Treatment Of Keloids Research Articles

Evaluating serum level of thymidylate synthase in post burn keloid patients before and after intralesional injection of 5-fluorouracil.

BackgroundKeloids are fibrous lesions formed at the site of trauma due to types I and III collagen irregular production. The presence of thymidylate synthase (TS) is a must for DNA synthesis and repairs causing cell death. 5-fluorouracil (5-FU) is a fluorinated pyrimidine analogue acting as an anti-metabolic agent that inhibits thymidylate synthase and interferes with ribo-nucleic acid (RNA) synthesis.Objectiveswe aimed to evaluate the level of thymidylate synthase in post burn keloid patients before and after intralesional injection of 5-fluorouracil.MethodsThe study included 20 keloid patients and 20 healthy subjects as a control. Serum TS was estimated using commercially available enzyme-linked immunosorbent assay (ELISA) kits before and after treatment with 5-fluorouracil.ResultsThere was a statistically significant difference in TS levels before and after 5-FU treatment (p < 0.05). Also, results have shown that 5-FU injection has good satisfactory results in treatment of keloid causing reduction in scar volume and symptoms improvement (90% of the patients improved). On the other hand, there was no statistically significant difference in TS levels and the outcomes of the treatment.ConclusionOur findings suggest that intralesional 5-FU injection in keloid has very satisfactory results. However, thymidylate synthase enzyme has a minimal role in evaluating the treatment of keloid, so further studies are required to elaborate the relation between this enzyme and keloid scars.

Alternatives for keloid scars treatment: an integrative review

Keloid scars affect different populations, compromising patients’ quality of life. The literature presents several treatments. The study aimed to conduct an integrative review of systematic review articles and/or meta-analyses addressing keloid treatment in the PubMed, LILACS, MEDLINE, and Cochrane databases from 2015 to 2021. After identification and following the selection and eligibility criteria, 24 articles were included for qualitative review. We observed that the difficulty in evaluating recurrence affected different keloids treatment modalities, still presenting many failure rates and the need for further studies.

ASSOCIATION OF BLOOD COMPOSITION OF HORMONES, CYTOKINES AND LEUKOCYTES WITH LASER TREATMENT OUTCOMES OF KELOID SCARS

One of the topical aspects of the problem of keloid treatment is the lack information about biomarkers that can predict the success of the treatment of this pathology. The aim of the work is to identify the association of changed levels of hormones, cytokines and the number of leukocytes in the blood with the laser treatment result of keloid scars. Materials and methods. Hormonal, cytokine and leukocyte blood composition was studied in 45 women: 30 with keloid scars, 15 with normotrophic scars (control). Blood was taken before treatment on the 5th–7th day of the menstrual cycle. Keloids were treated with multiple laser perforations of the scar tissue. Clinical characteristics of keloid scars were assessed using the Vancouver scale before treatment and after 3 months. According to the result of treatment, two subgroups were formed: with positive dynamics of keloids and with no result of treatment. Data analysis was carried out using non-parametric statistics, the level of statistical significance was p&lt;0.05. Results and discussion. In all patients with keloids, the blood level of cortisol is reduced, and tumor necrosis factor-alpha is increased, which promotes to the proliferation of fibroblasts with inhibition of apoptosis. In addition, in the subgroup with a positive result of treatment, the number of segmented neutrophils and the level of anti-inflammatory interleukin-10 were increased. Discriminant analysis confirmed the high informational significance of these indicators. In patients with no result of keloid treatment, the level of a growth hormone is sevenfold increased, the concentration of luteinizing hormone, prolactin, interleukin-10 are reduced. That can lead to a weakening of anti-inflammatory effects and stimulation of fibrosis. Discriminant analysis highlighted the high informational significance of cortisol, growth hormone and tumor necrosis factor-alpha. Regression analysis established the association of detected changes in blood composition with clinical parameters of keloids in each subgroup. Conclusion. The revealed differences in the blood composition in patients with keloid scars are associated with a positive or negative result of laser treatment of keloids.

The Inhibition of Adipose-Derived Stem Cells on the Invasion of Keloid Fibroblasts.

Background: Keloids represent the dysregulation of cutaneous wound healing caused by aberrant fibroblast activities. Adipose-derived stem cells have been recognized as a promising treatment for keloids. However, the molecular mechanisms have not been fully elucidated.Objectives: to explicitly demonstrate the relationship between adipose-derived stem cells alleviating keloids and alterations of Col-1, Col-3, CTGF, and P-4-HB.Methods: Skin biopsies were obtained from 10 keloid patients and 9 healthy volunteers. Fibroblasts isolated from all samples were divided into two groups, one co-cultured with adipose-derived stem cells and the other grown independently. We compared the wound-healing rates, fibroblast survival rates, apoptosis rates, mRNA expressions, and protein levels of Col-1, Col-3, CTGF, and P-4-HB between separated groups.Results: We found no significant differences between normal fibroblasts and keloid fibroblasts in terms of wound-healing rate, survival rate, or apoptosis rate at the baseline. With adipose-derived stem cells, wound-healing rate and survival rate of normal fibroblasts were promoted, whereas in keloid fibroblasts, they were reduced. The apoptosis rate of normal fibroblasts and keloid fibroblasts were restrained, with the restraint in keloid fibroblasts being more evident. The protein levels of Col-3, CTGF, and P-4-HB were lower in keloid fibroblasts co-cultured with adipose-derived stem cells than in normal fibroblasts under similar conditions.Conclusions: Adipose-derived stem cells strongly suppressed keloid fibroblasts' proliferative and invasive behavior. However, adipose-derived stem cells negatively regulated keloid fibroblast apoptosis. Adipose-derived stem cells can be a potential keloid therapy worth further investigation.

A Comparative Study of Effectiveness of Cryotherapy with Intralesional Triamcinolone Vs Fractional CO2 Laser with Topical Betamethasone for the Treatment of Keloids.

Keloids are hyperproliferative response of dermal connective tissue to trauma. Their management remains a challenge for practitioners as there is still no universally accepted treatment, leading to recurrences which are frustrating for patients and clinicians alike. Hence, it becomes essential to determine a modality with highest efficacy, least recurrence and produces good aesthetic results. To compare the therapeutic effectiveness of combination of cryotherapy with intralesional corticosteroid and a combination of fractional CO2 laser followed by topical corticosteroids for treatment of keloids. This was a single centre, cross-sectional study consisting of 170 patients. Patients were randomly allocated in two groups, group one received a combination of cryotherapy with intralesional corticosteroid and group two was treated by laser ablation of keloid followed by topical corticosteroid application for four treatment sessions each after which they were evaluated for improvement. There was remarkable difference in the treatment outcome of both the group, with group two showing more improvement (p value <0.001) and markedly fewer side effects. Patients in group two had less pain as compared to patients in group one, making them more compliant to treatment. Majority (31.8%) of patients belonged to 31-40 years of age group. The most common reason for treatment was for cosmetic concerns, seen in 70.6% of the patients. Both regimens showed excellent responses with minimum recurrence rates, indicating their high efficacy in management of keloids. However, regimen II was found to be aesthetically superior for the treatment of these exuberant scars.

Keloidal Tissue Implanted into an Animal Model and Its Significance for Advancing Keloid Treatment

Keloidal Tissue Implanted into an Animal Model and Its Significance for Advancing Keloid Treatment

The objective evaluation of triamcinolone acetonide efficacy in keloids management using Antera3D® imaging system.

Keloids are pathological scars characterized by nodular fibrous tissue that extends beyond the border of initial damage. These lesions do not spontaneously regress and can cause cosmetic disfigurements and functional disabilities. IntraLesional Injection of Triamcinolone Acetonide (ILITA), alone or in combination with other therapy, is one of the first-line treatment modalities. In this study the authors evaluated the objective efficacy of ILITA treatment in keloids management using this new imaging system. 37 patients with 45 keloid scars were treated with intralesional injection of triamcinolone acetonide (TAC) 20 mg/ml at an interval of three weeks. Antera3D® camera took the images and dates of the treated area in each patient, before the treatment (T0) and at three weeks after the last injection (T1). The system processed the levels of color, elevations, melanin and hemoglobin expression. All the scars were also evaluated, at the same times, by validated Vancouver Scar Scale (VSS). Comparison of the variables was performed using a Wilcoxon signed-rank test with a p < 0.05. At T0, mean VSS score was 8.67 ± 1.35 which reduced to 3.62 ± 1.72 at final follow up. Antera3D® scores were statistically significant differences in color (8.14 ± 2.41 vs 9.54 ± 1.81), protrusion (381.3 ± 15.6 vs 198.6 ± 21.3), melanin (0.53 ± 0.02 vs 0.62 ± 0.2) and hemoglobin (1.26 ± 0.41 vs 2.21 ± 0.41) expression levels after the treatment. In our clinical trial, the data results demonstrated that ILITA seems to be effective in reducing keloid dimensions and symptoms such as itching and pain, even if the treatment has local minimal adverse effects such as pain, telangiectasias and atrophy. Keloids are pathological scars characterized by nodular fibrous tissue that extends beyond the border of initial damage. Large keloids can cause cosmetic disfigurements and functional disabilities that affect quality of life. In literature, several treatment approaches have been described but, to date, no single method is considered superior. The International Advisory Panel on Scar Management recommended the use of intralesional steroid injections for keloids treatment. The efficacy of treatment may be evaluated with subjective scale; as no one can guarantee an objective evaluation. To eliminate the observer and/or patient factors, and to obtain a reliable, consistent, feasible, valid and objective evaluation a skin analysis camera system called Antera3D® (Miravex, Dublin, Ireland) can be used.In this study the authors evaluated the objective efficacy of triamcinolone acetonide treatment in keloids management using this imaging system. In this series, for Antera3D® scores there were statistically significant differences in color, protrusion, melanin and hemoglobin expression levels before and after treatment. The device directly shows the treatment changes, measured objectively and accurately, without bias of traditional evaluation scoring scale.Antera3D® system guarantees an objective evaluation of effectiveness of scar treatment enabling clinicians to modulate the therapy according to the scores registered.

RETRACTED ARTICLE: Long non-coding RNA H19 aggravates keloid progression by upregulating SMAD family member 5 expression via miR-196b-5p

Statement of Retraction Zhichao Li, Cheng Gong & Huiming Wei (2022) Long non-coding RNA H19 aggravates keloid progression by upregulating SMAD family member 5 expression via miR-196b-5p, Bioengineered, 13:1, 1447-1458, DOI: 10.1080/21655979.2021.2019868 Since publication, significant concerns have been raised about the integrity of the data and reported results in the article. When approached for an explanation, the authors did not provide their original data or any necessary supporting information. As verifying the validity of published work is core to the integrity of the scholarly record, we are therefore retracting the article. All authors listed in this publication have been informed. We have been informed in our decision-making by our policy on publishing ethics and integrity and the COPE guidelines on retractions. The retracted article will remain online to maintain the scholarly record, but it will be digitally watermarked on each page as ‘Retracted’.

An approach to treatment modalities of keloids: a comparative study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; In spite of the presence of such an array of treatment modalities, none of these can be claimed to be an ideal treatment option as most of them have limited efficacy, significant side effects or increased chances of recurrence. Hence the study was undertaken to search an ideal treatment for keloids which is safe, effective, and with low rate of recurrence.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Total of 200 patients were recruited out of which only 160 patients were included in study. The patients were divided into three groups and administered with different modes of treatment. Patients in all the groups were followed up at 3 weekly intervals for evaluation of response. At the end of the study, the data was compiled and analysed using appropriate statistical tests.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; In only 32 patients completed study in group 1, 2 and 3 respectively. Group 1, 2 and 3 were more or less equally efficacious with clearance rate. Complete clearance was seen in 24 patients in group 1 patients, in group 2 there were 22 patients with complete clearance and in group 3 there were 24 patients.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Intralesional triamcinolone acetonide, intralesional triamcinolone acetonide with hyaluronidase and intralesional radiofrequency with intralesional triamcinolone acetonide are almost equally effective modalities for the treatment of keloids. But, intralesional triamcinolone acetonide with hyaluronidase fares better than other two as far as safety is concerned with least side effects.&lt;/p&gt;&lt;p class="after-h2"&gt; &lt;/p&gt;

Single-Cell Sequencing Analysis and Weighted Co-Expression Network Analysis Based on Public Databases Identified That TNC Is a Novel Biomarker for Keloid.

BackgroundThe pathophysiology of keloid formation is not yet understood, so the identification of biomarkers for kelod can be one step towards designing new targeting therapies which will improve outcomes for patients with keloids or at risk of developing keloids.MethodsIn this study, we performed single-cell RNA sequencing analysis, weighted co-expression network analysis, and differential expression analysis of keloids based on public databases. And 3 RNA sequencing data from keloid patients in our center were used for validation. Besides, we performed QRT-PCR on keloid tissue and adjacent normal tissues from 16 patients for further verification.ResultsWe identified the sensitive biomarker of keloid: Tenascin-C (TNC). Then, Pseudotime analysis found that the expression level of TNC decreased first, then stabilized and finally increased with fibroblast differentiation, suggesting that TNC may play an potential role in fibroblast differentiation. In addition, there were differences in the infiltration level of macrophages M0 between the TNC-high group and the TNC-low group. Macrophages M0 had a higher infiltration level in low TNC- group (P<0.05).ConclusionOur results can provide a new idea for the diagnosis and treatment of keloid.

Non-Invasive and Surgical Modalities for Scar Management: A Clinical Algorithm.

Scars can lead to aesthetic and functional impairments. The treatment of scars requires meticulous planning and an individually adapted therapeutic strategy. A conceptual algorithm for scar treatment makes everyday clinical work easier for the practitioner and offers more safety for the patient. Based on a retrospective analysis of 1427 patients who presented for treatment of a variety of scars, we developed an algorithm for scar management and treatment. The treatments are presented using case descriptions. Additionally, an electronic search of MEDLINE, EMBASE, and ClinicalTrials.gov databases was performed utilizing combinations of relevant medical subject headings for “scar treatment”, “hypertrophic scar treatment” and “keloid treatment”. Reference lists of relevant articles and reviews were hand-searched for additional reports. Observed outcomes included: conservative scar therapy, minimally invasive scar therapy, and surgical scar therapy using local, regional and free flaps. With this work, we provide an algorithm for safe scar treatment. For better understanding, we have described a clinical case for each algorithm modality.

The Most Current Algorithms for the Treatment and Prevention of Hypertrophic Scars and Keloids: A 2020 Update of the Algorithms Published 10 Years Ago.

Background:In 2010, this Journal published my comprehensive review of the literature on hypertrophic scars and keloids. In that article, I presented evidence-based algorithms for the prevention and treatment of these refractory pathologic scars. In the ensuing decade, substantial progress has been made in the field, including many new randomized controlled trials. To reflect this, I have updated my review.Methods:All studies were evaluated for methodologic quality. Baseline characteristics of patients were extracted along with the interventions and their outcomes. Systematic reviews, meta-analyses, and comprehensive reviews were included if available.Results:Risk factors that promote hypertrophic scar and keloid growth include local factors (tension on the wound/scar), systemic factors (e.g., hypertension), genetic factors (e.g., single-nucleotide polymorphisms), and lifestyle factors. Treatment of hypertrophic scars depends on scar contracture severity: if severe, surgery is the first choice. If not, conservative therapies are indicated. Keloid treatment depends on whether they are small and single or large and multiple. Small and single keloids can be treated radically by surgery with adjuvant therapy (e.g., radiotherapy) or multimodal conservative therapy. For large and multiple keloids, volume- and number-reducing surgery is a choice. Regardless of the treatment(s), patients should be followed up over the long term. Conservative therapies, including gel sheets, tape fixation, topical and injected external agents, oral agents, and makeup therapy, should be administered on a case-by-case basis.Conclusions:Randomized controlled trials on pathologic scar management have increased markedly over the past decade. Although these studies suffer from various limitations, they have greatly improved hypertrophic scar and keloid management. Future high-quality trials are likely to improve the current hypertrophic scar and keloid treatment algorithms further.

The Efficacy of Skin Cooling for Pain Relief during Intralesional Steroid Injection for Keloid Treatment: A Randomized Cross-Over Study

Objective: To evaluate if pre-treatment skin cooling can reduce the pain during steroid injection. Materials and Methods: A randomized cross-over study was conducted between September 2015 and October 2016. This study received ethical approval ID035904 No. MURA2016/152. Forty-four subjects with keloid that needed intralesional steroid injection were divided into three pretreatment groups, no treatment, skin cooling with ice pack, and skin applying with a mixture of lidocaine 2.5% and prilocaine 2.5% (EMLA®), in random order. Pain intensity was measured by using 100-mm visual analogue scale (VAS). The satisfaction levels were assessed with orderly interval rating scale from 1 to 5. Repeated-measure analysis of variance (ANOVA) and Bonferroni pairwise comparison were used for data analyses. Results: The mean VAS score at the time of needle puncturing into the skin and during steroid infiltration was statistically significant lower in skin cooling compared to no treatment group (p&lt;0.001) and EMLA group (p&lt;0.05). The satisfaction level was also statistically significant higher in skin cooling compared to no treatment group (p&lt;0.001) and EMLA group (p&lt;0.001). Thirty-seven patients (84%) selected skin cooling method as the most favorable pre-anesthetic method for intralesional steroid injection. Conclusion: Skin cooling with ice before intralesional steroid injection of keloid effectively reduces pain and patients are also satisfied. Keyword: Keloid, Corticosteroid, Pre-treatment, pain, skin cooling

Combined laser treatment for ear keloids: Case series: Comparison between two mini-invasive protocols: Comparison between two mini-invasive protocols.

Keloids are benign fibrous tumors derived by excessive proliferation of fibroblasts and collagen synthesis after an injury, and they do not regress spontaneously. Earlobes keloids may develop either on the helix or on the anterior or posterior lobe, up to several years after piercing. To evaluate the effectiveness of a combined protocol of CO2laser+dye laser versus CO2laser+dye laser+Enerjet. Eighty patients with a total of 83 ear keloids were divided in two groups: One group has been treated in the same session with a single CO2laser procedure+a pulsed Dye laser procedure; the second group has been treated as the group one with an adjunctive Enerjet procedure. Of the 40 patients for a total of 41 treated keloids in the first group, 85.4% of keloids did not recur during a follow-up period (3months-7years), 14.6% of the lesions recurred (6/41) with mild thickening of the scar and underwent to further treatments. The second group (40 patients, 42keloids) results showed a 90.5% of keloids which did not recur during a follow-up period (3months-2years), while 9.5% of the lesions recurred (4/42) with mild thickening of the scar and underwent to further treatments. Lasers demonstrated a synergistic effect when combined together and an excellent outcome has been obtained in the 88% of treated lesions, with a slighter higher prevalence of excellent outcome of the group treated with a further procedure with Enerjet.

Important role of mechanical microenvironment on macrophage dysfunction during keloid pathogenesis.

Keloid is considered as a tumor-like skin disease with multiple aetiologies including immunological factors and mechanical microenvironment. Macrophages are plastic and diverse immune cells that play a critical role in maintaining tissue homeostasis by removing dead cells, debris, pathogens and repairing tissues after inflammation. The imbalance of M1/M2 macrophages and disturbances in macrophage functions can steer the progression of chronic inflammation and lead to the development of pathological fibrosis in keloid disease. Recently, it has been shown that macrophages are sensitive to mechanical signals, especially stretching tension and tissue stiffness, which can determine macrophage polarization and functions. Higher stretching tension is known to be an important pathogenic factor of keloid, and the formation of keloid will lead to an increase in tissue stiffness. As little is known about the underlying reasons of macrophages dysfunction in keloid, an understanding of how the mechanical microenvironment interacting with macrophages and affecting their behaviours may help provide mechanism insights into keloid pathogenesis. We thus hypothesize that the synergistic effect of stretching tension and matrix stiffness may contribute to the major pathophysiological niche attributes of macrophages' in vivo mechanical microenvironment in keloids. These mechanism insights of how macrophages sense and respond to their mechanical microenvironment would propel the development of novel strategies for keloid treatment.

Pruritus in Keloid Scars: Mechanisms and Treatments.

Keloids are scars that extend beyond the margins of an insulting cutaneous injury. Keloids are often thought to be primarily a cosmetic issue, as they are typically quite raised and pigmented. However, these scars also present with functional symptoms of pruritus and pain that significantly impact quality of life. The symptom of pruritus is frequently overlooked by dermatologists, and treatments are often primarily focused on the gross appearance of the scar. This review describes the prevalence and importance of pruritus in keloids. In addition, the putative mechanisms underlying the development of keloid pruritus, which include neuronal and immunological mechanisms, are discussed. Furthermore, this review describes keloid treatments that have been shown to reduce pruritus, treatments that specifically target the itch, and emerging therapies.

Use of Triamcinolone in keloid

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Keloids are well known for recurrence. There is no standardized regimen for the treatment of keloids. Many different treatment modalities such as surgical excision, intralesional corticosteroids, radiotherapy, and pressure earrings have been used for keloids. Surgical excision alone may result in recurrence rate of 40-100%. Many different modalities of treatment have been tried to prevent recurrence. Aims and objectives of the study was to evaluate the efficacy of Triamcinolone in preventing recurrence of Keloid.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods: &lt;/strong&gt;40 patients who underwent excision of keloid at a tertiary care centre. Surgery alone was performed in 20 patients and surgery with post operative intra lesional Triamcinolone injection was given weekly interval for 6 weeks in another 20 patients. Patients were followed up for the period of 2 years&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results: &lt;/strong&gt;Recurrence was found in 5 patients who underwent excision alone and there was no recurrence among patients who received post operative intra lesional triamcinolone.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Multi modality treatment is better to prevent recurrence of Keloid.&lt;/p&gt;

Botulinum toxin A promotes the transdifferentiation of primary keloid myofibroblasts into adipocyte-like cells.

Keloid is a type of unusually raised scar. Botulinum toxin A (BTX-A) has a great application potential in keloids treatment. Here, we investigated the functional role of BTX-A in keloids. We separated keloid tissues and normal skin tissues from keloid patients and found that the expression of myofibroblast markers, α-SMA, Collagen I, and Collagen III was increased in the keloid tissues as compared with normal skin tissues. Keloid fibroblasts derived from keloid tissues were treated with TGF-β1 to induce the differentiation of fibroblasts into myofibroblasts. The keloid myofibroblasts displayed a significant up-regulation of α-SMA. BTX-A enhanced the expression of adipocyte markers, PPARγ and C/EBPα, and increased the accumulation of lipid droplets, and reduced the expression of α-SMA, Collagen I, and Collagen III in the keloid myofibroblasts. Moreover, BTX-A enhanced the expression of BMP4 and p-smad1/5/8. Noggin (BMP4 antagonist) treatment reversed BTX-A-mediated increase of PPARγ and C/EBPα expression and lipid droplets, and down-regulation of α-SMA, Collagen I, and Collagen III in primary keloid myofibroblasts. In conclusion, BTX-A promoted the transdifferentiation of primary keloid myofibroblasts into adipocyte-like cells, which may attribute to activate BMP4/Smad signalling pathway. Thus, this study provides new insights into the mechanism of BTX-A in keloid.

The effectiveness of long Pulsed Nd:YAG Laser alone for treatment of keloids and hypertrophic scars versus its combination with bleomycin.

Pathological scars are benign hyper-proliferative growths of dermal collagen that causes severe psychological and physical problems. This study was performed to assess and compare safety and clinical efficiency of combined pulsed Nd-YAG laser and intralesional bleomycin versus pulsed Nd-YAG laser alone to treat the hypertrophic scars and keloids. Randomly, 40 patients with hypertrophic scars or keloids were divided into two groups A and B. Group A were handled by pulsed Nd:YAG laser and intralesional bleomycin while group B were handled by pulsed Nd:YAG laser only. Response was assessed subjectively by clinical imaging and modified Vancouver Scar Scale (mVSS). While for objective evaluation, skin biopsies were taken from volunteer patients before and after treatment, and were examined by Hematoxylin and eosin staining (H&E) and Masson trichrome staining. Our study demonstrated almost complete improvement in 4 (20%) patients, partial improvement in 16 (80%) patients and 0 patient with no improvement in group A. Furthermore, in group B, we demonstrated almost complete improvement in 2 (10%) patients, partial in 14 (70%) patients and no improvement in 4 (20%) patients. Modified Vancouver Scar Scale reduced from 10.15 to 3.5 in group A and from 11.05 to 4.95 in group B. Elastica Masson-Goldner staining and Hematoxylin and eosin staining showed that treatment in both groups structurally changed tissue collagen. Long-pulsed Nd-YAG laser combined with intralesional bleomycin could be a promising way for treatment of keloids or hypertrophic scars.

Tauroursodeoxycholic Acid Decreases Keloid Formation by Reducing Endoplasmic Reticulum Stress as Implicated in the Pathogenesis of Keloid.

Keloids are a common form of pathologic wound healing and are characterized by an excessive production of extracellular matrix. This study examined the major contributing mechanism of human keloid pathogenesis using transcriptomic analysis. We identified the upregulation of mitochondrial oxidative stress response, protein processing in the endoplasmic reticulum, and TGF-β signaling in human keloid tissue samples compared to controls, based on ingenuity pathway and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses. Electron microscopic examinations revealed an increased number of dysmorphic mitochondria and expanded endoplasmic reticulum (ER) in human keloid tissue samples than that in controls. Western blot analysis performed using human tissues suggested noticeably higher ER stress signaling in keloids than in normal tissues. Treatment with tauroursodeoxycholic acid (TUDCA), an ER stress inhibitor, significantly decreased scar formation in rabbit models, compared to normal saline and steroid injections. In summary, our findings demonstrate the contributions of mitochondrial dysfunction and dysregulated ER stress signaling in human keloid formation and the potential of TUDCA in the treatment of keloids.