Keloid Research Articles

In the face and neck, keloid scar distribution is related to skin thickness and stiffness changes associated with movement.

Keloid scars tend to occur in high-tension sites due to mechanical stimuli that are involved in their development. To date, a detailed analysis of keloid distribution focused specifically on facial and neck areas has not been reported, and limited literature exists as to the related mechanical factors. To rectify this deficiency of knowledge, we first quantified the facial and neck keloid distribution observed clinically in 113 patients. Subsequently, we performed a rigorous investigation into the mechanical factors and their associated changes at these anatomic sites in healthy volunteers without a history of pathologic scarring. The association between keloid-predilection sites and sebaceous gland-dense and acne-prone sites was also examined. To assess skin stretch, thickness and stiffness, VECTRA, ultrasound and indentometer were utilised. Baseline skin stiffness and thickness were measured, as well as the magnitude of change in these values associated with facial expression and postural changes. Within the face and neck, keloids were most common near the mandibular angle (41.3%) and lateral submental (20.0%) regions. These areas of increased keloid incidence were not associated with areas more dense in sebaceous glands, nor linked consistently with acne-susceptible regions. Binomial logistic regression revealed that changes in skin stiffness and thickness related to postural changes significantly predicted keloid distribution. Skin stiffness and thickness changes related to prolonged mechanical forces (postural changes) are most pronounced at sites of high keloid predilection. This finding further elucidates the means by which skin stretch and tension are related to keloid development. As a more detailed analysis of mechanical forces on facial and neck skin, this study evaluates the nuances of multiple skin-mechanical properties, and their changes in a three-dimensional framework. Such factors may be critical to better understanding keloid progression and development in the face and neck.

The effects of systemic diseases, genetic disorders and lifestyle on keloids.

Keloid are a fibroproliferative disorder caused by abnormal healing of skin, specifically reticular dermis, when subjected to pathological or inflammatory scars demonstrating redness, elevation above the skin surface, extension beyond the original wound margins and resulting in an unappealing cosmetic appearance. The severity of keloids and risk of developing keloids scars are subjected to elevation by other contributing factors such as systemic diseases, general health conditions, genetic disorders, lifestyle and natural environment. In particular, recently, daily physical work interpreted into mechanical force as well as the interplay between mechanical factors such as stress, strain and stiffness have been reported to strongly modulate the cellular behaviour of keloid formation, affect their location and shape in keloids. Herein, we review the extensive literature on the effects of these factors on keloids and the contributing predisposing mechanisms. Early understanding of these participating factors and their effects in developing keloids may raise the patient awareness in preventing keloids incidence and controlling its severity. Moreover, further studies into their association with keloids as well as considering strategies to control such factors may help clinicians to prevent keloids and widen the therapeutic options.

Effective keloid management using a combinatorial continuous-wave and repeat fractionated ablative CO2 laser regimen.

Keloids are benign proliferative scars that form as a result of dysregulated growth and collagen deposition in response to cutaneous injury. Laser therapies have emerged as promising options for the treatment of keloids, with performance varying by laser type and lesion characteristics. To assess the combined continuous wave and repetitive fractionated CO2 laser treatment of keloids. A retrospective chart review of 22 cases of keloid scars treated with combined CO2 laser modes. A single session of continuous wave followed by five sessions of fractional delivery. Efficacy was assessed using the Patient and Observer Scar Assessment Scale (POSAS) and the Vancouver Scar Scale. The Numeric Rating Scale was used to assess patient satisfaction and pain. Most patients were female (77.3%) with skin type IV (72.7%), age was 24.3 ± 9.3 years, most keloids were located on the earlobe (56.5%) or arm or hand (17.4%), size ranged from 5 to 10 cm, and time since injury ranged from 3 months to 35 years. No serious adverse events were reported. At 6 months, significant improvements from baseline occurred in all characteristics, scar color (4.8 ± 2.8 to 1.9 ± 1.1), rigidity (5.0 ± 2.8 vs. 5.4 ± 2.8), thickness (5.4 ± 2.8 vs. 2.0 ± 1.1), and irregularity (5.9 ± 2.4 vs. 1.9 ± 0.9). The Vancouver scores followed a similar trend. Patient-rated overall improvement from 37 ± 17.6 at baseline to 16.1 ± 8.5 at 6 months, and improvement in associated pain and pruritus. Combination of two ablative laser delivery modes within a single laser platform provided for effective and safe keloid management and left patients highly satisfied.

Exploring Aesthetic Outcomes and Complications in Auricular Reconstruction Utilising Autologous Cartilage: A Systematic Review and Narrative Synthesis.

Auricular reconstruction remains a challenging procedure, requiring a high degree of manual dexterity and attention to detail in order to reconstruct the complex three-dimensional geometry of the ear successfully. Most techniques will rely on autologous cartilage for auricular framework fabrication, carrying a risk of donor and recipient site morbidity. The aim of this report is to investigate the complications and aesthetic outcomes associated with autologous cartilage harvest in auricular reconstruction. A systematic review protocol was registered with theInternational Prospective Register of Systematic Reviews (PROSPERO) and reported in accordance with the Preferred Reporting for Items for Systematic Reviews and Meta-Analyses. Comprehensive electronic search strategies for four databases were developed. Studies were screened according to the inclusion and exclusion criteria by two independent reviewers. The literature search identified 7171 articles. Filtering for relevance and duplication reduced the number of articles to 52. A total of 12,215 patients underwent auricular reconstruction utilising autologous cartilage. Indications included 11,696 patients due to microtia, 334 patients due to burns or trauma, 70 patients due to constricted ears, and 115 patients due to prominent ears. The most commonly reported donor site complications included chest wall deformities (n = 159). The most commonly reported recipient site complications included hypertrophic or keloid scars (n = 279), haematoma (n = 155), tissue expander exposure (n = 111), cartilage or framework exposure (n = 122), and cartilage framework deformation or resorption (n = 50). Although a challenging procedure, auricular reconstruction utilising autologous cartilage is possible. Exceptional aesthetic results can be achieved when performed by a skilled surgeon on appropriately selected individuals. However, the potential risks and complications associated with the procedure should be discussed with the patient and family beforehand.

COMPARISON OF THE EFFICACY OF INTRALESIONAL 5% FU VERSUS INTRALESIONAL TRIAMCINOLONE IN PATIENTS PRESENTING WITH KELOID AND HYPERTROPHIC SCAR AT TERTIARY CARE HOSPITAL, KARACHI

Despite the fact that keloids and hypertrophic scars are frequent benign hyper-proliferative growths of dermal fibroblasts, the clinical concerns, such as physical and psychological issues, are serious and impairing, and there are few effective therapies. Although 5-fluorouracil (5-FU) and intralesional triamcinolone acetonide (TAC) are widely used to manage both scars, their effectiveness is still debatable. To compare the efficacy of intralesional 5% FU versus intralesional triamcinolone in patients presenting with keloid and hypertrophic scar at Tertiary Care Hospital, Karachi. This RCT study was conducted on patients presenting with keloid and hypertrophic scars at the Outpatient Department of Dermatology, JPMC, Karachi, meeting inclusion criteria. A brief history of demographic information and written informed consent were taken from each patient. A total of 158 patients were enrolled in the study and were randomly allocated to Group A, Intralesional triamcinolone group, and B: Intralesional 5% FU group twice weekly for a total of 4 sessions. During each visit, the keloid height was measured, photographed again, and documented. Efficacy was labeled if patients with keloid and hypertrophic scar in either group showed ≥ 50% reduction in height. Comparison of efficacy between groups showed a significant difference as the efficacy rate was higher in patients treated with 5-FU 45mg as compared to the patients administrated with TAC 10mg (70.9% vs. 50.6%; P-value=0.009). This analysis revealed that irrespective of the patient's age, sex, illness duration, or lesion site, intra-lesional 5-fluorouracil (5-FU) offered the significant benefit of a faster and more effective response than triamcinolone (TAC) in the treatment of keloids and hypertrophic scars.

Keloid and Hypertrophic Scars Treatment.

Hypertrophic scars are contained within the site of injury and may regress over time, while keloids spread beyond the borders of the initial injury and do not regress. On histologic examination, hypertrophic scars tend to have collagen in a wavy, regular pattern, whereas keloids have no distinct pattern of collagen. To retrospectively analyze improvement in keloid and hypertrophic scars characteristics following treatment with Ablative 10600nm and a non-Ablative 1570nm Hybrid Laser Device. Treatment parameters with the ProScan Hybrid Mode were 40W/1.3-1.5ms for the CO2 and 12W/4ms for the 1570nm in a 1:1 ratio. Outcomes were assessed based on physician scar grading as measured by the Vancouver Scar Scale and patient-reported satisfaction. Excel was used for data analysis, and a p value < 0.05 was considered statistically significant. Adverse events and patient pain were also recorded. A total of 31 hypertrophic scars and 30 keloid scars were treated. There was a significant reduction in Vancouver Scar Scale scores for both hypertrophic and keloid scars (62% ± 8% and 58% ± 7%; p = 2.6E-17 and p = 8.29E-26, respectively). In a scar-based comparison, a statistically significant difference was observed for all measures reflecting favorable outcomes for hypertrophic scars (VSS, p = 1.1E-05; satisfaction, p = 0.0112; pain, p = 0.00081). Only one adverse event was reported, a superficial burn treated with topical antibiotics. The device was found to be safe and effective, with promising results for the treatment of hypertrophic and keloid scars. 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.

A Different Approach for Protruding Earlobe Correction—Modified Fish-tail Technique

BackgroundProtruding ears are the most common auricular abnormalities seen in children (1). Protruding ears are a condition that has social and psychological consequences due to its physical appearance and one of the main causes of peer bullying at young ages (2). While various surgical methods exist to address prominent ears, the options for correcting the lobule are relatively scarce. In this study, we are aimed to present the modified fish-tail technique that we have developed and to compare it with other techniques in the literature.MethodsThe patients were selected from the cases that underwent otoplasty for prominent ear correction in our clinic between 2020 and 2022. A total of 21 cases that required protruded lobule correction during otoplasty were included in our study. Keloid and hypertrophic scar formation, wound dehiscence, hematoma, infection and recurrence in the lobule were evaluated. The patients were followed up for at least 1 year for early and late complications.ResultsEach patient in the study underwent bilateral prominent ear correction, including bilateral modified fish-tail technique. All cases were followed for at least 12 months. There was no wound dehiscence, infection, recurrence in lobule prominence or hematoma during the follow-up period. No hypertrophic scar or keloid was observed in any case.ConclusionsOur method stands out for its ability to achieve both adjustable vertical height and effective lobule correction with a reduced need for skin excision. We recommend the modified fish-tail technique as an alternative technique for prominent lobule surgery.Level of Evidence IVThis 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.

Surgical Treatment of Keloid Scars on the Ear: The Usefulness of the Fillet Flap

Background: Keloid scars occur idiopathically, and the ear is a common site of keloid scar formation after ear-piercing. Management is always challenging because of the high likelihood of recurrence. When treating a large keloid scar, surgical debulking is inevitable. Among various surgical options, the fillet flap is useful for very large scars with broad stalks that cannot be removed by simple excision and primary closure.Methods: From April 2016 to June 2021, scar revision with a fillet flap was performed on 24 auricular keloid scars. The operation was performed to debulk the scar as much as possible, while retaining a thin envelope of scar tissue. The patients were observed for 1 year postoperatively. Oral tranilast (a transforming growth factor-β suppressor) was administered to reduce the risk of recurrence during follow-up. When recurrence was observed, triamcinolone was injected into the scar.Results: All 24 cases were successfully treated without major problems such as flap loss. The postoperative contour and volume of the scars were appropriate when recurrence did not occur. During the follow-up period, there were nine cases of keloid recurrence, and the mean number of triamcinolone injections was 2.7. One patient experienced a second recurrence 10 months after the first recurrence and needed two more injections.Conclusion: The fillet flap is an appropriate option for removing a large keloid scar with a broad stalk. Although it does not guarantee that recurrence will not take place, it provides a small and flat scar into which triamcinolone can be injected if the keloid scar recurs.

The potential of RNA therapeutics in dermatology.

Ribonucleic acid (RNA) therapeutics hold great potential for the advancement of dermatological treatments due to, among other reasons, the possibility of treating previously undruggable targets, high specificity with minimal side effects, and ability to include multiple RNA targets in a single product. Although there have been research relating to RNA therapeutics for decades, there have not been many products translated for clinical use until recently. This may be because of challenges to the application of RNA therapeutics, including the dearth of effective modes of delivery to the target, and rapid degradation of RNA in the human body and environment. This article aims to provide insight on (1) the wide-ranging possibilities of RNA therapeutics in the field of dermatology as well as (2) how key challenges can be addressed, so as to encourage the development of novel dermatological treatments. We also share our experience on how RNA therapeutics have been applied in the management of hypertrophic and keloid scars.

The Effects of Massage with Topical Agents (Mepiform Ultra Scar Gel or Scarnos Gel) on Scar Tissue Thickness and Fibroblast Proliferation in Rats

Background: Keloid and hypertrophic scars are prominent scars that are excessively repaired with upregulated synthesis, deposition, and accumulation of collagen. Topical agents are used to reduce inflammation and fibrotic changes via reduced transepithelial water loss. Increased mechanical pressure applied through scar massage can accelerate scar maturation by inducing fibroblast proliferation, which enhances the remodeling of connective tissue matrices and collagen degradation.Methods: This study comparatively analyzed the effectiveness of topical agents applied to post-burn wounds on the dorsal surface of Sprague-Dawley rats through twice-daily massaging. Postoperative histological analysis of the tissues was performed after surgical en bloc removal of the treatment area at 4, 10, and 16 weeks.Results: Histological analyses revealed larger amounts of fibroblasts in Mepiform and Scarnos gel-treated tissue than in Vaseline-treated tissue. Granulation was prevented in scars treated with the topical agents.Conclusion: Mepiform Ultra scar gel and Scarnos gel, accompanied by massaging, may be effective anti-scarring topical agents to alleviate contact burn scars in Sprague-Dawley rats.

Cost benefit analysis of intralesional injections in keloids using Luer lock and non-locking syringes

Background: For keloid scarring, intralesional corticosteroid injections continue to be the most often utilised first therapeutic option. This is a common procedure done on an outpatient basis by surgeons and orthopaedists. Luer lock syringes which lock the needle with syringe prevent any leakage or spillage of drug while pushing it near the keloid compared to normal syringes. Methods: We intend to do a cost benefit analysis based on the retrospective data of intralesional steroid injections done by the authors (AP and SK) in their private practice. Results: The time between 2021 to 2022, 200 injection data was retrieved, 100 each using non locking syringes and Luer lock syringes. The spillage rate with non-Luer lock syringes was 14%. Conclusions: We found that luer lock syringes prove to be cost effective after giving more than 200 injections in keloids than non-locking syringes.

Association of Human Leukocyte Antigens (HLA) with Keloids and Hypertrophic Scar in Thais

Background: Keloids and hypertrophic scars are abnormal fibro-proliferative lesions. Associations between genes, the human leukocyte antigen (HLA) system in particular, and keloids have been studied in various ethnic groups but not in Thais. Objective: To investigate the association of HLA alleles with keloids and hypertrophic scars in Thais. Materials and Methods: The present study employed a retrospective case-control design. Scar assessment was performed on 139 kidney donors who underwent nephrectomy at Ramathibodi Hospital between January 2008 and December 2015. The wound scars after nephrectomy were evaluated and graded by a plastic surgeon using the modified Vancouver Scar Scale. Kidney donors who were unable to communicate well or who had autoimmune diseases or complications from surgery were excluded from the study. The diagnosis of a keloid scar, hypertrophic scar, and flat scar was made by clinical criteria. The donors were categorized into groups with three scar types, flat as the control group, hypertrophic, and keloid. The associations between the frequencies of HLA antigen with hypertrophic scar and keloids were measured with an odds ratio using logistic regression analysis. Results: Of the 139 living kidney donors, 15 (10.8%) had keloids, 46 (33.1%) had hypertrophic scars, and 78 (56.1%) had flat scars. Sixty-one HLA-A, -B, -DRB1, and -DQB1 alleles were evaluated in the present study. Compared with controls, the allele frequency of HLA-DRB1*15 was significantly higher in the keloid group at 43.33% versus 24.36% (odds ratio 2.37, 95% confidence interval 1.06 to 5.33, p=0.036). No significant association between HLA alleles and hypertrophic scars was found. Conclusion: The present study demonstrated the positive association of HLA-DRB1*15 with keloids in Thai individuals. The HLA-DRB1*15 could be a susceptibility factor for the development of keloids. Keywords: Human leukocyte antigen; Keloids; Thais, HLA-DRB1; Positive association

Support for dermatological research in Sub-Saharan Africa: insights from African hair and skin research programs.

The structure and physiology of skin and hair in people of African ancestry are different from other ethnic categories and studies from other continents cannot necessarily be extrapolated to Sub-Saharan Africa (SSA) due to the differences in genetics, lifestyle, climate, cultures, and hair and skin care practices. The aim of this report is to highlight the recent advances in local skin and hair research in SSA from a grant program. African Hair and Skin Research Grants from an industrial sponsor were awarded between 2013 and 2022 on five main topics: acne, hair and scalp, keloid scars, atopic dermatitis, and air pollution. A literature search in Scopus identified publications on these topics in African or black skin in SSA and worldwide to provide insight into the impact of the program. The number of publications from around the world on the skin and hair of people of African ancestry has increased significantly over the past 30 years on all five topics, especially as a result studies conducted in the United States. Fewer studies have been conducted in SSA but there has been an increasing number of publications over the past 10 years, especially from South Africa. Scientific and clinical partnerships between the industry, academia, and public healthcare sectors have contributed to a steady increase in hair and skin publications from SSA, which may be useful for the development of tailored products and public educational campaigns to raise awareness of the risks of using inappropriate products.

Fractional CO2 laser Combined with TCA for the Treatment of Keloid Scars

Scarring is a complex phenomenon , Following an injury to the skin, whether voluntary or post-surgical, the healing process begins. This is a long physiological process designed to restore the integrity of the skin covering [1]. In certain circumstances, ad integrum restitution cannot be achieved, leading to pathological scarring. Risk factors can be local, depending on the topography of the lesion, or general, depending on age or genetic predisposition. We distinguish two types of pathological scars: hypertrophic and keloid [2]. Indeed, it has been confirmed that the latter are the cause of serious psychological problems, as they are not only aesthetically embarrassing, but also lead to an alteration in patients' quality of life and self-esteem [3]. The therapeutic arsenal is broad, and includes corticosteroids in intra-lesional and topical injections, pressotherapy, surgery, radiotherapy, cryotherapy, 5-fluorouracil (5-FU) and lasers [4]

A cadaveric study and clinical application of the free superficial circumflex iliac artery perforator flap reconstruction of limb soft tissue defects

Introduction In recent decades the superficial circumflex iliac artery perforator (SCIP) flap technique has gradually overcome the previous disadvantages of its pedicle and donor site to be widely applied in treating tissue's defects. This article investigates the vascular anatomy of the SCIP flap and evaluates the result of using the flap to reconstruct limb defects. Materials and Methods The study was performed in two parts. Firstly a cross-sectional descriptive anatomical study comprising 49 groin dissections in 25 cadavers, with contrast radiographic demonstration of the vascular anatomy. Secondly a retrospective case series of 51 free SCIP flaps in 49 patients. Surgical outcomes were evaluated using the Vancouver Scar Scale on the regional function and the aesthetics of implanted flap and donor sites. Results The results of anatomical analysis on cadavers showed the superficial circumflex iliac arteries were detected in all specimens with an average diameter of 1.4 ± 0.3 mm. The superficial subcutaneous venous systems were also recorded, including two veins (superficial circumflex vein and superficial epigastric vein) in 79.5% with an average diameter of 2.3 ± 0.6 mm. The flap results showed the alive flap rate was 90.2%, partial-necrosis flap was 3.9% and total necrosis of the flap in 5.9%. In the aesthetic evaluation, fine line scars were seen in 13/51 cases (25.5%), stretch scars in 33/51 cases (64.7%) and hypertrophic scars in 5/51 patients (9.8%), with no cases of keloid scars. Conclusion The SCIP flap is a reliable free-tissue transfer for reconstructing limb soft tissue defects. Moreover, the SCIP flap is an ideal flap with pleasing aesthetics because the donor-site scar is situated in a well-hidden site. Care must be taken when vein grafts are used to lengthen the flap as flap necrosis rates increase.

Evaluation the role of SODERMIX cream on hypertrophic and keloid scar

Evaluation the role of SODERMIX cream on hypertrophic and keloid scar

Dermatofibroma and keloid scar: similarities and differences

Dermatofibroma and keloid scar: similarities and differences

Suture-anchored cutaneous tension induces persistent hypertrophic scarring in a novel murine model.

Hypertrophic scars cause impaired skin appearance and function, seriously affecting physical and mental health. Due to medical ethics and clinical accessibility, the collection of human scar specimens is frequently restricted, and the establishment of scar experimental animal models for scientific research is urgently needed. The four most commonly used animal models of hypertrophic scars have the following drawbacks: the rabbit ear model takes a long time to construct; the immunodeficient mouse hypertrophic scar model necessitates careful feeding and experimental operations; female Duroc pigs are expensive to purchase and maintain, and their large size makes it difficult to produce a significant number of models; and mouse scar models that rely on tension require special skin stretch devices, which are often damaged and shed, resulting in unstable model establishment. Our group overcame the shortcomings of previous scar animal models and created a new mouse model of hypertrophic scarring induced by suture anchoring at the wound edge. We utilized suture anchoring of incisional wounds to impose directional tension throughout the healing process, restrain wound contraction, and generate granulation tissue, thus inducing scar formation. Dorsal paired incisions were generated in mice, with wound edges on the upper back sutured to the rib cage and the wound edges on the lower back relaxed as a control. Macroscopic manifestation, microscopic histological analysis, mRNA sequencing, bioinformatics, and in vitro cell assays were also conducted to verify the reliability of this method. Compared with those in relaxed controls, the fibrotic changes in stretched wounds were more profound. Histologically, the stretched scars were hypercellular, hypervascular, and hyperproliferative with disorganized extracellular matrix deposition, and displayed molecular hallmarks of hypertrophic fibrosis. In addition, the stretched scars exhibited transcriptional overlap with mechanically stretched scars, and human hypertrophic and keloid scars. Phosphatidylinositol 3-kinase-serine/threonine-protein kinase B signaling was implicated as a profibrotic mediator of apoptosis resistance under suture-induced tension. This straightforward murine model successfully induces cardinal molecular and histological features of pathological hypertrophic scarring through localized suture tension to inhibit wound contraction. The model enables us to interrogate the mechanisms of tension-induced fibrosis and evaluate anti-scarring therapies.

Twist-related protein 1 promotes transforming growth factor β receptor 1 in keloid fibroblasts via regulating the stability of myocyte enhancer factor 2A.

Keloid scarring is caused by a fibroproliferative disorder due to abnormal activation of genes, the underlying mechanism of which is still unclear. The basic helix-loop-helix transcription factor Twist-related protein 1 (TWIST1) controls cell proliferation and differentiation in tissue development and disease processes. In this study, we aimed to clarify the essential role of TWIST1 in the pathogenesis of keloids. Immunohistochemistry, cell counting kit-8 assays, western blotting, PCR, matrigel invasion assays and immunofluorescence assays were applied to demonstrate the effects and mechanisms of TWIST1 in fibroblasts derived from normal skin and keloids. Mass spectrometry, ubiquitination assays, chromatin immunoprecipitation and dual luciferase reporter assay were applied to explore the interaction of TWIST1 with downstream molecules. In the present study, we confirmed that TWIST1 was upregulated in keloid tissue of patients and in keloid-derived fibroblasts (KFBs). In vitro, TWIST1 inhibition prevented KFB proliferation, invasion and activation. We also discovered a link between TWIST1 and the transforming growth factor β (TGF-β) signaling related molecules TGF-β receptor 1 (TΒR1), SMAD family member 2 (Smad2) and Smad3, and the fibrosis markers α-smooth muscle actin, collagen type I and collagen type III in KFBs. Mechanistically, we uncovered a brand-new mechanism by which TWIST1 interacts with myocyte enhancer factor 2A (MEF2A) and suppresses its ubiquitination and degradation. Using chromatin immunoprecipitation and dual-luciferase reporter assay, TΒR1 was identified as a novel downstream target of MEF2A, which directly binds to its promoter. Overexpression of TWIST1 promoted the recruitment of MEF2A to the TΒR1 promoter and restored TΒR1 functional expression. Our research highlights a significant function of TWIST1 in the development of keloid and its related fibroblasts, partially facilitated by elevated MEF2A-dependent TΒR1 expression. Blocking the expression of TWIST1 in KFBs could potentially pave a novel therapeutic avenue for keloid treatment.

The Efficacy of Bleomycin for Treating Keloid and Hypertrophic Scar

The Efficacy of Bleomycin for Treating Keloid and Hypertrophic Scar