Keloid Therapy Research Articles

Combined Therapeutic Strategies for Keloid Treatment.

Recent advances in keloid management favor the administration of combination therapy over monotherapy. The authors evaluated the safety and efficacy of combination therapy to treat keloids using fractional lasers, cryotherapy, and intralesional corticosteroids. The authors performed a retrospective study involving 35 Korean patients. Each patient underwent treatment using the 1,550 nm nonablative fractional erbium-glass laser, followed by the 10,600 nm ablative fractional carbon dioxide laser. Laser treatment was immediately followed by the administration of superficial cryotherapy and intralesional triamcinolone injection. Therapeutic efficacy was assessed using the Vancouver Scar Scale (VSS) score and the 7-point patient self-assessment score. The mean total and subcategory VSS scores showed statistically significant improvements. The height and pliability scores showed the most significant and quickest responses to the combination therapy. The patients reported remarkable improvement in itching, pain, and limitations of motion after a single combination therapy session. Twenty patients were followed up for 1 year after the discontinuation of the combination treatment, and the recurrence was observed only in one patient. No significant adverse effects were observed throughout the follow-up period. Combination keloid therapy using fractional lasers, superficial cryotherapy, and intralesional triamcinolone injection is safe and more effective than individual monotherapies.

The Efficacy of Combining Fractional Carbon Dioxide Laser With Verapamil Hydrochloride or 5-Fluorouracil in the Treatment of Hypertrophic Scars and Keloids: A Clinical and Immunohistochemical Study.

Ablative fractional laser-assisted therapy is increasingly used to facilitate drug delivery and intensify clinical efficacy of topically applied drugs. To evaluate the effectiveness of combined ablative fractional CO2 laser and topically applied 5-fluorouracil (5-FU) or verapamil hydrochloride in the treatment of hypertrophic scars (HTSs) and keloids and to examine their possible effects on TGF-β1 expression. Thirty patients with HTSs and keloids were randomly treated with combined CO2 laser followed by topical verapamil or 5-FU application or CO2 laser monotherapy. All patients received 4 treatments at 1-month intervals. Subjective and objective assessment was obtained using the Vancouver Scar Scale (VSS). Histological changes and immunohistochemical staining for TGF-β1 were performed. Compared with baseline, there was a significant reduction in the VSS 1 month after the last treatment session in all groups (p < .05). Laser-assisted 5-FU delivery tended to show a higher extent of improvement in scar characteristics than laser-assisted verapamil hydrochloride delivery, without significance. No significant side effects were reported in all patient groups. TGF-β1 expression was significantly decreased after laser sessions. Combined fractional CO2 laser and topical 5-FU or verapamil hydrochloride offer a safe therapy for HTSs and keloids.

TRAF4 Promotes Fibroblast Proliferation in Keloids by Destabilizing p53 via Interacting with the Deubiquitinase USP10

Keloids represent one extreme of aberrant dermal wound healing. One of the important characteristics of keloids is uncontrolled fibroblasts proliferation. However, the mechanism of excessive proliferation of fibroblasts in keloids remains elusive. In this study, we demonstrated that TRAF4 was highly expressed in keloid fibroblasts and promoted fibroproliferation. We investigated the underlying molecular mechanism and found that TRAF4 suppressed the p53 pathway independent of its E3 ubiquitin ligase activity. Specifically, TRAF4 interacted with the deubiquitinase USP10 and blocked the access of p53 to USP10, resulting in p53 destabilization. Knockdown of p53 rescued cell proliferation in TRAF4-knockdown keloid fibroblasts, suggesting that the regulation of proliferation by TRAF4 in keloids relied on p53. Furthermore, in keloid patient samples, TRAF4 expression was inversely correlated with p53-p21 signaling activity. These findings help to elucidate the mechanisms underlying keloid development and indicate that blocking TRAF4 could represent a potential strategy for keloid therapy in the future.

Z-plasty and Postoperative Radiotherapy for Anterior Chest Wall Keloids: An Analysis of 141 Patients.

Background:The therapies for anterior chest wall keloids include surgical excision, postoperative radiotherapy, silicone taping stabilization, and steroid plaster. However, to date, there is no universally accepted combination treatment strategy for anterior chest wall keloids.Methods:All consecutive patients with single or multiple anterior chest wall keloids who underwent keloid excision, tension-reducing suturing, z-plasty, and postoperative radiotherapy in 2013–2016 in Nippon Medical School were included in this case series study. Only keloids that arose from small injuries such as folliculitis or acne were selected. The surgery was followed by tension-reducing self-management of the wounds with silicone tape and steroid plaster. The postsurgical radiotherapy modality was 18 Gy administered in 3 fractions over 3 days. The primary study outcome was keloid recurrence during the 24-month follow-up period. Recurrence was defined as the development of stiff and red lesions in even a small part of the scar that did not respond to 6 months of steroid plaster therapy.Results:In total, 141 patients with 141 lesions were enrolled. Of the 141 lesions, 15 (10.6%) recurred. All recurrences were successfully treated by steroid plaster and steroid injection. The recurrence patients did not differ from the nonrecurrence patients in terms of the size of the original keloid or gender distribution.Conclusions:Anterior chest wall keloids can be successfully treated by customized plans that involve appropriate surgical modalities (including z-plasty) followed by postoperative radiotherapy (18 Gy in 3 fractions over 3 days) and scar self-management with silicone tape and steroid plaster.

Dexamethasone-containing bioactive dressing for possible application in post-operative keloid therapy

Bioactive dressing based on bacterial cellulose modified with carboxymethyl groups (mBC) was successfully prepared and studied. The surface of mBC was activated using carbodiimide chemistry and decorated with alginate/hydroxypropyl cellulose submicroparticles containing dexamethasone phosphate (DEX-P). Prior to their deposition particles were coated with chitosan in order to facilitate their binding to mBC, and to increase the control over the release process. The detailed physicochemical characterization of the particles and the bioactive dressing was performed, including the determination of the particles’ size and size distribution, DEX-P encapsulation efficiency and loading, particles’ distribution on the surface of the mBC membrane, as well as DEX-P release profiles from free and mBC-bound particles. Finally, the preliminary cytotoxicity studies were performed. The fabricated bioactive material releases DEX-P in a controlled manner for as long as 25 h. Biological tests in vitro indicated that the dexamethasone-containing submicroparticles are not toxic toward fibroblasts, while effectively inhibiting their proliferation. The prepared bioactive dressing may be applied in the treatment of the post-operative wounds in the therapy of keloids and in other fibrosis-related therapies.Graphical abstract

A thermosensitive RGD-modified hydroxybutyl chitosan hydrogel as a 3D scaffold for BMSCs culture on keloid treatment

Cell therapy with bone marrow-derived mesenchymal stem cells (BMSCs) is a potential method for many disease treatments, including keloid. In the present study, an Arg-Gly-Asp (RGD) modified hydroxybutyl chitosan (HBC) hydrogel (HBC-RGD) was developed to enhance the adhesion and proliferation of BMSCs within the hydrogel. The successful synthesis of HBC-RGD was confirmed by FTIR and 1H NMR. Both HBC and HBC-RGD hydrogel had desired thermosensitivity, biocompatibility and enzymatic degradability in vitro. Compared with HBC hydrogel, HBC-RGD hydrogel was more beneficial for the adhesion and proliferation of BMSCs. Furthermore, the BMSCs incorporated HBC-RGD (BMSCs/HBC-RGD) hydrogel could inhibit the proliferation of keloid fibroblasts (Kfs) and suppress the nodular collagenous fibers of keloid tissue. These results suggested that the HBC-RGD hydrogel could be applied as a potential 3D hydrogel scaffold for cell culture, and BMSCs/HBC-RGD hydrogel was potential to be applied for keloid therapy with subcutaneous in-situ injection in the future.

KELOIDS TREATMENT USING TRIPLE MEDICINE COMBINATION

Relevance. A lot of conservative approaches have been proposed to the management of keloids, but none of them provides a guaranteed positive result and a stable absence of relapse.&#x0D; Objective: to evaluate the effectiveness and side effects of triple keloid scar therapy.&#x0D; Materials and methods. Thirty-three patients aged 18-69 years, who received treatment of keloids by triple medicine combination therapy, were investigated retrospectively. All patients were divided into two groups. In first one (16 patients) intralesional injections of mixture of 5-fluorouracil, triamcinolone acetonide and bovine origin hyaluronidase were performed. In the second group (17 patients) instead of triamcinolone betamethasone suspension was used. Four sessions of therapy were performed with a monthly interval. Results were assessed 1 month and 6 months after the last session. The planimetric investigation and measurement of scars’ volume were performed. The influence of treatment on the number of telangiectasias within the scar was performed with the help of our method of computer processing of its digital photographs.&#x0D; Results. There was not statistically significant difference in linear size, area and volume of the scars in patients of two groups before beginning of the treatment. One month after the fourth session scars’ width increased statistically significantly. Their length and area also increased but difference did not reach statistically significant level. At the same time maximal height of the scars over surrounding tissues (p&lt;0.001) and their volume (p=0.012 та 0.001) reduced significantly in both groups. There was not difference in percentage of scar volume reduction ((67.4±18.01) % and (74.3±14.71) % correspondingly, p=0.308) in different groups. The main negative effect of treatment was redness of the scars due to purpura and increase of telangiectasias number. Reliable increase of the part of the scars’ surface taken by the telangiectasias was registered in both groups without difference between them. Despite the overall improvement in self-esteem, the patients noted that the change in the color of the scar after the treatment came into the first plane among the factors causing aesthetic dissatisfaction. Supplementary methods of telangiectasias and hyperemia correction were used in 12 patients of the first and 11 patients of the second group. Pain syndrome and itching were eliminated in 11 out of 14 (78.6%) patients in the first group and in 11 out of 15 (73.3%) patients in the second group (p = 0.753). Performed treatment positively influenced patients’ quality of life. Their self-esteem increased essentially ((3.4±2.16) points, p=0.005 and (3.2±1.92) points, p=0.001 correspondingly). At re-examination 6 months after the termination of triple therapy, no statistically significant changes in the size of scars were found, pain and itching did not restore. The quality of life self-esteem remained unchanged.&#x0D; Conclusion. The combined use of 5-fluorouracil, glucocorticoid, and hyaluronidase reduced the protrusion and volume of not-burn keloids in patients of both groups (by (67.4 ± 18.01) % and (74.3 ± 14.71) % respectively (p = 0.308)). Triple medicine therapy permitted to eliminate the pain syndrome and itching in 78.6 % of patients of group where triamcinolone acetonide was used, and in 73.3% of patients who received mixture that included betamethasone suspension (p=0.753). Triple medicine therapy effectiveness, both in term scars’ resizing, and eliminating clinical symptoms and improving the quality of life, was the same for both variants of the combination of drugs. The main side effect, that somewhat worsened the aesthetic result of treatment, was the increase of telangiectasias number. The part of the scar area taken by telangiectasias increased from the (3.4±1.16) % to the (9.7±3.51) %, p&lt;0.001 in the first group and from the (3.3±1.31) % to the (9.7±3.05) %, p&lt;0.001 in the second one. The use of glucocorticoid in triple therapy, which to a lesser extent will stimulate the formation of telangiectasias, will improve the cosmetic result of the treatment.

KELOIDS TREATMENT USING TRIPLE MEDICINE COMBINATION

Relevance. A lot of conservative approaches have been proposed to the management of keloids, but none of them provides a guaranteed positive result and a stable absence of relapse.&#x0D; Objective: to evaluate the effectiveness and side effects of triple keloid scar therapy.&#x0D; Materials and methods. Thirty-three patients aged 18-69 years, who received treatment of keloids by triple medicine combination therapy, were investigated retrospectively. All patients were divided into two groups. In first one (16 patients) intralesional injections of mixture of 5-fluorouracil, triamcinolone acetonide and bovine origin hyaluronidase were performed. In the second group (17 patients) instead of triamcinolone betamethasone suspension was used. Four sessions of therapy were performed with a monthly interval. Results were assessed 1 month and 6 months after the last session. The planimetric investigation and measurement of scars’ volume were performed. The influence of treatment on the number of telangiectasias within the scar was performed with the help of our method of computer processing of its digital photographs.&#x0D; Results. There was not statistically significant difference in linear size, area and volume of the scars in patients of two groups before beginning of the treatment. One month after the fourth session scars’ width increased statistically significantly. Their length and area also increased but difference did not reach statistically significant level. At the same time maximal height of the scars over surrounding tissues (p&lt;0.001) and their volume (p=0.012 та 0.001) reduced significantly in both groups. There was not difference in percentage of scar volume reduction ((67.4±18.01) % and (74.3±14.71) % correspondingly, p=0.308) in different groups. The main negative effect of treatment was redness of the scars due to purpura and increase of telangiectasias number. Reliable increase of the part of the scars’ surface taken by the telangiectasias was registered in both groups without difference between them. Despite the overall improvement in self-esteem, the patients noted that the change in the color of the scar after the treatment came into the first plane among the factors causing aesthetic dissatisfaction. Supplementary methods of telangiectasias and hyperemia correction were used in 12 patients of the first and 11 patients of the second group. Pain syndrome and itching were eliminated in 11 out of 14 (78.6%) patients in the first group and in 11 out of 15 (73.3%) patients in the second group (p = 0.753). Performed treatment positively influenced patients’ quality of life. Their self-esteem increased essentially ((3.4±2.16) points, p=0.005 and (3.2±1.92) points, p=0.001 correspondingly). At re-examination 6 months after the termination of triple therapy, no statistically significant changes in the size of scars were found, pain and itching did not restore. The quality of life self-esteem remained unchanged.&#x0D; Conclusion. The combined use of 5-fluorouracil, glucocorticoid, and hyaluronidase reduced the protrusion and volume of not-burn keloids in patients of both groups (by (67.4 ± 18.01) % and (74.3 ± 14.71) % respectively (p = 0.308)). Triple medicine therapy permitted to eliminate the pain syndrome and itching in 78.6 % of patients of group where triamcinolone acetonide was used, and in 73.3% of patients who received mixture that included betamethasone suspension (p=0.753). Triple medicine therapy effectiveness, both in term scars’ resizing, and eliminating clinical symptoms and improving the quality of life, was the same for both variants of the combination of drugs. The main side effect, that somewhat worsened the aesthetic result of treatment, was the increase of telangiectasias number. The part of the scar area taken by telangiectasias increased from the (3.4±1.16) % to the (9.7±3.51) %, p&lt;0.001 in the first group and from the (3.3±1.31) % to the (9.7±3.05) %, p&lt;0.001 in the second one. The use of glucocorticoid in triple therapy, which to a lesser extent will stimulate the formation of telangiectasias, will improve the cosmetic result of the treatment.

Dose Effect in Adjuvant Radiation Therapy for the Treatment of Resected Keloids

Surgical excision of keloids can result in an insidious cycle of tissue injury and repeat keloid formation unless combined with adjuvant therapy to halt this cycle. We present our results of postoperative radiation therapy for keloids with various dose regimens. A retrospective review of 124 patients with 250 keloid lesions treated with postoperative radiation therapy was analyzed. In this institutional review board-approved study, 125 keloids were treated to 20 Gy in 5 fractions and 125 keloids were treated to 12 to 16 Gy in 3 to 4 fractions. Local failure was defined as redevelopment of any clinically apparent keloid at the treated site. The median age was 34 years (14-84 years). Keloids were located on the ear (34%), neck/shoulder (19%), abdomen (13%), chest (10%), face (9%), breast (7%), extremities (4%), and back (3%). Median keloid size was 4 cm (0.5-20 cm). At a median follow-up of 40 months, the recurrence rate for all lesions was 5.6%. Lesions treated to 20 Gy had a recurrence rate of 1.6% compared with 9.6% with <20 Gy and an odds ratio of 0.16 (P = .02). Upon univariate and multivariate analysis there were no differences in recurrence rate with respect to location, race, gender, age, previously treated lesions, and presence of multiple keloids. The lone predictor for improved control rate was the dose of 20 Gy in 5 fractions compared with less than that. Control rate for lesions treated to a biologically equivalent dose2 of 35 to 36 Gy2, 48 to 52.5 Gy2, and 60 to 72 Gy2 were 10% (P = .007), 8.9% (P = .16), and 1.6% (P = .02), respectively. Surgical excision followed by immediate adjuvant radiation therapy for keloids provides excellent local control and cosmesis. Treatment with a biologically equivalent dose2 > 60 (20 Gy in 5 fractions) yielded superior local control over lower dose regimens.

Antifibrotic Effect of Ethanolic Extract of Nerium indicum Mill. Standardized 5α-Oleandrin on Keloid Fibroblasts Cells

Keloid is a skin lesion caused by an abnormal proliferation of fibroblasts and the deposition of collagen in the wound healing process. Therapy for keloids is relatively limited and mostly has side effects. Recent studies show that 5α-oleandrin from N. indicum Mill. (N. indicum) has anti-keloid effect by inhibiting (proliferation, migration activity and TGF-β1 expression) keloid fibroblast. Further studies with N. indicum extract standardized 5α-oleandrin should be conducted to develop it as an anti-keloid agent by performing at proliferative effects, collagen accumulation, and keloid fibroblast migration. The antifibrotic activity of N. indicum extract on the proliferation of keloid fibroblasts was measured by MTT assay, whereas collagen deposits were observed by Sirius Red method. Observation of keloid fibroblast migration by scratch assay is according to Liang et al. (2009). Ethanol extract of N. indicum standardized 5α-oleandrin can inhibit the proliferation of keloid fibroblas with IC50 0.458 μg/mL, also inhibited collagen deposits with IC50 0.055 μg/mL at incubation for 72 hours. In incubation 48 hours after treatment with ethanol extract of 1.0 μg/mL occurred inhibition of migration significantly compared with control.

Development and Characterisation of the Imiquimod Poly(2-(2-methoxyethoxy)ethyl Methacrylate) Hydrogel Dressing for Keloid Therapy.

The imiquimod-poly(2-(2-methoxyethoxy)ethyl methacrylate) hydrogel (poly(MEO2MA) hydrogel) dressing was developed for the keloid therapy application. Four groups of the hydrogels, including the imiquimod-poly(MEO2MA) hydrogel, crosslinked with 0.2 mol %, 0.4 mol %, 0.6 mol %, and 0.8 mol % of di(ethylene glycol) dimethacrylate cross-linker (DEGDMA), were synthesised and characterised for fabricating the imiquimod-poly(MEO2MA) hydrogel pad. The lower critical solution temperature (LCST) of the poly(MEO2MA) hydrogel was measured at approximately 28 °C and was used as a trigger to control the imiquimod loading and release. The loaded amounts of the imiquimod in the poly(MEO2MA) hydrogel, crosslinked with 0.2 mol % and 0.8 mol % of DEGDMA, were about 27.4 μg and 14.1 μg per 1 mm3 of the hydrogel, respectively. The imiquimod-release profiles of two samples were characterised in a phosphate buffered saline (PBS) solution at 37 °C and the released imiquimod amount were about 45% and 46% of the total loaded imiquimod. The Cell Counting Kit-8 (CCK-8) assay was utilised to analyse the cell viability of keloid fibroblasts cultured on the samples of imiquimod-poly(MEO2MA) hydrogel, crosslinked with 0.2 mol % and 0.8 mol % of DEGDMA. There was around a 34% decrease of the cell viabilities after 2 days, compared with the pure-poly(MEO2MA) hydrogel samples. Therefore, the developed imiquimod-poly(MEO2MA) hydrogel dressing can affect the proliferation of keloid fibroblasts. It should be possible to utilise the hydrogel dressing for the keloid therapy application.

Gene expression profiling analysis of keloids with and without hydrocortisone treatment

The present study aimed to investigate the genetic effects of hydrocortisone (HC) treatment on keloids and screen medicines to be used in a combination therapy of keloids with HC. The dataset GSE7890 was downloaded from Gene Expression Omnibus. It contained data regarding 4 fibroblast samples from normal scar tissue and 5 samples from keloid tissue with HC treatment, as well as 5 samples from normal scar and 5 samples from keloids without HC treatment. Following the identification of differentially expressed genes (DEGs), the functions of these DEGs were analyzed by Gene Ontology (GO) and pathway enrichment analyses. Furthermore, adverse effects of HC were identified using WebGestalt. Additionally, candidate small molecule drugs associated with keloids were selected from a connectivity map database. A total of 166 and 41 DEGs, with and without HC treatment respectively, were only present in dermal fibroblasts from keloids (termed genesets A and B, respectively). A set of 26 DEGs was present following both treatments (geneset C). A number of DEGs in geneset B (COL18A1 and JAG1) were associated with endothelial cell differentiation. However, in genesets A and C, certain genes (CCNB1 and CCNB2) were involved in the cell cycle and p53 signaling pathways, and a number of genes (IL1R1 and COL1A1) were associated with bone loss. Additionally, numerous small molecule drugs (including acemetacin) were associated with keloids. Thus, it has been determined that HC may treat keloids by targeting genes associated to endothelial cell differentiation (COL18A1 and JAG1). However, HC has a number of adverse effects, including bone loss. Acemetacin may be applied in a combination therapy, along with HC, to treat keloids.

Measurement of Pressure in Compressive Magnet Therapy for Auricular Keloids.

Measurement of Pressure in Compressive Magnet Therapy for Auricular Keloids.

TIEG1 Represses Smad7-Mediated Activation of TGF-β1/Smad Signaling in Keloid Pathogenesis

Transforming growth factor-β (TGF-β)/Smad signaling plays a key role in excessive fibrosis and keloid formations. Smad7 is a negative feedback regulator that prevents activation of TGF-β/Smad signaling. However, the regulatory mechanism for Smad7 in the keloid pathogenic process remains elusive. Here, we show that expression of TIEG1 is markedly higher in keloid fibroblasts, whereas protein, mRNA, and promoter activity levels of Smad7 are decreased. When TIEG1 was knocked down with small interfering RNA, both the promoter activity and protein expression of Smad7 were increased, whereas collagen production and the proliferation, migration, and invasion of keloid fibroblasts were decreased. In contrast, TIEG1 overexpression led to a decrease in Smad7 expression and Smad7 promoter activity. Upon TGF-β1 stimulation, TIEG1 promoted Smad2 phosphorylation by down-regulating Smad7. Luciferase reporter assays and chromatin immunoprecipitation assays further showed that TIEG1 can directly bind a GC-box/Sp1 site located between nucleotides -1392 and -1382 in the Smad7 promoter to repress Smad7 promoter activity. Taken together, these findings show that TIEG1 is highly expressed in human keloids and that it directly binds and represses Smad7 promoter-mediated activation of TGF-β/Smad2 signaling, thus providing clues for development of TIEG1 blocking strategies for therapy or prophylaxis of keloids.

The "Sandwich Therapy": A Microsurgical Integrated Approach for Presternal Keloid Treatment.

BackgroundKeloid therapy remains a great challenge for plastic surgeons, especially when the defect cannot be closed primarily, necessitating tissue transplantation. Here, we introduce a new treatment modality, called the sandwich therapy, for presternal keloids; the sandwich therapy incorporates preradiotherapy, superficial circumflex iliac artery perforator (SCIP) flap transplantation, and postradiotherapy.MethodsFrom December 2012 to October 2013, 12 patients received the “sandwich therapy.” For the protocol, all patients went through 5 days of specific events: the precut procedure, preradiotherapy, resection and SCIP flap transplantation, donor site radiotherapy, and final presternal radiotherapy.ResultsAll the flaps survived completely. No complication was observed during the perioperative period. With a mean follow-up of 12 months, only 1 case was reported with an incisional hypertrophic scar. In all patients, the main discomfort complaints were resolved postoperatively.ConclusionsA low-tension or without-tension closure could be achieved with SCIP flap transplantation. The perioperative radiotherapy could further lower the risk of keloid recurrence. The sandwich therapy provides a new surgical approach to presternal keloid treatment.

Advances in therapy of auricular keloid

Auricularis keloids are the keloids locating on the earlobe and helix which often caused by ear piercing, burn wound and skin injury. Because of its high recurrence, the treatment of auricularis keloids is troublesome to ENT doctors. In the past, clinicians harvested some achievements by combining surgical therapy, drug therapy and physical therapy. Keloid therapies were reviewed in this article.

Examination of Epithelial Mesenchymal Transition in Keloid Tissues and Possibility of Keloid Therapy Target.

Background:Keloid is a fibroproliferative skin disorder that is characterized by collagen accumulation and blood vessel proliferation in the reticular layer of the dermis. It is caused by prolonged inflammation after cutaneous injury. Several studies suggested recently that epithelial mesenchymal transition (EMT) is involved in the development of fibrosis. This study assessed whether EMT also participates in keloid development and/or aggravation.Methods:Resected keloid (n = 19) and normal skin (n = 13) samples were subjected to immunohistochemical, immunofluorescent, and Western blot analyses of their expression of epidermal (E-cadherin) and mesenchymal (vimentin) proteins.Results:Immunohistochemical analysis showed that the keloid tissues had more vimentin-positive cells in the epidermis than the normal tissues. When normal primary keratinocytes were cultured with proinflammatory cytokines, the cobblestone-shaped cells changed to a spindle shape and many vimentin-positive cells were detected. When immortalized HaCaT keratinocytes were cocultured in split-well plates with normal or keloid-derived fibroblasts, they also underwent EMT, as indicated by their greater vimentin expression on Western blot analysis compared with HaCaT cells that were cultured alone.Conclusions:EMT was observed in keloid specimens. EMT was induced by inflammatory cytokines and fibroblasts. EMT may be involved in keloid generation and/or aggravation and may have potential as a keloid treatment target.

A Comparison of the Effectiveness of Triamcinolone and Radiation Therapy for Ear Keloids after Surgical Excision: A Systematic Review and Meta-Analysis.

The ear is a common site for keloid formation, usually after trauma or ear piercing. This study is a meta-analysis to identify effective treatments for ear keloids after surgical excision. A systematic literature review and meta-analysis were performed using core databases. Postoperative adjuvant treatment modalities for ear keloids and recurrence rates were extracted and analyzed. Fixed and random effect models were applied. Twenty-five studies published before August of 2015 were identified. The recurrence rate after surgical excision of an ear keloid in the triamcinolone group was estimated as 15.4 percent (95 percent CI, 9.4 to 24.1 percent; p < 0.001). The recurrence rate in the radiation therapy group was estimated as 14.0 percent (95 percent CI, 9.6 to 19.9 percent; p < 0.001). Although a large-scale, randomized study is required for confirmation, both triamcinolone and radiation therapy provided outstanding treatment for ear keloids after surgical excision without a significant difference between the two treatments.

DLQI and POSAS Scores in Keloid Patients.

The treatment of keloids remains complex and challenging. A multitude of different treatment options exists. While current guidelines frequently promote the combination of intralesional triamcinolone acetonide (TAC) and cryotherapy as a first-line therapy for keloids, its efficacy has mainly been proven clinically and objective evaluation is widely missing. Here, we aimed to evaluate the efficacy of TAC and cryotherapy for the improvement of keloids by employing two well-recognized questionnaires for the evaluation of scar appearance and patient's quality of life. Twenty keloid patients from our outpatient scar clinic were treated with individual doses of TAC and cryotherapy in four consecutive sessions. Retrospectively, Patient and Observer Scar Assessment Scale (POSAS) and Dermatology Life Quality Index (DLQI) questionnaire data from those patients were analyzed to evaluate changes over five visits (one baseline, four after treatment). Both overall patient and observer scores of the POSAS significantly decreased (41.10 ± 9.771 to 29.85 ± 11.42 [p < 0.001] and 33.75 ± 6.231 to 22.70 ± 5.992 [p < 0.001], respectively), while DLQI scores significantly declined over the time period studied, indicating significant improvements in scar appearance. Objective evaluation confirmed the clinically demonstrated improvements of scar appearance and symptoms after treatments with TAC and cryotherapy which was associated with significant improvements in quality of life as indicated by DLQI measures. Standardized questionnaires help in objectifying clinical improvements; however, more detailed options for scar documentation, such as objective imaging, may be additionally required for an in-depth analysis of treatment progress.

The Use of Free Tissue Transfer with An Anterolateral Thigh Flap for the Treatment of Large Keloids On the Head and Neck

Keloids are cosmetically, psychologically and functionally debilitating wounds that have proven difficult to treat with surgical excision alone. Large keloids are particularly challenging to treat because many of the current therapies for keloids are unsuitable, and the remaining defect after excision is difficult to close. The authors report a case involving a large disfiguring keloid on the head and neck, which was treated with surgical excision and immediate reconstruction with a free anterolateral thigh fasciocutaneous flap. No further adjuvant therapy was undertaken. At one-year follow-up, there was no recurrence at the recipient site, and the donor site healed without deformity. The free fasciocutaneous anterolateral thigh flap may be effective at treating large keloids in the head and neck region; however, well-controlled clinical studies are needed to establish this.