Can we use radiotherapy alone in the treatment of keloids?

Objective The use of radiation for the treatment of keloids has been the topic of debate for years. Methods In this study, 46 symptomatic cases were treated with ⁹⁰Sr-⁹⁰Y β-rays. Patients were given four fractions of 5 Gy per fraction either as weekly or twice weekly schedules. Results Radiation dose of 20 Gy given twice weekly in four fractions showed response in 92% of the cases as compared to 81% in those receiving four fractions of 5 Gy weekly. Conclusion Further studies with numerous dose fractionation schedules would open up new dimensions in the radiotherapy of keloids.     

Role of adjuvant radiotherapy in recurrent earlobe keloids

Earlobe keloids are commonly encountered in dermatological practice and often prove to be recurrent, despite a variety of treatment options. Recurrent keloids, particularly in the head and neck, are associated with unsightly cosmetic consequences, particularly in younger patients. There is no consensus regarding the optimal treatment for recurrent keloids. However, re-excision accompanied by adjuvant treatment is often recommended. Low-dose fractionated radiotherapy (12 Gy in three fractions) delivered within 24 hours of excision remains an effective adjuvant option, although due consideration needs to be given to the small risk of radiation-induced malignancy. We aim to discuss the role of adjuvant radiotherapy for recurrent keloids and present the relevant literature.     

d-Penicillamine in the treatment of keloids

Long term low-dosage penicillamine has been shown to be ineffective in tow prospective trials of its efficacy in the treatment of keloids.     

The treatment of keloids

Keloids are benign fibrous growths with characteristic clinical features, whose underlying pathogenic mechanisms are not fully understood. While numerous treatment approaches are available, there is little evidence for efficacy based on controlled clinical studies. Therapeutic results are often not satisfactory. The best approach employs multiple modalities appropriate for the stage of the lesion. Combining invasive methods such as cryotherapy, surgery, intralesional steroid injections, laser or radiotherapy with external or physical approaches has helped to optimize treatment efficacy. Newer clinical studies with intralesional substances such as interferons which may directly influence collagen metabolism show promising results; these substances may be valuable therapeutic additions.     

Postoperative radiotherapy of keloids: a twenty-year experience.

In spite of several treatment modalities available, there is no method able to guarantee absolute success in the therapeutic approach to keloids. To evaluate the effectiveness and safety of postoperative radiotherapy we performed a retrospective study on 156 keloids, histologically ascertained, treated by means of orthovoltage radiotherapy in the last twenty years. The total doses administered ranged from 15 to 40 Gy. The radiotherapy started within 7 days from surgery in 127 lesions (81.4%), and within 3 weeks in the remaining 29 (18.6%). Surgical methods to minimize tension at wound sites were adopted. The follow-up ranged from 6 to 216 months. After irradiation a complete remission was obtained in 141 lesions (90.4%) and a partial response in 15 lesions (9.6%). The five-year relapse-free rate was 86.68%. Cosmetic results were evaluated as good or acceptable in 82.73% of the lesions. Afterwards, 17 lesions (10.89%) have relapsed. No stochastic or non stochastic effects have been observed.     

Postoperative prevention of hypertrophic scars and keloids using radiotherapy

A group of 63 patients with keloids or hypertrophic scars were treated with excision and postoperative superficial X-ray irradiation. The cosmetic and functional results were very good in more than two-thirds of these cases. In 10% a relapse occurred, which is in keeping with the international literature. Finally, other radiotherapeutic modalities such as brachytherapy, in combination with hyperthermia are discussed.     

Role of liquid nitrogen alone compared with combination of liquid nitrogen and intralesional triamcinolone acetonide in treatment of small keloids

Keloids are well-defined fibrous tissue overgrowths extending beyond the original defects. The purpose of our study was to compare the efficacy of liquid nitrogen cryosurgery alone with liquid nitrogen cryosurgery and intralesional triamcinolone acetonide combination. Study on 60 clinically diagnosed lesions of keloids from 21 patients was conducted to compare the efficacy of liquid nitrogen cryosurgery alone. The statistical analysis shows synergistic action of cryosurgery and corticosteroids may offer promise in the treatment.     

Laser treatment of keloids and hypertrophic scars

BACKGROUND: Lasers have been used in the treatment of hypertrophic scars and keloids for more than 20 years. Different laser systems have been examined; among them pulsed dye lasers are currently considered the laser of choice in these settings. OBJECTIVES: The purpose of this study is to review the pertinent literature and provide updated information on different laser therapies available for treatment of keloids and hypertrophic scars. METHODS: A Medline literature search was performed for relevant publications. RESULTS: In this review the results of published studies in the treatment and prevention of hypertrophic scars and keloids are presented. Suggested mechanisms of action are reviewed. A review of the optimal laser parameters to modulate treatment outcome will be discussed. Different lasers are effective in not only the treatment but also the prevention of hypertrophic scars and keloids, among them PDL is more promising. Most of the suggested theories are based on the selective photothermolysis in which the light energy emitted from a vascular laser is absorbed by hemoglobin, generating heat and leading to coagulation necrosis, neocollagenesis, collagen fiber heating with dissociation of disulfide bonds and subsequent collagen fiber realignment. CONCLUSION: The optimal laser is currently 585 nm PDL, although the recent results of Q-switched 532 nm frequency-doubled Nd:YAG are promising. Early use of lasers are beneficial, especially in those who are prone to develop these lesions.     

Cryosurgical treatment of hypertrophic scars and keloids

The treatment of hypertrophic scars and keloids is a problem that has not yet been satisfactorily solved. We report here the results obtained with cryosurgery by the contact freezing method in 45 patients with 56 evaluated lesions. During the period of the investigation, cryosurgical treatment was completed in 23 patients with 28 lesions: in 53.6% we recorded an excellent result (ER), in 32.1% a good result, and in 14.7% a poor result. None of the lesions was totally resistant. Lesions that had been present for under 1 year (ER = 77.8%) and hypertrophic scars (ER = 72.2%) responded better than older lesions (ER = 41.2%) and keloids (ER = 20.0%), respectively. Optimal results were obtained after 4 +/- 2 sessions. Evaluation of the cryosurgical treatment in all patients revealed that the flattening of the lesions was increased after each session. Hypertrophic scars and lesions less than 4 cm2 in area responded more quickly than keloids and larger lesions, respectively. Pretreatment had a negative influence on the results of cryosurgery. No relapses were observed. The treatment was generally well tolerated, slight pain during freezing (52.1%) and hypo-/hyperpigmentation (22.9%) being the most frequent side-effects. Cryosurgery is simple to learn, and the technique is recommended for the treatment of hypertrophic scars and keloids.     

Efficacy and safety of intralesional 5-fluorouracil in the treatment of keloids

BACKGROUND: The treatment of keloids remains challenging. Cryosurgery and intralesional corticosteroids have been considered as the mainstream of therapy; however, the long-term use of corticosteroids has been found to be associated with serious side effects. Intralesional 5-fluorouracil (5-FU) has only been used in one study for the treatment of hypertrophic scars and keloids, mostly in combination with other treatments. The efficacy of 5-FU as an individual therapeutic agent is unknown. OBJECTIVE: To evaluate the efficacy and safety of intralesional injections of 5-FU in the treatment of small keloid lesions. METHODS: Twenty-four (12 male, 12 female) consecutive patients with keloids of 6 cm or less in their maximum dimension were treated with intralesional injections of 50-150 mg 5-FU per week for a maximum of 16 injections. RESULTS: One third (8/24, 33.3%) of the patients showed more than 75% flattening of the keloid. Three out of 8 patients (with >75% flattening) required less than 16 (13, 13 and 15) injections for achieving the desired response. Overall, about half of the patients showed more than 50% flattening of the treated keloid. A correlation with the duration of keloid was found. Six (54.5%) out of 11 patients with keloids of < or =5 years duration, in contrast to only 2 (15.4%) out of 13 patients with keloids of >5 years duration showed more than 75% flattening (p < 0.05). Side effects included pain (all patients), hyperpigmentation (all patients) and ulceration (1 patient). No difference in peripheral blood count was noted before, during and after the therapy. CONCLUSION: Intralesional 5-FU can be safely used for the management of small keloids of shorter duration.     

Postoperative electron beam radiotherapy for keloids: objective findings and patient satisfaction in self-assessment

AIM: To evaluate the role of postoperative radiotherapy in the management of keloids. METHODS: Forty-seven patients with a combined total of 60 keloids were treated with 6-MeV electron beam radiotherapy after surgical excision of the keloids. Mean daily fractions of 4 Gy (range, 3-5 Gy) were administered up to a total dose of 16 Gy (range, 12-18 Gy). The median follow-up was 70 months. Patients were asked to complete a questionnaire addressing their satisfaction with the treatment results. This self-assessment was compared with the clinical outcome. RESULTS: Four keloids (7%) relapsed completely, and five recurrences (8%) were classified as limited relapses. All recurrences were observed at sites of high stretch-tension. Keloid-associated symptoms, e.g. itching and pain, were improved in 81%. Hypopigmentation was observed in 29 patients (62%), a mild redness of the scar in eight patients (17%), and grade 1 telangiectasias in two patients (4%). No severe complications or secondary malignancies were observed. Self-assessments did not fully correspond to the clinical examination and recurrence status. Twelve patients were not satisfied with the treatment result, but only two of these relapsed completely. Three relapsed patients described the result of therapy as excellent or good. CONCLUSION: Postoperative electron radiotherapy is well tolerated and very effective in preventing keloid recurrence. To avoid an overestimation of cosmetic outcome, patients should be informed about achievable results before therapy starts.     

A combination of nonoperative treatment modalities used for treatment of keloids

Keloid is one abnormal wound healing that occurs commonly in predisposed individuals. Many treatment modalities have been tried, either alone or in variety, including surgical removal, laser therapy, radiation therapy, silicone cream or gel application, cryosurgery, and intralesional injection of various agents. These treatment options have been practiced with largely transient and limited success. In the present study, the present authors prospectively assessed the efficacy of combination methods of the treatment of recalcitrant keloid. One hundred fifty‐one sites of keloids in 122 patients were chosen, age of patients varied between 15 and 60 years, size of scar more than 2 cm² with pain, itch, or other discomfort, and duration of more than 2 years. Keloids were treated with combination methods of lasers and ³²P radiation on originating scars. One hundred eleven of 151 evaluated sites scored “excellence” and 40 belonged to “effectiveness”. These patients demonstrated local control and have remained free of local recurrence for more than 2 years. In addition, there were only 21 and 32 sites with pigmentation and depigmentation, respectively. Over the past 5 years, we established a treatment protocol combining laser with ³²P‐patch contact brachyradiotherapy, which represents a safe and effective option in the treatment of keloids.     

康瑞保凝胶治疗肥厚性瘢痕和瘢痕疙塔临床观察

评价康瑞保凝胶治疗肥厚性瘢痕和 瘢痕疙瘩的有效性和安全性。75例肥厚性瘢痕和瘢痕疙瘩使用 康瑞保凝胶,每日3次,连续6个月。结果 治愈率9.3％,显效率50367%,总有效率59.97%,此药无明显不良反应。