mean difference [MD]: 2.96, 95% confidence interval [CI]: 2.08-3.84, p < 0.01). There was no obvious difference in the results between regions. A subgroup analysis by scar type revealed that the curative effect of the Nd:YAG laser on keloid scars (MD: 2.02, 95% CI: 0.58-4.63, p = 0.10) was less marked compared with that on hypertrophic scars (MD: 3.05, 95% CI: 1.58-4.52, p < 0.01). With the combined use of the Nd:YAG laser and other treatment methods, a more significant change in VSS score was noted (MD: 4.28, 95% CI: 2.07-6.49). CONCLUSIONS This meta-analysis showed that the Nd:YAG laser can improve the condition of keloid and hypertrophic scars and effectively reduce VSS score. Moreover, the curative effect of this approach on keloid scars is less marked compared with that on hypertrophic scars. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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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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Soliman M, Etman Y, AbdElhameed A, Elsharaby R, Tawfik A. Comparative Study between Nd-YAG laser, fractional CO2 Laser, and combined Nd-YAG with fractional CO2 Laser in the Management of keloid: clinical and molecular Study. J Cosmet Dermatol 2021; 20:1124-1132. [PMID: 33373109 DOI: 10.1111/jocd.13920] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/04/2020] [Accepted: 10/23/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Fractional CO2 laser and Nd-YAG laser have been reported to have promising results in the management of keloids. So far, there have been no comparative studies between these laser modalities. AIMS The study aimed to compare the efficacy of fractional CO2, Nd-YAG, and a combination of both in the management of keloids. PATIENTS AND METHODS Forty-five keloid patients were divided into 3 equal groups: the first received fractional CO2 only, the second received Nd-YAG only, and the third received a combination of both lasers. Each group received its designated treatment every 4 weeks for 4 sessions. The improvement was evaluated by the "Patient and Observer Scar Assessment Scale" (POSAS). Detection of procollagen I mRNA by RT-PCR analysis was done. RESULTS The assessment by POSAS showed the most significant clinical improvement in the combination group and a less significant improvement in the fractional CO2 group, while the least improvement was seen in the Nd-YAG group. Molecular assessment via procollagen I yielded matching results. CONCLUSION The study showed that the combination of fractional CO2 and Nd-YAG lasers has a synergistic effect being the most effective in the management of keloids, fractional CO2 being more effective than ND-YAG and Nd-YAG being the least effective.
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Affiliation(s)
- Mona Soliman
- Dermatology Unit, Medical Laser Department, National Institute of Laser Enhanced Sciences (NILES), Cairo University, Cairo, Egypt
| | - Yasmeen Etman
- Department of Dermatology, Mahalla El-kubra General Hospital, El Mahalla El Kubra, Egypt
| | | | | | - Abeer Tawfik
- Dermatology Unit, Medical Laser Department, National Institute of Laser Enhanced Sciences (NILES), Cairo University, Cairo, Egypt
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Fuenmayor P, Quiñonez H, Salas R, Pujadas Z. Experience Treating Earlobe Keloids with Laser Diode 980nm Excision Followed by Triamcinolone Infiltration. Lasers Surg Med 2020; 53:468-475. [PMID: 32827340 DOI: 10.1002/lsm.23310] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/08/2020] [Accepted: 07/30/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND OBJECTIVE Lasers have a favorable synergistic effect when combined with other modalities of treatment against keloids. Different types of lasers have been used with triamcinolone infiltration, resulting in promising success rates. The purpose of this study is to describe our first experience treating earlobe keloids with 980 nm laser diode excision followed by triamcinolone infiltration and present our outcomes after 24 months of follow-up. STUDY DESIGN/MATERIALS AND METHODS A retrospective chart review of 11 patients with 14 earlobe keloids treated with excision using a 980 nm laser diode followed by triamcinolone acetonide infiltration, between January 2015 and May 2016. Database included demographics, Fitzpatrick skin type, laterality, lesion size, and postoperative visits information. Outcomes were assessed in terms of keloid recurrence rates, complications, and patient subjective aesthetical result satisfaction after 24 months of follow-up. RESULTS All procedures were technically completed, and follow-up accomplished without attrition. One (7.14%) patient experienced keloid recurrence after the third month. Four (28.57%) patients experienced early wound dehiscence, successfully treated with debridement and re-suture. Self-assessment of aesthetical result was considered "very good" in 64.28% of patients. CONCLUSION Surgical excision with 980 nm laser diode followed by triamcinolone infiltration is well-tolerated and shows favorable results treating earlobe keloids, and can be considered a first-line treatment. Comparison between different types of lasers and control groups in large clinical trials is warranted in order to obtain strong clinical evidence for clear indications and recommendations. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.
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Affiliation(s)
- Pedro Fuenmayor
- Plastic and Reconstructive Surgery Department, Hospital Universitario de Caracas, Universidad Central de Venezuela, Los Chaguaramos, Distrito Capital, Venezuela
| | - Hector Quiñonez
- Plastic and Reconstructive Surgery Department, Hospital Universitario de Caracas, Universidad Central de Venezuela, Los Chaguaramos, Distrito Capital, Venezuela
| | - Reinaldo Salas
- Plastic and Reconstructive Surgery Department, Hospital Universitario de Caracas, Universidad Central de Venezuela, Los Chaguaramos, Distrito Capital, Venezuela
| | - Zoe Pujadas
- Plastic and Reconstructive Surgery Department, Hospital Universitario de Caracas, Universidad Central de Venezuela, Los Chaguaramos, Distrito Capital, Venezuela
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Tawfic SO, El‐Tawdy A, Shalaby S, Foad A, Shaker O, Sayed SS, Metwally D. Evaluation of Fractional CO
2
Versus Long Pulsed Nd:YAG Lasers in Treatment of Hypertrophic Scars and Keloids: A Randomized Clinical Trial. Lasers Surg Med 2020; 52:959-965. [DOI: 10.1002/lsm.23249] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 04/04/2020] [Accepted: 04/06/2020] [Indexed: 01/01/2023]
Affiliation(s)
| | - Amira El‐Tawdy
- Department of Dermatology Cairo University Cairo 11562 Egypt
| | - Suzan Shalaby
- Department of Dermatology Cairo University Cairo 11562 Egypt
| | - Ahmed Foad
- Department of Dermatology Cairo University Cairo 11562 Egypt
| | - Olfat Shaker
- Department of Biochemistry Cairo University Cairo 11562 Egypt
| | | | - Dina Metwally
- Department of Dermatology Cairo University Cairo 11562 Egypt
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Abstract
Keloids are pathological scars that grow over time and extend beyond the initial site of injury after impaired wound healing. These scars frequently recur and rarely regress. They are aesthetically disfiguring, can cause pain, itching, discomfort as well as psychological stress, often affecting quality of life. Many treatment modalities, including surgical and non-surgical, have been explored and have been reported to be beneficial; however, none have been absolutely satisfactory or optimal for the treatment of all keloid subtypes to date. This poses a major challenge to clinicians. Often, a combinational therapeutic approach appears to offer the best results with higher patient satisfaction compared to monotherapy. The aetiopathogenesis of keloids is not fully elucidated; however, with recent advances in molecular biology and genetics, insight is being gained on the complex process of scar formation and hence new therapeutic and management options for keloids. In this paper, we explore the literature and summarise the general concepts surrounding keloid development and review both current (corticosteroids, surgical excision, silicone-based products, pressure therapy, radiotherapy, cryotherapy, laser therapy, imiquimod and 5-fluorouracil) and emerging (stem cell therapy, mitomycin C, verapamil, interferons, bleomycin, botulinum toxin type A and angiotensin-converting enzyme inhibitors) treatments. Increased knowledge and understanding in this area may potentially lead to the discovery and development of novel therapeutic options that are more efficacious for all keloid types. LAY SUMMARY Keloids are problematic scars that are difficult to treat and manage. The aetiopathogenesis of keloids is not clear; however, recent advances in molecular biology and genetics are beginning to shed light on the underlying mechanisms implicated in keloid scar formation which will hopefully lead to the development of treatment options for all keloid types. This review summarises current and emerging therapies.
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Affiliation(s)
- Nkemcho Ojeh
- Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Bridgetown, Barbados, West Indies
| | - Ambadasu Bharatha
- Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Bridgetown, Barbados, West Indies
| | - Uma Gaur
- Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Bridgetown, Barbados, West Indies
| | - Andrew LeRoy Forde
- Pine Medical Centre, 3rd Avenue Belleville, St. Michael, Barbados, West Indies
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Zhang W, Wang X, Huang J, Dong W, Long X. Spontaneous symmetrical giant keloids at the bilateral labia majora: a case report. J Int Med Res 2019; 48:300060519891664. [PMID: 31856627 PMCID: PMC7431886 DOI: 10.1177/0300060519891664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Keloids are caused by an imbalance between collagen matrix decomposition and
production during wound repair. Spontaneous keloids are a rare type of keloid
that arise without a significant history of trauma or surgery. We herein report
a case involving a 59-year-old woman with symmetric neoplasms at the bilateral
labia majora that had persisted for about 3 years and a >10-year history of
pruritus and pain at the bilateral labia majora with folliculitis. The bilateral
labia majora gradually swelled and lost their normal physiological morphology.
The patient was diagnosed with keloids. Under general anesthesia, the keloids
were resected. The right incision was sutured directly and the left was closed
using an inguinal flap. Adjuvant radiotherapy was administered after the
surgery. No recurrence of the keloids was observed at the 1-year follow-up, and
the patient was satisfied with the appearance of the vulvar region. This is the
first report of spontaneous symmetrical giant keloids at the bilateral labia
majora, and it emphasizes the importance of the effect of abnormal inflammation
on keloid formation. Repairing genital defects using an inguinal flap has only a
minor effect on the patient’s postoperative movement, and an ideal vulvar
appearance can be achieved.
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Affiliation(s)
- WenChao Zhang
- Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Xiaojun Wang
- Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Jiuzuo Huang
- Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Wenfang Dong
- Department of Plastic Surgery, The Twelfth Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiao Long
- Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing, China
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del Río-Sancho S, Castro-López V, Alonso MJ. Enhancing cutaneous delivery with laser technology: Almost there, but not yet. J Control Release 2019; 315:150-165. [DOI: 10.1016/j.jconrel.2019.09.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 09/20/2019] [Accepted: 09/23/2019] [Indexed: 12/30/2022]
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Khattab FM, Nasr M, Khashaba SA, Bessar H. Combination of pulsed dye laser and verapamil in comparison with verapamil alone in the treatment of keloid. J DERMATOL TREAT 2019; 31:186-190. [DOI: 10.1080/09546634.2019.1610550] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Fathia M. Khattab
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mohamad Nasr
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Shrook A. Khashaba
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Hagar Bessar
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Rajabi-Estarabadi A, Iglesia S, Griggs JW, Gurnani P, Smith SC, Collins CI, Nouri K. Cells to Surgery Quiz: April 2018. J Invest Dermatol 2018; 138:e37. [PMID: 29579460 DOI: 10.1016/j.jid.2018.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Ali Rajabi-Estarabadi
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Sofia Iglesia
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Jacob W Griggs
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Pooja Gurnani
- Florida International University Herbert Wertheim College of Medicine, Miami, Florida, USA
| | - Samuel C Smith
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Cassandra If Collins
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Keyvan Nouri
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
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