Management Of Keloids Research Articles

PP-0167 what about post-operative high-dose-rate brachytherapy in the management of keloids? 5-year outcomes

PP-0167 what about post-operative high-dose-rate brachytherapy in the management of keloids? 5-year outcomes

Microarray-based exploration of molecules associated with keloid pruritus

Keloids are frequently accompanied with pruritus. Because traumatic stimuli such as scratching promotes keloid enlargement, alleviating pruritus is an important aspect of keloid management. To investigate the mechanism of keloid pruritus, we conducted a microarray-based comparison of keloid and nonkeloid skin. Relative expression levels of pruritus-associated ligands and receptors were determined, followed by construction of a heat map focused on serotonergic signaling, and finally pathway analysis. Results demonstrate relative up-regulation of various transcripts within keloid lesions, including those encoding a histamine receptor (H1R), a serotonin receptor (5-HT-2A), and an endothelin receptor (ET-A). Serotonergic signaling may be involved in keloid pruritus.

Strontium-90 brachytherapy following intralesional triamcinolone and 5-fluorouracil injections for keloid treatment: A randomized controlled trial

BackgroundKeloid disease is hard to fully eradicate. Recurrence and other unsatisfactory results were found in many patients. No current therapeutic modality has been determined to be most effective for treating keloid scars. Intralesional corticosteroid injections is most commonly recommended for primary management of small and young keloids as well as hypertrophic scars. However, it’s difficult for patients to adhere to long-term triamcinolone acetonide injection therapy because of the pain, inconvenience or complications including hormonal imbalance or irregular menstruation.ObjectiveWe aimed to determine whether and how Strontium-90 brachytherapy as an adjuvant radiation could affect keloid recurrence after intralesional triamcinolone and 5-fluorouracil injections.MethodsWe included keloid patients from March 2019 to September 2019 and randomly allocated them to two groups after 3 intralesional triamcinolone and 5-fluorouracil injections at 3 weeks interval. The experimental group received Strontium-90 brachytherapy at a total dose of 15-20Gy, while the control group didn’t receive any adjuvant treatment. We performed both Vancouver Scar Scale scoring and Color Doppler ultrasound examination to monitor and evaluate lesions regularly. A one-year follow-up was completed for each patient.Results31 patients who had 42 keloids in total were recruited. We found intralesional triamcinolone and 5-fluorouracil injections could effectively reduce the thickness and modify the hardness of small and young keloids. Strontium-90 brachytherapy reduced the one-year recurrence rate from 85.7 percent to 44.4 percent after 3 intralesional triamcinolone and 5-fluorouracil injections. The lesions’ thickness or elasticity was not affected by Strontium-90 brachytherapy.ConclusionStrontium-90 brachytherapy as an adjuvant radiation could effectively reduce small sized keloids recurrence after intralesional triamcinolone and 5-fluorouracil injections. It worked by enhancing the lesions’ stability post-injection.Trial registrationThe clinical trial registration number: ChiCTR2000030141.Name of trial registry: Chinese Clinical Trial Registry (http://www.chictr.org.cn/)

Bibliometric and visual analysis of current status and trends of international research on keloids

Objective: To conduct a bibliometric and visual analysis of the current status and trends of international research on keloids. Methods: The articles on keloid research from 2000 to 2020 in the core collection of Web of Science database were retrieved. The bibliometrics method was applied to analyze the number of articles published per year, journals and the first authors, countries and institutions, research fields, the annual citation frequency of cumulative published articles, highly cited articles, keywords. CiteSpace5.6.R2 software was applied to visually cluster keywords of the included articles, while VOSviewer1.6.13 software was applied to visually cluster keywords in titles and abstracts of the included articles in order to analyze research directions and development trends. Results: A total of 2 693 keloid-related articles were retrieved. From 2000 to 2020, the number of keloid-related articles published every year showed a significant upward trend. Totally 777 journals published keloid-related articles, of which Dermatologic Surgery published the most. Rei Ogawa published the largest number of keloid-related articles as the first author of 52 related articles. Keloid-related researches were conducted in a total of 98 countries, of which the United States published the largest number of related articles (613 articles), followed by China (524 articles) and Japan (107 articles). A total of 2 656 institutions conducted keloid-related research, and the institution with the largest number of related articles published was Shanghai Jiao Tong University of China (67 articles). According to the subject classification of the Web of Science database, the included articles involved 110 research fields, and the top three were dermatology, surgery, and medicine, research and experimental. The included articles were cited 47 746 times in total, and the citation frequency of cumulative published articles increased by year. The most frequently cited article (152 times) was published in 2011. There were a total of 45 571 keywords in the included literature. The top 5 keywords ranked according to the number of articles involved from high to low were keloid (588 articles), hypertrophic scar (385 articles), expression (198 articles), fibroblast (155 articles), and scar (133 articles). The keyword map visualized by CiteSpace5.6.R2 software further displayed that the research focused on the cause, performance, and composition of keloids. VOSviewer1.6.13 software analysis showed that the research direction of keloids was divided into two categories of clinical keloid management and keloid mechanism research, the initial research hotspots were mainly to explore the diagnosis and treatment of keloids from individual cases, with a preference for apparent research, while in the later stage, the focus was on the overall management of keloids, in which the mechanism research went to the molecular level. Conclusions: At present, international research interest on keloids is showing an upward trend. Both foreign (the United States, etc.) and domestic research institutions are conducting in-depth explorations of keloids. With dermatology as the leader, the research trend is gradually shifting from observational research to molecular research.

Scar tissue I wish you saw: Patient expectations regarding scar treatment.

Although many invasive and noninvasive approaches exist, management of keloids and hypertrophic scars remains challenging. By better understanding patient expectations regarding scar treatments, dermatologists can provide higher quality and more satisfying care. Survey patients age 18 to 80years with a history of hypertrophic, keloid, or disfiguring scars. Overall, 187 participants completed the 25-question survey. Expectations and willingness were measured on a 1-5 Likert scale. Results were analyzed overall and by patient demographics. Older respondents more often expected scar reduction, while younger patients expected scar removal. Compared with Caucasians, Asian respondents were more symptomatic, more likely to have seen a physician, and more willing to undergo invasive therapies. Respondent willingness for treatment and their perceived efficacy significantly differed across gender, age, and race. This study explores a gap in the literature of what role patient expectations play in electing specific treatments. Although patient expectations are complex and context dependent, gaining more understanding of what therapies patients are willing to attempt, and their expectations from those therapies could help guide counseling with the goal setting realistic expectations to improve patient compliance and satisfaction.

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.

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. The study aimed to compare the efficacy of fractional CO2, Nd-YAG, and a combination of both in the management of keloids. 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. 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. 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.

Activating transcription factor 3 (ATF3) regulates cell growth, apoptosis, invasion and collagen synthesis in keloid fibroblast through transforming growth factor beta (TGF-beta)/SMAD signaling pathway

ABSTRACT The successful treatment of keloids is a great challenge in the plastic surgery field. Activating transcription factor 3 (ATF3) is discovered as an adaptive responsive gene, which plays a critical role in fibroblast activation. This study aimed to investigate the expression and biological role of ATF3 in the pathogenesis of keloids. ATF3 expression in normal skins and keloids was evaluated by real-time PCR, western blot and immunohistochemistry. Effects of ATF3 on cell growth, apoptosis, invasion and collagen production were evaluated in keloid fibroblast cells overexpressing or downregulating ATF3. ATF3 expression was significantly elevated in keloid tissues when compared with that of normal skins and parakeloidal skin tissues. Moreover, ATF3 promoted cell proliferation and collagen production in keloid fibroblast cells. Conversely, transfection with siRNA targeting ATF3 led to decreased cell viability and collagen synthesis via inhibiting transforming growth factor-β1 (TGF-β1) and fibroblast growth factor 2/8 (FGF2/8) production in keloid fibroblasts. ATF3 could reduce the apoptosis rate of keloid fibroblast cells. Molecularly, we found that ATF3 promoted BCL2 level and inhibit the expression of BCL2 associated agonist of cell death (Bad), Caspase3 and Caspase9 in keloid fibroblast cells. ATF3 also enhanced the invasive potential via upregulating the expression of Matrix Metalloproteinases (MMP) family members (MMP1, MMP2, MMP9 and MMP13). ATF3 could induce activation of TGF-β/Smad signaling pathway in fibroblasts. Collectively, ATF3 could promote growth and invasion, and inhibit apoptosis via TGF-β/Smad pathway in keloid fibroblast cells, suggesting that ATF3 might be considered as a novel therapeutic target for the management of keloid.

Experimental Study on Blue Light Interaction with Human Keloid-Derived Fibroblasts.

Keloids are an exuberant response to wound healing, characterized by an exaggerated synthesis of collagen, probably due to the increase of fibroblasts activity and to the reduction of their apoptosis rate: currently no standard treatments or pharmacological therapies are able to prevent keloid recurrence. To reach this goal, in recent years some physical treatments have been proposed, and among them the PhotoBioModulation therapy (PBM). This work analyses the effects of a blue LED light irradiation (410–430 nm, 0.69 W/cm2 power density) on human fibroblasts, isolated from both keloids and perilesional tissues. Different light doses (3.43–6.87–13.7–20.6–30.9 and 41.2 J/cm2) were tested. Biochemical assays and specific staining were used to assess cell metabolism, proliferation and viability. Micro-Raman spectroscopy was used to explore direct effects of the blue LED light on the Cytochrome C (Cyt C) oxidase. We also investigated the effects of the irradiation on ionic membrane currents by patch-clamp recordings. Our results showed that the blue LED light can modulate cell metabolism and proliferation, with a dose-dependent behavior and that these effects persist at least till 48 h after treatment. Furthermore, we demonstrated that the highest fluence value can reduce cell viability 24 h after irradiation in keloid-derived fibroblasts, while the same effect is observed 48 h after treatment in perilesional fibroblasts. Electrophysiological recordings showed that the medium dose (20.6 J/cm2) of blue LED light induces an enhancement of voltage-dependent outward currents elicited by a depolarizing ramp protocol. Overall, these data demonstrate the potentials that PBM shows as an innovative and minimally-invasive approach in the management of hypertrophic scars and keloids, in association with current treatments.

Cryosurgery as a Single Agent and in Combination with Intralesional Corticosteroids Is Effective on Young, Small Keloids and Induces Characteristic Histological and Immunohistological Changes: A Prospective Randomized Trial

Background: As the pathogenesis of keloids is poorly understood, there is no sound biological basis of keloid management. Few controlled therapeutic studies have been published, and recurrences are a major reason for treatment failure. Objective: To detect efficacy and safety of cryosurgery regimens on keloids and the occurring biological changes caused by the treatment. Methods: This prospective randomized study compared efficacy and tolerability as well as histological/immunohistochemical effects of liquid nitrogen contact cryosurgery as a single regimen (group A) and combined with intralesional corticosteroids (group B) on young (<2 years old), small (≤10 cm²) keloids in 40 patients (2-sided effect, α-error 1%, power 95%). Results: Marked flattening of the lesions was achieved by both regimens. Median lesional volumes decreased from 106 to 7 mm³ in group A (p = 0.001) and from 138 to 6 mm³ in group B (p < 0.0001; ns, between groups). Good to excellent responses were registered in 83.3 and 90% of patients in groups A and B, respectively, by evaluating the lesional volume, in 80 and 95% of patients by the physician’s evaluation and in 95% of patients in either group by the patient’s assessment. Follow-up of 6–36 months revealed no further significant changes. Cryosurgery was generally well tolerated, with minor pain during treatment not requiring (27.5%) or requiring local anaesthesia (5%) – but not analgesics –, and hypopigmentation (25%). Histological examination showed increased vessel number and lumen dilatation after treatment in group B and reduction of rete ridge length in both groups with more prominent changes in group A. Tenascin C staining demarcated keloids from normal skin before therapy, while after therapy the entire treated tissue was labelled. Interferon-γ expression was significantly decreased after therapy both regarding positively stained cells and intensity in both groups. Conclusion: Cryosurgery without and with intralesional corticosteroids is effective and safe on young, small keloids not only as a destructive physical procedure, but also by inducing biochemical and immunological scar rejuvenation.

Tissue Expression of Neuregulin-1 in Hypertrophic Scars and Keloids before and after Intralesional Bleomycin Injection

Hypertrophic scars and keloids are forms of abnormal wound healing. Both entities are the result of exuberant fibroblast response in the dermis. Nevertheless, their clinical and histopathological characteristics, as well as their pathogenesis, are differentThe aim of this study was to study the role of neuregulin- 1 in the pathogenesis of hypertrophic scars and keloids and studying the change in tissue expression after intralesional bleomycin injection. This prospective case - control study was carried on20patients who were suffering from keloids or hypertrophic scarsand were treated by intra lesional bleomycin injection, in addition to 20 apparently healthy individuals as a control group. Assement of hypertrophic scars and keloids before and after treatment byVancouver scar scale laboratory investigations including punch biopsies from hypertrophic scars, keloids and normal tissues, qRT-PCRfor gene expression of Neuregulin1 RNA was done. HTS group before treatment showed significantly higher level of neuregulin 1 but significantly lower after treatment and neuregulin 1 sensitivity was 80%, specificity was 100%,and accuracy was 90%.Neuregulin 1 before treatment showed significant positive correlation with Neuregulin 1after treatment.Better response was significantly associated with Lower baseline neuregulin 1.Higher neuregulin 1 was considered as risk predictor of HTS or keloid susceptibility and severity. Bleomycin usage has a better result and minimal complications and less recurrence rate, which shows its usefulness as the first-line treatment modality for management of keloids and hypertrophic scars.

“Management of Keloid with local application of Neem &amp; Raktchandana Lepa.”

When there is injury may be due to trauma, burn, or surgery. There is formation of scar tissue or fibrous tissue .This is attempt of body to repair itself by forming the bi product scar tissue or fibrous tissue. In some cases scar tissue grows excessively forming smooth hard growth called keloid. Typically keloid is not harmful to health. And it is do not require medical attention as like other skin problems. Unless and until it is appear on exposed areas like neck, face etc. People having cosmetic attention require treatment for it. Sometime the hardened tight scar tissue may restrict the movement. The available treatment for keloid is local corticosteroid injection which reduced inflammation and shrunk the keloid and surgery. But the chance of relapse is there with worst condition. Neem &amp; Raktachandan lepa for local application is used in this case. It contains natural alkaloids and steroidwhich relives inflammation and shrunk keloid.

Invited Commentary

On “heroic” eyebrow restoration Sam Lam should be commended for putting together a comprehensive case presentation that touched upon several key elements, most importantly the options in the management of eyebrow keloids, through this patient’s treatment course that first involved chemical-

SP-0765: Brachytherapy in management of (recurrent) keloid

SP-0765: Brachytherapy in management of (recurrent) keloid

Combination therapy of refractory keloid with ultrapulse fractional carbon dioxide (CO2) laser and topical triamcinolone in Asians‐long‐termprevention of keloid recurrence

Keloid often recur after treatment, and recent studies in keloid management favor the combination therapy of laser-assisted drug delivery over monotherapy. Unfortunately, the previous researches lack long-term follow-up. In this prospective study, 41 individuals with refractory keloids underwent eight treatment sessions at 4 weeks intervals consisting of ultrapulse fractional carbon dioxide laser (UFCL), followed by postoperative application topical triamcinolone acetonide (40 mg/ml). Four follow-up moments were chosen, with follow-up of 24 months. The effects of combination therapy on scar pliability, thickness, relief, vascularization, surface area, pain, and itchiness were examined by means of the Patient and Observer Scar Assessment Scale (POSAS). 38 patients completed the full 24 months of follow-up after the whole treatment. The results reveal a fast and abiding improvement of keloid scars after the combination therapy. The mean keloid POSAS scores showed a decreasing trend in subsequent times. All POSAS components improved significantly between baseline and 24 months after start of therapy (P < .05). Long-term follow-up results demonstrate that combination keloid therapy using UFCL and tropical triamcinolone has overall significant improvement and low recurrence rate with a long-term stable results.

Keloids: a review of therapeutic management.

Keloid scar formation arises from a disorganized fibroproliferative collagen response that extends beyond the original wound margins because of excessive production of extracellular matrix (ECM). Despite treatment options for keloid scars including medical and surgical therapies, such as intralesional steroid injection and surgical excision, the recurrence rate remains high. Herein we consolidate recently published narrative reviews, systematic reviews, and meta-analyses to provide an overview of updated treatment recommendations for keloidal scar formation. PubMed search engine was used to access the MEDLINE database to investigate updates regarding keloid incidence and treatment. More than 100 articles were reviewed. Keloid management remains a multimodal approach. There continues to be no gold standard of treatment that provides a consistently low recurrence rate; however, the increasing number of available treatments and synergistic combinations of these treatments (i.e., laser-based devices in combination with intralesional steroids, or 5-fluorouracil (5-FU) in combination with steroid therapy) is showing favorable results. Future studies could target the efficacy of novel treatment modalities (i.e., autologous fat grafting or stem cell-based therapies) for keloid management. This review article provides updated treatment guidelines for keloids and discusses insight into management to assist patient-focused, evidence-based clinical decision making.

Comparative evaluation of therapeutic efficacy and safety of intralesional triamcinolone acetonide injection vs intralesional radiofrequency with intralesional triamcinolone acetonide in treatment of keloids.

Management of keloid is difficult, so there is always a need for adequate and effective therapy. In this study, we explored and compared the efficacy and synergistic effect of combined intralesional radiofrequency (RF) and intralesional triamcinolone acetonide (TAC) with intralesional triamcinolone acetonide alone in the treatment of keloids. Sixty patients with keloid were divided in two groups of 30 patients each. In both groups total six sittings every 3 weeks and post treatment follow-up every 6 weeks was done. In group A, intralesional TAC was given. In group B, intralesional radiofrequency followed by triamcinolone was injected. In this study, there were 29 males and 31 females. In groups A and B, 73.4% and 80% of the patients, respectively, achieved grade 4 improvement at the end of 33 weeks, but there was greater mean POSAS score decline in group B in comparison with group A at each visit compared to baseline. Six patients in group A while three in group B showed recurrence. Side effects were equal in number in both groups Thus both the studied modalities of treatment produced equal efficacy and safety but with less recurrence in group B.

A Review of Current Keloid Management: Mainstay Monotherapies and Emerging Approaches.

Commonly affecting those with skin of color, keloids are an aberrant wound response that leads to wound tissue expanding above and beyond the original cutaneous injury. Keloids are notoriously and particularly difficult to treat because of their tendency to recur after excision. The current standard of care is intralesional steroid (triamcinolone acetonide). However, because no therapy has yet proven to be fully curative, keloid treatments have expanded to include a number of options, from injections to multimodal approaches. This review details current treatment of keloids with injections (bleomycin, verapamil, hyaluronic acid and hyaluronidase, botulinum toxin, and collagenase), cryotherapy, laser, radiofrequency ablation, radiation, extracorporeal shockwave therapy, pentoxifylline, and dupilumab.

Potentials for implementing pressure-controlled jet injection in management of keloids with intralesional 5FU and corticosteroids.

Needle-free jet injection implements kinetic energy of liquid jet for transcutaneous delivery of drugs into soft tissues. Combination therapy of intralesional 5-fluorouracil and triamcinolone offers efficacious treatment for keloids with a reduced adverse effect of the drug monotherapy. This study evaluates safety and efficacy of the drug combination administered to keloid scars via intralesional jet injections. A retrospective analysis of the keloid treatments was performed. Efficacy was assessed by reviewing pre- and post-treatment scores of the Vancouver Scar Scale (VSS) and Patient and Observer Scar Assessment Scale (POSAS) and by comparing baseline and photographs taken 3months after the treatments. Safety and tolerability were collected and analyzed. Twenty-one subjects (M/F=11/10) with 39 keloids received the treatments. Treatments were well-tolerated by all patients at mean injection pain of 2.0±1.0 per Numeric Pain Rating Scale (NPRS). Self-resolved lesion ulceration was observed in 4 patients. Post-treatment evaluation demonstrated a 53% decrease in total VSS score (P<0.05) and in all sub-categories. Mean patient score of POSAS decreased in the color, stiffness, thickness, and irregularity components. Pain and pruritus lessened by 69% and 79% (P<0.05 in both), respectively, among the patients with complaints prior to the treatment. Independent reviewers reported an average 51%-75% reduction in keloids. Improved appearance of keloids and symptomatic relief was achieved by intralesional administration of combined 5-fluorouracil and corticosteroid through the high-pressure jet injections. The synergy between the drug combination and the jet physical impact provided clinical effect.

Treatment of keloids with intralesional injection of bleomycin and triamcinolone acetonide

A keloid is a kind of overgrown scar due to aggressive healing response to a wound. Satisfactory management of keloid has always been a challenge. In this study we aimed to evaluate the efficacy of combination of intralesional bleomycin and triamcinolone acetonide in the treatment of keloids. Study on 20 clinically diagnosed lesions of keloids from 12 patients was conducted. Excellent response was seen in 70%, good response was seen in 10%, fair response was seen in 15%, poor response was seen in 5%. The main side effects observed were pain(100%), hyperpigmentation (50%), ulceration (15%), atrophy(5%).

Auricular keloid management in Asian skin: Clinical outcome of intralesional excision and postoperative triamcinolone acetonide intralesional injection.

Various options such as surgical excision, steroid injection, cryotherapy, pressure dressing, and radiation therapy are available for the treatment of auricular keloids. In particular, auricular keloid therapy using surgical excision is important because recurrence rates are low compared with keloids occurring in other parts of the body. We aimed to evaluate the clinical outcomes of intralesional excision followed by postoperative triamcinolone acetonide intralesional injection (TA ILI) as auricular keloid treatments. We conducted a surgery records and chart review of patients who underwent auricular keloid treatment with intralesional excision and TA ILI. Reduction in height and volume was assessed by two blinded dermatologists. We also analyzed the recurrence rate over a 2-year period and evaluated patient satisfaction using an 11-point questionnaire (0-10). Eighteen Korean patients (2 males and 16 females) with a mean age of 26.5years and a total of 20 lesions were evaluated. Lesion types by descending frequency were lobular (n=10, 50%), anterior/posterior button (n=3, 15%), wrap-around (n=3, 15%), dumbbell (n=2, 10%), and sessile (n=2, 10%). The total recurrence rate was 5% (1/20) within the 24-month follow-up period. Significant reduction (> 50%) in height and volume was achieved in 95% of patients. No serious or persistent adverse events were reported during the follow-up period. We confirmed that TA ILI after intralesional excision can be effective for auricular keloid management. A low recurrence rate similar to that of postoperative radiation therapy was obtained with an effective surgical procedure and minimal postoperative treatment.