Keloids: prevention and management

Keloids result from an abnormal wound-healing process in which the normal regulatory pathways during tissue regeneration and scar remodeling are disrupted. While the pathogenesis of keloids continues to be investigated, numerous treatment options exist. Although prevention of keloid formation is the best management, early recognition of keloid formation is integral in treatment and prevention of recurrence. Surgical resection with adjuvant silicone gel sheeting or triamcinolone injection is common, but can still result in recurrence. New treatments include chemotherapeutics such as 5-fluorouracil, bleomycin, and mitomycin C. Although further clinical investigation is required for newer treatments, initial results are promising.     

东方人耳部瘢痕疙瘩综合治疗方法探讨

目的 探讨东方人耳部瘢痕疙瘩综合治疗的有效性.方法 采用手术切除瘢痕疙瘩,直接缝合或转移皮瓣修复,于手术切除后早期（24 h内）联合X线或电子线局部放射治疗,每日1次,共3～5次,7 d拆线后局部注射激素类抗瘢痕药物治疗,每2周1次,视切口愈合情况逐渐减量停药.结果 共治疗48例,除由于各种原凶失访12例外,36例随访1～3年,其中治愈30例（83.3%）,显效4例（11.1%）,总有效率94.4%.结论 手术切除病损,联合早期局部放射治疗及拆线时局部定期注射激素类抗瘢痕药物,是综合治疗耳部瘢痕疙瘩防止复发的有效方法.     

不同部位瘢痕疙瘩组织中IGF-I、IGF-IR的表达及其意义

目的 通过分析瘢痕疙瘩周围部和中央部组织中IGF-I、IGF-IR表达的差异,探讨瘢痕疙瘩呈浸润性生长的机制.方法 收集手术切除的瘢痕疙瘩组织8例及周围正常皮肤组织4例,对不同部位的瘢痕疙瘩组织和正常皮肤组织进行免疫组织化学染色,观察各组中IGF-I、IGF-IR的表达,比较瘢痕疙瘩不同部位和正常皮肤组织中IGF-I、IGF-IR表达的差异.结果 正常皮肤组织中成纤维细胞中IGF-I、IGF-IR的表达均呈阴性.瘢痕疙瘩周围组织成纤维细胞中IGF-I的表达明显高于中央部,差异有统计学意义(P<0.05);瘢痕疙瘩周围部组织纤维细胞中IGF-IR明显高于中央部,差异有统计学意义(P<0.05). 结论瘢痕疙瘩不同部位IGF-I、IGF-IR的表达差异可能是导致瘢痕疙瘩呈浸润性生长的机制之一.     

瘢痕皮瓣与5-氟尿嘧啶在治疗耳部瘢痕疙瘩中的应用

目的评价手术联合局部混合药物注射治疗耳部瘢痕疙瘩的疗效。方法对93例（117侧）耳部瘢痕疙瘩患者采用瘢痕内切除局部瘢痕瓣塑形的术式,术后1周瘢痕区注射曲安奈德加低浓度5-氟尿嘧啶,观察随访结果。结果术后随访1～2年,曲安奈德治疗组治愈28例（29侧）,显效10例（12侧）,无效5例（7侧）;曲安奈德联合氟尿嘧啶组治愈37例（51侧）,显效9例（14侧）,无效4例（4侧）。经Ridit分析,差异有统计学意义（P〈0．05）。结论瘢痕瓣塑形术联合术后曲安奈德、低浓度5-氟尿嘧啶注射治疗耳部瘢痕疙瘩效果满意,是治疗的选择方案之一。     

Use of a smartphone for imaging,modelling, and evaluation of keloids

ObjectiveWe used a smartphone to construct three-dimensional (3D) models of keloids, then quantitatively simulate and evaluate these tissues.MethodsWe uploaded smartphone photographs of 33 keloids on the chest, shoulder, neck, limbs, or abdomen of 28 patients. We used the parallel computing power of a graphics processing unit to calculate the spatial co-ordinates of each pixel in the cloud, then generated 3D models. We obtained the longest diameter, thickness, and volume of each keloid, then compared these data to findings obtained by traditional methods.ResultsMeasurement repeatability was excellent: intraclass correlation coefficients were 0.998 for longest diameter, 0.978 for thickness, and 0.993 for volume. When measuring the longest diameter and volume, the results agreed with Vernier caliper measurements and with measurements obtained after the injection of water into the cavity. When measuring thickness, the findings were similar to those obtained by ultrasound. Bland–Altman analyses showed that the ratios of 95% confidence interval extremes were 3.03% for longest diameter, 3.03% for volume, and 6.06% for thickness.ConclusionSmartphones were used to acquire data that was then employed to construct 3D models of keloids; these models yielded quantitative data with excellent reliability and validity. The smartphone can serve as an additional tool for keloid diagnosis and research, and will facilitate medical treatment over the internet.     

The safety and efficacy of intralesional triamcinolone acetonide for keloids and hypertrophic scars: A systematic review and meta-analysis

BackgroundTriamcinolone acetonide (TAC) is widely used for hypertrophic scars and keloids; however, TAC has variable efficacy and safety in different individuals.PurposeTo evaluate the efficacy and safety of intralesional TAC for treatment of hypertrophic scars and keloids.Data sourcesSearches of PubMed, EMBASE, the Cochrane Library, and ClinicalTrials.gov prior to 25 March 2020.Study selectionRandomized controlled trials in English that compared TAC with a placebo or other medications that are commonly used for intralesional injection in hypertrophic scars and keloids.Data extractionPrimary outcomes were reduction in scar height, vascularity, pliability, pigmentation, total scores on the Vancouver Scar Scale (VSS) or patient and observer scar assessment scale (POSAS), telangiectasia, and skin atrophy. Secondary outcomes included overall scar improvement.Data synthesisFifteen trials met the inclusion criteria. In the short term, TAC was associated with a significant improvement in vascularity (MD: −0.22, 95% CI: −0.42 to −0.02) and pliability (MD: −0.25, 95% CI: −0.44 to −0.06) compared to verapamil. In the medium term, compared to TAC, 5-FU showed a significant improvement in scar height (SMD: 0.95, 95% CI: 0.15–1.75), while TAC led to a significant improvement in vascularity compared to 5-FU (MD: −0.45, 95% CI: −0.76 to −0.14). Compared to TAC, TAC+5-FU showed a significant improvement in pliability (SMD: 0.98, 95% CI: 0.17–1.78) and pigmentation (MD: 0.45, 95% CI: 0.12–0.78). Botulinum toxin type A resulted in significantly better pliability (SMD: 1.99, 95% CI: 0.98–3.00) compared to TAC. In the long term, compared to TAC, 5-FU led to a significant improvement in scar height (MD: 0.55, 95% CI: 0.17–0.93), but significantly less vascularity (MD: −0.35, 95% CI: −0.65 to −0.05). Compared to TAC, TAC+5-FU produced a significant improvement in scar height (MD: 1.50, 95% CI: 1.12–1.88), pliability (MD: 0.45, 95% CI: 0.10–0.80), and pigmentation (MD: 0.55, 95% CI: 0.24–0.86).ConclusionTAC may be beneficial for the short-term treatment of hypertrophic scars and keloids; however, 5-FU, 5-FU+TAC, and verapamil may produce superior results for medium- and long-term treatments. TAC injections at concentrations of 20 mg/ml or 40 mg/ml are more likely to result in skin atrophy compared to 5-FU or verapamil, and are more likely to cause telangiectasia than 5-FU, 5-FU+TAC, or bleomycin.     

Histological analysis of hyalinised keloidal collagen formation in earlobe keloids over time: collagen hyalinisation starts in the perivascular area

Keloids grow and do not regress. They are characterised histologically by hyalinised keloidal collagen (HKC). HKC amounts vary, and the mechanism by which they form is unclear. To clarify how HKCs form and whether their formation associates with specific clinical features, we studied the histological findings of earlobe keloids and compared them with respective clinical features. A total of 50 earlobe keloids from 43 patients were used for histological analysis of keloid size (mm²), HKC area (mm²) and HKC area ratio (%). As a result, keloid durations ranged from 3 months to >13 years. Early‐stage keloids exhibited little HKC and a tendency for the HKCs to locate in perivascular regions. In later‐stage keloids, the HKCs were extremely interconnected and formed a thick bitten donut‐shaped region. HKC area ratios correlated positively with keloid duration (r² = 0·58, P<0·05). HKC area ratios and keloid durations did not correlate with keloid sizes. These patterns of HKC formation and growth may explain why local therapies, which effectively remove fibroblasts and accumulated collagen but not HKCs, are ineffective in older keloids. Keloids should be promptly treated after diagnosis, and older keloids with extensive HKCs may require surgical excision followed by radiotherapy.     

倍他米松病损内注射治疗瘢痕疙瘩疗效观察

目的：寻求简单有效的治疗瘢痕疙瘩的方法。方法：采用二丙酸倍他米松／倍他米松磷酸二钠病损内注射治疗瘢痕疙瘩６０例。结果：经１年随访,总有效率达８８．３３％。结论：通过讨论二丙酸倍他米松／倍他米松磷酸二钠作用机理、优点、不良反应等,作者认为该方法安全可靠、疗效显著。并发症少,尤其适合于中小面积瘢痕疙瘩的治疗。     

转化生长因子-β1Ⅱ型受体同源序列1对瘢痕疙瘩中成纤维细胞胶原合成的影响

目的　初步探讨转化生长因子 - β1(TGF - β1)Ⅱ型受体同源序列 1(TRH1)的生物学功能。　方法　根据已知序列合成TRH1多肽 ,以瘢痕疙瘩成纤维细胞为靶细胞 ,分别于蛋白水平和mRNA水平检测该多肽对TGF - β1所诱导的细胞胶原合成的拮抗作用。　 结果　TRH1可以明显抑制TGF - β1所诱导的瘢痕疙瘩成纤维细胞的胶原合成及细胞Ⅰ型前胶原mRNA的表达。结论　TRH1可能通过模拟TGF - β1Ⅱ型受体的结构来竞争性结合TGF - β1,从而拮抗或降低了TGF -β1对细胞的诱导作用。