Background:Hypertrophic scars and keloids,common complications following median sternotomy for cardiac surgery,significantly impact patient quality of life due to their aesthetic and symptomatic burden.Recent advanceme...Background:Hypertrophic scars and keloids,common complications following median sternotomy for cardiac surgery,significantly impact patient quality of life due to their aesthetic and symptomatic burden.Recent advancements in laser therapy have made it a prominent option for managing these complex scars,yet a com-prehensive understanding of its efficacy is lacking.The aim of this scoping review is to explore the effects of laser therapy in managing hypertrophic scars and keloids after median sternotomy.Methods:This scoping review ana-lyzed studies up to February 2024 from databases including PubMed,EMBASE,CINAHL,Scopus,Web of Science,and the Cochrane Library.We included any study that assessed laser therapy’s effects on hypertrophic scars and keloids following median sternotomy.Studies were selected based on predefined inclusion criteria with-out publication year,design,or origin restrictions.Results:Six studies met the inclusion criteria,involving a total offive RCTs and one review.These studies primarily tested 585 and 595-nm pulsed dye laser(PDL)treatments,focusing on scar appearance,patient symptoms,and treatment satisfaction.Most studies reported significant improvements in scar height reduction and patient symptom relief after treatment,with mixed results for scar erythema and elasticity.Adverse events were generally mild and transient.Conclusions:Laser therapy offers a beneficial approach for improving the appearance and symptoms of hypertrophic scars and keloids post-median sternotomy.However,further research is necessary to optimize treatment parameters and explore the long-term psychosocial impacts of this therapy.This review highlights the need for more comprehensive studies to establish standardized treatment protocols and evaluate their effectiveness.展开更多
[Objectives]To investigate the mechanisms and pharmacologic effects of Citri Reticulatae Pericarpium against keloids by network pharmacology systematically.[Methods]TCMSP,Uniprot and BATMAN-TCM databases were used to ...[Objectives]To investigate the mechanisms and pharmacologic effects of Citri Reticulatae Pericarpium against keloids by network pharmacology systematically.[Methods]TCMSP,Uniprot and BATMAN-TCM databases were used to obtain the active constituents and targets of Citri Reticulatae Pericarpium."Keloid"was used as key word to search for related therapeutic targets from Drug Bank,OMIM,TTD,and GEO databases.The Chinese medicine compound-target network was constructed by Cytoscape software.Besides,gene ontology(GO)and Kyoto Encyclopedia of genes and genome enrichment analysis were also performed.Afterward,Discovery Studio software was used to assess the interaction of key components and genes.[Results]Five active components of Citri Reticulatae Pericarpium,773 compound targets and 676 keloid treatment targets were obtained in the databases.After the intersection,there are 47 targets of Citri Reticulatae Pericarpium for treating keloids.Hub genes were identified such as MMP9,IL6,TNF,TP53,and VEGFA,which were enriched in tumor necrosis factor-α,nuclear factor kappa-B,and other signaling pathways.The molecular docking stimulation confirmed the interaction between the MMP9 and three components of Citri Reticulatae Pericarpium.[Conclusions]Citri Reticulatae Pericarpium may play an important role in treating keloids through modulating genes and signaling pathways.The present study sheds light on the mechanisms of active compounds of Citri Reticulatae Pericarpium for the treatment of keloids.展开更多
BACKGROUND Hypertrophic scars and keloid treatment is a major problem in plastic surgery.While small keloids can be treated with resection followed by radiotherapy,large keloids require treatment with a tissue expande...BACKGROUND Hypertrophic scars and keloid treatment is a major problem in plastic surgery.While small keloids can be treated with resection followed by radiotherapy,large keloids require treatment with a tissue expander.Conventional methods increase the need for auxiliary incisions,causing new scar hyperplasia.AIM To introduce a new method for the treatment of keloids with an expander.METHODS Between 2018 and 2021,we performed surgeries to treat large keloids in nine patients with a two-stage approach.In the first stage,an intrascar incision was made in the keloid,and a customized expander was implanted under the keloid and the surrounding normal skin.A period of 3-6 mo was allowed for skin expansion.In the second stage,after the initial incision healed,a follow-up surgery was performed to remove the expander,resect the keloid,and repair the expanded skin flap.To accomplish this,an incision was made along the scar boundary to avoid making a new surgical incision and creating new scars.Superficial radiotherapy was then performed postoperatively.RESULTS Two patients had anterior chest keloids.After treatment,the anterior chest incision was broken repeatedly and then sutured again after debridement.It healed smoothly without scar hyperplasia.Keloids were successfully removed in 7 patients without recurrence.CONCLUSION This method was performed through a keloid incision and with a custom expander embedded.After full expansion,the keloid was directly resected using a linear suture,which avoids new surgical incisions and scars and can successfully remove large-area keloids.The treatment is effective,providing new insights and strategies for the treatment of similar large-area keloid and hypertrophic scar cases in the future.展开更多
Objective: To design and test a treatment regimen which is clinically responsive, readily available, cost effective, and applicable especially to children and women of child bearing age. Design Setting: A prospective ...Objective: To design and test a treatment regimen which is clinically responsive, readily available, cost effective, and applicable especially to children and women of child bearing age. Design Setting: A prospective cohort study. Setting: Two major postgraduate teaching hospitals: one in Tripoli, Libya and the other in Jeddah, Saudi Arabia. Participants: Fifty-seven patients with 79 keloids, referred from Plastic Surgery Units between April 1996 and January 2005. Main Outcome Measure: Degree of flattening of the keloidal lesion and symptomatic recovery. Results: Result of treatment has been analyzed using unified set criteria. Seventy-seven percent of this cohort had complete response. 19% of cases had partial response, 50% acknowledged the treatment outcome had been “satisfactory” and 44% had an “acceptable” outcome. There was no significant acute or delayed reaction. Conclusion: The technique appears universally adaptable, cost effective, and can safely be prescribed for children and women of child-bearing age. In spite of prolonged treatment course, compliance was excellent.展开更多
Keloids are a fibroproliferative disorder of the skin and can cause physical discomfort and psychological burden.Apart from local factors such as skin tension and infection,increasing evidence has suggested that syste...Keloids are a fibroproliferative disorder of the skin and can cause physical discomfort and psychological burden.Apart from local factors such as skin tension and infection,increasing evidence has suggested that systemic endocrine factors also contribute to the emergence and development of keloids.Hormone disorders have long been suspected to be a risk factor;however,previous studies have mainly focused on the role of female hormones and neglected the critical role of male hormones.As we reviewed the published literature addressing sex steroids in pathological scars,we speculated that androgens(i.e.,male hormones)could become actively involved through sebum-associated hypersensitivity reactions and acne-derived skin lesions,resulting in persistent cutaneous inflammation.This hypothesis was also supported by previous in vitro studies,in which elevated androgen levels and androgenic receptors were detected in keloid tissues.Moreover,relief of pain and pruritus has been observed in patients with keloids who accidently received anti-androgen treatment for other irrelevant indications.Thus,we propose that androgen-related disorders are critical in the pathogenesis of keloids,and systemic treatment targeting sex hormones may provide long-term benefits for predisposed patients with multiple keloids.展开更多
Successful treatment of keloids has eluded the medical community since their first description. Multitudes of therapeutic options are available, but none achieves satisfactory resolution of keloids. One major stumblin...Successful treatment of keloids has eluded the medical community since their first description. Multitudes of therapeutic options are available, but none achieves satisfactory resolution of keloids. One major stumbling block is lack of understanding about their genesis. Assuming keloids are tumors, attempts have been made to treat this condition with standard radiotherapy, with dismal results. Keloidal masses are not an active biological entity. They are aggregations of cellular, hypovascular, hypoxic bundles of collagen, which are produced by atypical fibroblasts in the wounds and eventually cease production due to a hostile biological environment. Having no demonstrable inherent process of disposal of these collagen bundles, this excessive collagen tends to linger to form the bulk of keloids. The lesions eventually become symptomatic and aesthetically unacceptable, and therapeutic intervention is sought. Of all available treatments, such as post-resection radiotherapy, primary radiotherapy in selected cases and primary brachytherapy stand out above any other form of treatment. Be it brachytherapy or external beam treatment, one fundamental aspect of radiation action is the process of “radiolysis”, explaining why “radiobiological” approaches have been ineffective.展开更多
Keloids are fibroproliferative disorders that can result from cutaneous injuries to the reticular dermis.Recurrence rates as high as 100%have been reported following surgical excision alone.Consequently,a variety of p...Keloids are fibroproliferative disorders that can result from cutaneous injuries to the reticular dermis.Recurrence rates as high as 100%have been reported following surgical excision alone.Consequently,a variety of post-surgical techniques have been employed to prevent keloid recurrence,including the use of radiation.Although numerous studies have shown that post-excisional X-rays,electron beams,lasers,and brachytherapy can reduce the rate of keloid recurrence,numerous inconsistencies,including a wide range of definitions for keloid recurrence,render it difficult to compare the outcomes.The treatment of severe keloids in children is much more challenging,and there have been few previous reports.It is generally believed that children with keloids should be treated with nonsurgical treatment such as hormone injections and radiotherapy.For severe keloids,these methods require a long treatment period,and their efficacy is not ideal.Moreover,the side effects of the treatment can affect children’s health.If keloid scars are not effectively treated,they will often seriously affect the physical and mental health of children.The purpose of this review is to discuss case studies of children with severe keloids who were only treated with surgery and their postoperative recovery.In this case,the deep-embedded circular mattress suture technique(LBD,the looped,broad,and deep buried suturing technique)was used in the scar resection.After 18 months of follow-up,the surgical scar was evaluated using the Vancouver Scar Scale(VSS).The scar was stable and did not recur.The child was satisfied.This case shows that it is completely feasible to treat severe keloids with surgery alone,as long as the tension is reduced during the operation to prevent surgical scar hyperplasia.展开更多
Objective To investigate the inhibitory effect of photodynamic on keloid by observing the changes of various indicators of keloid under the action of different concentration of photosensitizer aminoketovaleric acid co...Objective To investigate the inhibitory effect of photodynamic on keloid by observing the changes of various indicators of keloid under the action of different concentration of photosensitizer aminoketovaleric acid combined with laser.Methods Fifteen healthy nude mice were randomly divided into experimental group 1,experimental group 2 and control group.Keloid tissue was implanted into the back to form stable pathological scars.10%aminoketovaleric acid solution,20%aminoketovaleric acid solution,saline solution were applied to the back of the nude mice within 4,8 and 12 weeks,respectively,for half an hour,635 nm CW laser irradiation,and scar tissue was cut at 6,10 and 14 weeks for detection.Scar related indicators.Results Scar index,number of fibroblasts,number of TGF-beta 1 protein and alpha-SMA in the experimental group were lower than those in the control group,and more than 2 indexes in the experimental group were lower than those in the experimental group 1.There was significant difference among the groups.Conclusion 20%aminoketovaleric acid can produce cytotoxic effect,induce apoptosis of fibroblasts,regulate and reduce epithelial-mesenchymal transition of scar,and inhibit keloid.展开更多
Background:Hypoxia is the typical characteristic of keloids.The development of keloids is closely related to the abnormal phenotypic transition of macrophages.However,the role of exosomal microRNAs(miRNAs)derived from...Background:Hypoxia is the typical characteristic of keloids.The development of keloids is closely related to the abnormal phenotypic transition of macrophages.However,the role of exosomal microRNAs(miRNAs)derived from hypoxic macrophages in keloids remains unclear.This study aimed to explore the role of hypoxic macrophage-derived exosomes(HMDE)in the occurrence and development of keloids and identify the critical miRNA.Methods:The expression of CD206+M2 macrophage in keloids and normal skin tissues was examined through immunofluorescence.The polarization of macrophages under a hypoxia environment was detected through flow cytometry.The internalization of macrophage-derived exosomes in human keloid fibroblasts(HKFs)was detected using a confocal microscope.miRNA sequencing was used to explore the differentially expressed miRNAs in exosomes derived from the normoxic and hypoxic macrophage.Subsequently,the dual-luciferase reporter assay verified that phosphatase and tension homolog(PTEN)was miR-26b-5p’s target.The biological function of macrophage-derived exosomes,miR-26b-5p and PTEN were detected using the CCK-8,wound-healing and Transwell assays.Western blot assay was used to confirm the miR-26b-5p’s underlying mechanisms and PTEN-PI3K/AKT pathway.Results:We demonstrated that M2-type macrophages were enriched in keloids and that hypoxia treatment could polarize macrophages toward M2-type.Compared with normoxic macrophages-derived exosomes(NMDE),HMDE promote the proliferation,migration and invasion of HKFs.A total of 38 differential miRNAs(18 upregulated and 20 downregulated)were found between the NMDE and HMDE.miR-26b-5p was enriched in HMDE,which could be transmitted to HKFs.According to the results of the functional assay,exosomal miR-26b-5p produced by macrophages facilitated HKFs’migration,invasion and proliferation via the PTEN-PI3K/AKT pathway.Conclusions:The highly expressed miR-26b-5p in HMDE promotes the development of keloids via the PTEN-PI3K/AKT pathway.展开更多
The pervasive use of photo editing applications such as Photoshop and FaceTune has significantly altered societal beauty standards, particularly for individuals with skin of color, often leading to unrealistic expecta...The pervasive use of photo editing applications such as Photoshop and FaceTune has significantly altered societal beauty standards, particularly for individuals with skin of color, often leading to unrealistic expectations regarding skin appearance and health. These tools allow users to smooth skin textures, lighten skin tones, and erase imperfections, perpetuating Eurocentric beauty ideals that frequently marginalize the natural diversity of skin tones and textures. Consequently, individuals with skin of color may seek dermatological interventions—such as skin lightening treatments, aggressive acne scar revisions, and other cosmetic procedures—aimed at achieving appearances that align more closely with digitally manipulated images. This pursuit of an unattainable aesthetic can result in increased dissatisfaction with common skin conditions like hyperpigmentation and keloids, which are often misrepresented in edited photos. Additionally, the psychological impact of these alterations can exacerbate feelings of inadequacy, contributing to conditions such as anxiety and body dysmorphic disorder. Dermatologists face the dual challenge of addressing patients’ clinical needs while also managing their expectations shaped by digital enhancements. To combat this, it is essential for dermatologists to integrate patient education that emphasizes the beauty of diverse skin tones and the discrepancies between digital images and authentic skin health. By fostering an understanding of realistic outcomes and promoting the acceptance of natural skin characteristics, dermatologists can empower individuals with skin of color to prioritize authentic skin health over digitally influenced ideals, ultimately leading to more satisfying dermatological care and improved self-image.展开更多
Objective：Radiation therapy combined with surgical excision was considered as one of the most effective treatment plans for keloid lesions.However,there was no unanimity found over present literatures regarding the i...Objective：Radiation therapy combined with surgical excision was considered as one of the most effective treatment plans for keloid lesions.However,there was no unanimity found over present literatures regarding the issue on optimized treatment strategy for keloids.We here provide a comprehensive review over this issue and emphasize on the influencing factors.Data Sources：The data analyzed in this review were searched from articles included in PubMed and EMBASE databases.Study Selection：The original articles and critical reviews discussing the application of radiation therapy in keloids treatment were selected for this review.Results：The application of radiation therapy has transitioned from simple superficial X-ray irradiation to brachytherapy.Furthermore,several factors including radiation type,dose,fraction,interval,and complications were reviewed,and the results revealed that these factors were significant toward clinical outcome at various levels.Conclusions：Both past and present evidence support the idea that combination therapy of radiation and surgical therapy is safe and feasible.However,the optimization of treatment strategy was based on different radiation types and should take dose,fractions,interval,and complications into consideration,which will then decrease the rate of recurrence and increase the level of satisfaction.展开更多
Background:The clinical features of keloids consist of aberrant proliferation,secretion,differentiation and apoptosis of keloid dermis-derived fibroblasts(KFBs).Notably,the apoptosis rate of KFBs is lower than the pro...Background:The clinical features of keloids consist of aberrant proliferation,secretion,differentiation and apoptosis of keloid dermis-derived fibroblasts(KFBs).Notably,the apoptosis rate of KFBs is lower than the proliferation rate.Though the anti-fibrotic effect of adipose-derived stem cells(ADSCs)on keloids has become a hot topic of research,the exact anti-fibrotic mechanism of the paracrine effect remains unclear.This study aimed to find out how the conditioned medium of ADSCs(ADSC-CM)exerts an anti-fibrotic effect in KFBs.Methods:KFBs and ADSCs were extracted and cultured.Then,ADSC-CM was prepared.Whether ADSC-CM could inhibit KFB growth and induce apoptosis was verified by the use of a cell counting kit-8,an 5-Ethynyl-2-deoxyuridine(Edu)kit and flow cytometry.The expressions of cyclooxygenase-1(COX-1),COX-2,caspase 3 and B-cell lymphoma-2(Bcl-2)in ADSC-CM-cultured KFBs were tested by real-time PCR and western blotting.To clarify the role of COX-2 in ADSC-CM-induced KFB apoptosis,a specific COX-2 inhibitor,celecoxib,was applied to KFBs cultured in ADSC-CM.Moreover,we tested the production of arachidonic acid(AA)and prostaglandin E2(PGE2)by ELISA.Then,we established a keloid transplantation model in a nude mouse to validate the therapeutic effect in vivo.Results:The proliferation ability of KFBs cultured in ADSC-CM was found to be weakened and apoptosis was significantly increased.Caspase 3 expression was significantly upregulated and Bcl-2 was downregulated in ADSC-CM-cultured KFBs.Furthermore,ADSC-CM strikingly elevated COX-2 mRNA and protein expressions,but COX-1 expression was unaltered.COX-2 inhibitors reduced ADSC-CM-induced apoptosis.Additionally,COX-2 inhibition blocked the elevation of caspase 3 and reversed the decrease in Bcl-2 expression.ADSC-CM increased PGE2 levels by 1.5-fold and this effect was restrained by COX-2 inhibition.In the nude mouse model,expressions of AA,COX-2 and PGE2 were higher in the translated keloid tissues after ADSC-CM injection than in the controls.Conclusions:We showed activation of the COX-2/PGE2 cascade in KFBs in response to ADSC-CM.By employing a specific COX-2 inhibitor,COX-2/PGE2 cascade activation played a crucial role in mediating the ADSC-CM-induced KFB apoptosis and anti-proliferation effects.展开更多
Objectives:The present study investigated whether Tripartite Motif-Containing Protein 32(TRIM32)contributes to the aberrant activation of keloid fibroblasts(KFs)via glycolysis.Methods:The expression levels of TRIM32,p...Objectives:The present study investigated whether Tripartite Motif-Containing Protein 32(TRIM32)contributes to the aberrant activation of keloid fibroblasts(KFs)via glycolysis.Methods:The expression levels of TRIM32,pyruvate dehydrogenase kinase 1(PDK1),hexokinase 2(HK2),and glucose transporter 1(GLUT1)in normal human skin fibroblasts(NFs)and KFs were analyzed using RT-qPCR analyses and western blotting.Cellular proliferation,invasion,and migration were evaluated using Transwell,wound healing,5-ethynyl-2′-deoxyuridine(EdU),and cell counting kit-8(CCK-8)assays.The extracellular acidification rate(ECAR)was measured using the XF96 Extracellular Flux Analyzer.Glucose uptake and ATP production were measured using specific assay kits.The expression ofα-smooth muscle actin(α-SMA)was determined by immunofluorescence assays.The expression levels of collagen I,α-smooth muscle actin(α-SMA),fibronectin(FN),and components of the phosphoinositide-3-kinase/protein kinase B(PI3K/AKT)signaling pathway were quantified by western blotting.Results:The expression of TRIM32 and glycolysis-related proteins was significantly elevated in KFs compared to that in NFs.TRIM32 overex-pression enhanced the proliferation,invasion,and migration of KFs,as well as extracellular matrix(ECM)deposition,glucose uptake,and ATP production,while TRIM32 silencing produced the opposite effects.The glycolysis inhibitor,2-deoxy-glucose(2-DG),significantly suppressed the biological functions of KFs;however,TRIM32 overexpression effectively counteracted the inhibitory effects of 2-DG.TRIM32 activated the PI3K/AKT signaling pathway in KFs.The PI3K inhibitor LY294002 decreased cellular glycolysis,with TRIM32 overexpression mitigated these inhibitory effects.Conclusion:This study demonstrated that TRIM32 enhances the viability of KFs by regulating glycolytic activity,potentially mediated via the PI3K/AKT signaling pathway,thereby suggesting novel therapeutic approaches for the treatment of keloids.展开更多
Introduction Keloids, a type of skin lesion that presents as patho-logically excessive dermal fibrosis and aberrant wound healing, are caused by cell proliferation and hyaline degeneration of connective tissues. The s...Introduction Keloids, a type of skin lesion that presents as patho-logically excessive dermal fibrosis and aberrant wound healing, are caused by cell proliferation and hyaline degeneration of connective tissues. The specific pathogenesis of keloids is still unknown(1-2)There are multiple therapeutic strategies for keloids, including surgery, cryotherapy, laser or light-based therapy, and intralesional corticosteroid injection. However, none of these is optimal. Surgical excision combined with adjuvant radiation is considered to be a safer and more efficacious method(3)From publicly available data, the recurrence rate of keloids after simple surgical excision amounts to 45%-100%(4)Based on published reports, postoperative radiotherapy results in a control rate of 67%- 81%, and the recurrence rate decreases to 24.5%-35%(4-12)This article reviews papers related to postoperative radiotherapy treatment for keloids, and also discusses radiation types, parameters, safety and effectiveness.展开更多
Introduction Keloids are a benign proliferative disease of the skin caused by abnormal healing of physiological wounds.Keloids are similar to hypertrophic scars.However,keloids extend beyond the margin of the original...Introduction Keloids are a benign proliferative disease of the skin caused by abnormal healing of physiological wounds.Keloids are similar to hypertrophic scars.However,keloids extend beyond the margin of the original wound and do not spontaneously regress,while hypertrophic scars are confined to the original wound and generally maintain their shape.1 Keloids cause pain,pruritus,restricted joint activity and cosmetic problems,and negatively affect quality of life.The bioactivity of keloids is regulated by various factors,such as transforming growth factor(TGF)-β,connective tissue growth factor(CTGF),and hypoxia inducible factor(HIF).2-4 These inflammatory factors are involved in keloid fibrosis,collagen production,and the deposition of extracellular matrix.However,the pathogenesis of keloids remain unclarified,and it is still one of the most challenging diseases in clinical practice.展开更多
Keloid management has always been frustrating and challenging. The combination therapy of surgical excision and radiation therapy was deemed as the last resort for decades. The authors performed a thorough and compreh...Keloid management has always been frustrating and challenging. The combination therapy of surgical excision and radiation therapy was deemed as the last resort for decades. The authors performed a thorough and comprehensive review over the mechanisms on how radiation therapy damages the keloid cells. The keloid cells' cellular response towards damage induced by irradiation was also studied based on original and current literatures. Mechanisms of damage generated by radiation therapy on keloid cells remained partially understood. However, direct damage was identified playing dominant role, in contrast to damage involved cancer cell apoptosis. Moreover, the p53 pathway and some inflammatory factors like interleukin-6 were believed to function in cellular response to irradiation. However, the transforming growth factor beta, which was the major dysregulated pathway involved in pathogenesis of keloid formation showed no apparent correlation with cellular response to irradiation damage. These pathways could partially explain radiation resistance in some refractory keloid lesions. The scientific basis and experimental proof in this field was still inadequate, which drove us to find more evidence to identify the key regulator response to damage engendered by radiation therapy. Further pathway identification may benefit the drug development to prevent keloid recurrence.展开更多
There has been a long-standing need for guidelines on the diagnosis and treatment of keloids and hypertrophic scars that are based on an understanding of the pathomechanisms that underlie these skin fibrotic diseases....There has been a long-standing need for guidelines on the diagnosis and treatment of keloids and hypertrophic scars that are based on an understanding of the pathomechanisms that underlie these skin fibrotic diseases.This is particularly true for clinicians who deal with Asian and African patients because these ethnicities are highly prone to these diseases.By contrast,Caucasians are less likely to develop keloids and hypertrophic scars,and if they do,the scars tend not to be severe.This ethnic disparity also means that countries vary in terms of their differential diagnostic algorithms.The lack of clear treatment guidelines also means that primary care physicians are currently applying a hotchpotch of treatments,with uneven outcomes.To overcome these issues,the Japan Scar Workshop(JSW)has created a tool that allows clinicians to objectively diagnose and distinguish between keloids,hypertrophic scars,and mature scars.This tool is called the JSW Scar Scale(JSS)and it involves scoring the risk factors of the individual patients and the affected areas.The tool is simple and easy to use.As a result,even physicians who are not accustomed to keloids and hypertrophic scars can easily diagnose them and judge their severity.The JSW has also established a committee that,in cooperation with outside experts in various fields,has prepared a Consensus Document on keloid and hypertrophic scar treatment guidelines.These guidelines are simple and will allow even inexperienced clinicians to choose the most appropriate treatment strategy.The Consensus Document is provided in this article.It describes(1)the diagnostic algorithm for pathological scars and how to differentiate them from clinically similar benign and malignant tumors,(2)the general treatment algorithms for keloids and hypertrophic scars at different medical facilities,(3)the rationale behind each treatment for keloids and hypertrophic scars,and(4)the body site-specific treatment protocols for these scars.We believe that this Consensus Document will be helpful for physicians from all over the world who treat keloids and hypertrophic scars.展开更多
Numerous studies have shown that macrophages can orchestrate the microenvironment from the early stage of wound healing to the later stages of scar formation.However,few reviews have highlighted the significance of ma...Numerous studies have shown that macrophages can orchestrate the microenvironment from the early stage of wound healing to the later stages of scar formation.However,few reviews have highlighted the significance of macrophages during the formation of abnormal scars.The purpose of this reviewwas to outline the polarization of macrophages from early to late stage of pathological scar formation,focusing on spatiotemporal diversity of M1 and M2 macrophages.In this review,the role of macrophages in the formation of hypertrophic scars and keloids is summarized in detail.First,an increased number of M2 cells observed before injuries are significantly associated with susceptibility to abnormal scar pathogenesis.Second,decreased expression of M1 at the early stage and delayed expression of M2 at the late stage results in pathological scar formation.Third,M2 cells are highly expressed at both the margin and the superficial region,which is consistent with the invasive property of keloids.Finally,this review helps to characterize strategies for the prediction and prevention of pathological scar formation.展开更多
Background:Keloids are the result of abnormal wound healing and often are subject to infections and recurrent inflammation.We present a study conducted with a 1470 nm diode laser using an intralesional optical fiber d...Background:Keloids are the result of abnormal wound healing and often are subject to infections and recurrent inflammation.We present a study conducted with a 1470 nm diode laser using an intralesional optical fiber device for the treatment of inflamed keloid scars.We evaluate its efficacy as a novel alternative method to decrease keloid infection and inflammation.Methods:The patients who underwent 1470 nm laser treatment from February 2016 to February 2018 at the plastic and reconstructive surgery department of the Shanghai Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University with keloid accompanying serious local infection and fester were included.Patients took curative effect evaluation before and 1 year after the treatment.The test items included infection frequency in each year;pain,by visual analogue scale(VAS);itch,using VAS;quality of life(QOL),using QOL scale;and blood supply,using PeriCam PSI.Results:A total of 19 patients(mean age 35.21 years,range 11–66)with history of inflamed keloids with episodes of infection or abscess were enrolled.Patients underwent to a 1470 nm laser therapy for average of 1.16 times.After treatment,infection frequency and blood supply in keloids were reduced(p<0.001).Pain,itching,and QOL were improved(p<0.001).Conclusion:The present study shows that 1470 nm fiber laser treatment could improve inflamed keloids fairly well by decreasing inflammation,and a relative stabilization of collagen composition.Therefore,it is an effective minimally invasive scar therapy,but further studies are essential to confirm the present results.展开更多
文摘Background:Hypertrophic scars and keloids,common complications following median sternotomy for cardiac surgery,significantly impact patient quality of life due to their aesthetic and symptomatic burden.Recent advancements in laser therapy have made it a prominent option for managing these complex scars,yet a com-prehensive understanding of its efficacy is lacking.The aim of this scoping review is to explore the effects of laser therapy in managing hypertrophic scars and keloids after median sternotomy.Methods:This scoping review ana-lyzed studies up to February 2024 from databases including PubMed,EMBASE,CINAHL,Scopus,Web of Science,and the Cochrane Library.We included any study that assessed laser therapy’s effects on hypertrophic scars and keloids following median sternotomy.Studies were selected based on predefined inclusion criteria with-out publication year,design,or origin restrictions.Results:Six studies met the inclusion criteria,involving a total offive RCTs and one review.These studies primarily tested 585 and 595-nm pulsed dye laser(PDL)treatments,focusing on scar appearance,patient symptoms,and treatment satisfaction.Most studies reported significant improvements in scar height reduction and patient symptom relief after treatment,with mixed results for scar erythema and elasticity.Adverse events were generally mild and transient.Conclusions:Laser therapy offers a beneficial approach for improving the appearance and symptoms of hypertrophic scars and keloids post-median sternotomy.However,further research is necessary to optimize treatment parameters and explore the long-term psychosocial impacts of this therapy.This review highlights the need for more comprehensive studies to establish standardized treatment protocols and evaluate their effectiveness.
基金Supported by Central Government Funds of Guiding Local Scientific and Technological Development for Sichuan Province(2021ZYD0057).
文摘[Objectives]To investigate the mechanisms and pharmacologic effects of Citri Reticulatae Pericarpium against keloids by network pharmacology systematically.[Methods]TCMSP,Uniprot and BATMAN-TCM databases were used to obtain the active constituents and targets of Citri Reticulatae Pericarpium."Keloid"was used as key word to search for related therapeutic targets from Drug Bank,OMIM,TTD,and GEO databases.The Chinese medicine compound-target network was constructed by Cytoscape software.Besides,gene ontology(GO)and Kyoto Encyclopedia of genes and genome enrichment analysis were also performed.Afterward,Discovery Studio software was used to assess the interaction of key components and genes.[Results]Five active components of Citri Reticulatae Pericarpium,773 compound targets and 676 keloid treatment targets were obtained in the databases.After the intersection,there are 47 targets of Citri Reticulatae Pericarpium for treating keloids.Hub genes were identified such as MMP9,IL6,TNF,TP53,and VEGFA,which were enriched in tumor necrosis factor-α,nuclear factor kappa-B,and other signaling pathways.The molecular docking stimulation confirmed the interaction between the MMP9 and three components of Citri Reticulatae Pericarpium.[Conclusions]Citri Reticulatae Pericarpium may play an important role in treating keloids through modulating genes and signaling pathways.The present study sheds light on the mechanisms of active compounds of Citri Reticulatae Pericarpium for the treatment of keloids.
文摘BACKGROUND Hypertrophic scars and keloid treatment is a major problem in plastic surgery.While small keloids can be treated with resection followed by radiotherapy,large keloids require treatment with a tissue expander.Conventional methods increase the need for auxiliary incisions,causing new scar hyperplasia.AIM To introduce a new method for the treatment of keloids with an expander.METHODS Between 2018 and 2021,we performed surgeries to treat large keloids in nine patients with a two-stage approach.In the first stage,an intrascar incision was made in the keloid,and a customized expander was implanted under the keloid and the surrounding normal skin.A period of 3-6 mo was allowed for skin expansion.In the second stage,after the initial incision healed,a follow-up surgery was performed to remove the expander,resect the keloid,and repair the expanded skin flap.To accomplish this,an incision was made along the scar boundary to avoid making a new surgical incision and creating new scars.Superficial radiotherapy was then performed postoperatively.RESULTS Two patients had anterior chest keloids.After treatment,the anterior chest incision was broken repeatedly and then sutured again after debridement.It healed smoothly without scar hyperplasia.Keloids were successfully removed in 7 patients without recurrence.CONCLUSION This method was performed through a keloid incision and with a custom expander embedded.After full expansion,the keloid was directly resected using a linear suture,which avoids new surgical incisions and scars and can successfully remove large-area keloids.The treatment is effective,providing new insights and strategies for the treatment of similar large-area keloid and hypertrophic scar cases in the future.
文摘Objective: To design and test a treatment regimen which is clinically responsive, readily available, cost effective, and applicable especially to children and women of child bearing age. Design Setting: A prospective cohort study. Setting: Two major postgraduate teaching hospitals: one in Tripoli, Libya and the other in Jeddah, Saudi Arabia. Participants: Fifty-seven patients with 79 keloids, referred from Plastic Surgery Units between April 1996 and January 2005. Main Outcome Measure: Degree of flattening of the keloidal lesion and symptomatic recovery. Results: Result of treatment has been analyzed using unified set criteria. Seventy-seven percent of this cohort had complete response. 19% of cases had partial response, 50% acknowledged the treatment outcome had been “satisfactory” and 44% had an “acceptable” outcome. There was no significant acute or delayed reaction. Conclusion: The technique appears universally adaptable, cost effective, and can safely be prescribed for children and women of child-bearing age. In spite of prolonged treatment course, compliance was excellent.
基金This study was supported by the National Natural Science Foundation(grant no.81671921)Shanghai Municipal Key Clinical Specialty(grant no.shslczdzk00901).
文摘Keloids are a fibroproliferative disorder of the skin and can cause physical discomfort and psychological burden.Apart from local factors such as skin tension and infection,increasing evidence has suggested that systemic endocrine factors also contribute to the emergence and development of keloids.Hormone disorders have long been suspected to be a risk factor;however,previous studies have mainly focused on the role of female hormones and neglected the critical role of male hormones.As we reviewed the published literature addressing sex steroids in pathological scars,we speculated that androgens(i.e.,male hormones)could become actively involved through sebum-associated hypersensitivity reactions and acne-derived skin lesions,resulting in persistent cutaneous inflammation.This hypothesis was also supported by previous in vitro studies,in which elevated androgen levels and androgenic receptors were detected in keloid tissues.Moreover,relief of pain and pruritus has been observed in patients with keloids who accidently received anti-androgen treatment for other irrelevant indications.Thus,we propose that androgen-related disorders are critical in the pathogenesis of keloids,and systemic treatment targeting sex hormones may provide long-term benefits for predisposed patients with multiple keloids.
文摘Successful treatment of keloids has eluded the medical community since their first description. Multitudes of therapeutic options are available, but none achieves satisfactory resolution of keloids. One major stumbling block is lack of understanding about their genesis. Assuming keloids are tumors, attempts have been made to treat this condition with standard radiotherapy, with dismal results. Keloidal masses are not an active biological entity. They are aggregations of cellular, hypovascular, hypoxic bundles of collagen, which are produced by atypical fibroblasts in the wounds and eventually cease production due to a hostile biological environment. Having no demonstrable inherent process of disposal of these collagen bundles, this excessive collagen tends to linger to form the bulk of keloids. The lesions eventually become symptomatic and aesthetically unacceptable, and therapeutic intervention is sought. Of all available treatments, such as post-resection radiotherapy, primary radiotherapy in selected cases and primary brachytherapy stand out above any other form of treatment. Be it brachytherapy or external beam treatment, one fundamental aspect of radiation action is the process of “radiolysis”, explaining why “radiobiological” approaches have been ineffective.
文摘Keloids are fibroproliferative disorders that can result from cutaneous injuries to the reticular dermis.Recurrence rates as high as 100%have been reported following surgical excision alone.Consequently,a variety of post-surgical techniques have been employed to prevent keloid recurrence,including the use of radiation.Although numerous studies have shown that post-excisional X-rays,electron beams,lasers,and brachytherapy can reduce the rate of keloid recurrence,numerous inconsistencies,including a wide range of definitions for keloid recurrence,render it difficult to compare the outcomes.The treatment of severe keloids in children is much more challenging,and there have been few previous reports.It is generally believed that children with keloids should be treated with nonsurgical treatment such as hormone injections and radiotherapy.For severe keloids,these methods require a long treatment period,and their efficacy is not ideal.Moreover,the side effects of the treatment can affect children’s health.If keloid scars are not effectively treated,they will often seriously affect the physical and mental health of children.The purpose of this review is to discuss case studies of children with severe keloids who were only treated with surgery and their postoperative recovery.In this case,the deep-embedded circular mattress suture technique(LBD,the looped,broad,and deep buried suturing technique)was used in the scar resection.After 18 months of follow-up,the surgical scar was evaluated using the Vancouver Scar Scale(VSS).The scar was stable and did not recur.The child was satisfied.This case shows that it is completely feasible to treat severe keloids with surgery alone,as long as the tension is reduced during the operation to prevent surgical scar hyperplasia.
文摘Objective To investigate the inhibitory effect of photodynamic on keloid by observing the changes of various indicators of keloid under the action of different concentration of photosensitizer aminoketovaleric acid combined with laser.Methods Fifteen healthy nude mice were randomly divided into experimental group 1,experimental group 2 and control group.Keloid tissue was implanted into the back to form stable pathological scars.10%aminoketovaleric acid solution,20%aminoketovaleric acid solution,saline solution were applied to the back of the nude mice within 4,8 and 12 weeks,respectively,for half an hour,635 nm CW laser irradiation,and scar tissue was cut at 6,10 and 14 weeks for detection.Scar related indicators.Results Scar index,number of fibroblasts,number of TGF-beta 1 protein and alpha-SMA in the experimental group were lower than those in the control group,and more than 2 indexes in the experimental group were lower than those in the experimental group 1.There was significant difference among the groups.Conclusion 20%aminoketovaleric acid can produce cytotoxic effect,induce apoptosis of fibroblasts,regulate and reduce epithelial-mesenchymal transition of scar,and inhibit keloid.
基金supported by the National Natural Science Foundation of China(81873937).
文摘Background:Hypoxia is the typical characteristic of keloids.The development of keloids is closely related to the abnormal phenotypic transition of macrophages.However,the role of exosomal microRNAs(miRNAs)derived from hypoxic macrophages in keloids remains unclear.This study aimed to explore the role of hypoxic macrophage-derived exosomes(HMDE)in the occurrence and development of keloids and identify the critical miRNA.Methods:The expression of CD206+M2 macrophage in keloids and normal skin tissues was examined through immunofluorescence.The polarization of macrophages under a hypoxia environment was detected through flow cytometry.The internalization of macrophage-derived exosomes in human keloid fibroblasts(HKFs)was detected using a confocal microscope.miRNA sequencing was used to explore the differentially expressed miRNAs in exosomes derived from the normoxic and hypoxic macrophage.Subsequently,the dual-luciferase reporter assay verified that phosphatase and tension homolog(PTEN)was miR-26b-5p’s target.The biological function of macrophage-derived exosomes,miR-26b-5p and PTEN were detected using the CCK-8,wound-healing and Transwell assays.Western blot assay was used to confirm the miR-26b-5p’s underlying mechanisms and PTEN-PI3K/AKT pathway.Results:We demonstrated that M2-type macrophages were enriched in keloids and that hypoxia treatment could polarize macrophages toward M2-type.Compared with normoxic macrophages-derived exosomes(NMDE),HMDE promote the proliferation,migration and invasion of HKFs.A total of 38 differential miRNAs(18 upregulated and 20 downregulated)were found between the NMDE and HMDE.miR-26b-5p was enriched in HMDE,which could be transmitted to HKFs.According to the results of the functional assay,exosomal miR-26b-5p produced by macrophages facilitated HKFs’migration,invasion and proliferation via the PTEN-PI3K/AKT pathway.Conclusions:The highly expressed miR-26b-5p in HMDE promotes the development of keloids via the PTEN-PI3K/AKT pathway.
文摘The pervasive use of photo editing applications such as Photoshop and FaceTune has significantly altered societal beauty standards, particularly for individuals with skin of color, often leading to unrealistic expectations regarding skin appearance and health. These tools allow users to smooth skin textures, lighten skin tones, and erase imperfections, perpetuating Eurocentric beauty ideals that frequently marginalize the natural diversity of skin tones and textures. Consequently, individuals with skin of color may seek dermatological interventions—such as skin lightening treatments, aggressive acne scar revisions, and other cosmetic procedures—aimed at achieving appearances that align more closely with digitally manipulated images. This pursuit of an unattainable aesthetic can result in increased dissatisfaction with common skin conditions like hyperpigmentation and keloids, which are often misrepresented in edited photos. Additionally, the psychological impact of these alterations can exacerbate feelings of inadequacy, contributing to conditions such as anxiety and body dysmorphic disorder. Dermatologists face the dual challenge of addressing patients’ clinical needs while also managing their expectations shaped by digital enhancements. To combat this, it is essential for dermatologists to integrate patient education that emphasizes the beauty of diverse skin tones and the discrepancies between digital images and authentic skin health. By fostering an understanding of realistic outcomes and promoting the acceptance of natural skin characteristics, dermatologists can empower individuals with skin of color to prioritize authentic skin health over digitally influenced ideals, ultimately leading to more satisfying dermatological care and improved self-image.
文摘Objective：Radiation therapy combined with surgical excision was considered as one of the most effective treatment plans for keloid lesions.However,there was no unanimity found over present literatures regarding the issue on optimized treatment strategy for keloids.We here provide a comprehensive review over this issue and emphasize on the influencing factors.Data Sources：The data analyzed in this review were searched from articles included in PubMed and EMBASE databases.Study Selection：The original articles and critical reviews discussing the application of radiation therapy in keloids treatment were selected for this review.Results：The application of radiation therapy has transitioned from simple superficial X-ray irradiation to brachytherapy.Furthermore,several factors including radiation type,dose,fraction,interval,and complications were reviewed,and the results revealed that these factors were significant toward clinical outcome at various levels.Conclusions：Both past and present evidence support the idea that combination therapy of radiation and surgical therapy is safe and feasible.However,the optimization of treatment strategy was based on different radiation types and should take dose,fractions,interval,and complications into consideration,which will then decrease the rate of recurrence and increase the level of satisfaction.
基金supported by grant from the National Natural Science Foundation of China(No.81772085).
文摘Background:The clinical features of keloids consist of aberrant proliferation,secretion,differentiation and apoptosis of keloid dermis-derived fibroblasts(KFBs).Notably,the apoptosis rate of KFBs is lower than the proliferation rate.Though the anti-fibrotic effect of adipose-derived stem cells(ADSCs)on keloids has become a hot topic of research,the exact anti-fibrotic mechanism of the paracrine effect remains unclear.This study aimed to find out how the conditioned medium of ADSCs(ADSC-CM)exerts an anti-fibrotic effect in KFBs.Methods:KFBs and ADSCs were extracted and cultured.Then,ADSC-CM was prepared.Whether ADSC-CM could inhibit KFB growth and induce apoptosis was verified by the use of a cell counting kit-8,an 5-Ethynyl-2-deoxyuridine(Edu)kit and flow cytometry.The expressions of cyclooxygenase-1(COX-1),COX-2,caspase 3 and B-cell lymphoma-2(Bcl-2)in ADSC-CM-cultured KFBs were tested by real-time PCR and western blotting.To clarify the role of COX-2 in ADSC-CM-induced KFB apoptosis,a specific COX-2 inhibitor,celecoxib,was applied to KFBs cultured in ADSC-CM.Moreover,we tested the production of arachidonic acid(AA)and prostaglandin E2(PGE2)by ELISA.Then,we established a keloid transplantation model in a nude mouse to validate the therapeutic effect in vivo.Results:The proliferation ability of KFBs cultured in ADSC-CM was found to be weakened and apoptosis was significantly increased.Caspase 3 expression was significantly upregulated and Bcl-2 was downregulated in ADSC-CM-cultured KFBs.Furthermore,ADSC-CM strikingly elevated COX-2 mRNA and protein expressions,but COX-1 expression was unaltered.COX-2 inhibitors reduced ADSC-CM-induced apoptosis.Additionally,COX-2 inhibition blocked the elevation of caspase 3 and reversed the decrease in Bcl-2 expression.ADSC-CM increased PGE2 levels by 1.5-fold and this effect was restrained by COX-2 inhibition.In the nude mouse model,expressions of AA,COX-2 and PGE2 were higher in the translated keloid tissues after ADSC-CM injection than in the controls.Conclusions:We showed activation of the COX-2/PGE2 cascade in KFBs in response to ADSC-CM.By employing a specific COX-2 inhibitor,COX-2/PGE2 cascade activation played a crucial role in mediating the ADSC-CM-induced KFB apoptosis and anti-proliferation effects.
文摘Objectives:The present study investigated whether Tripartite Motif-Containing Protein 32(TRIM32)contributes to the aberrant activation of keloid fibroblasts(KFs)via glycolysis.Methods:The expression levels of TRIM32,pyruvate dehydrogenase kinase 1(PDK1),hexokinase 2(HK2),and glucose transporter 1(GLUT1)in normal human skin fibroblasts(NFs)and KFs were analyzed using RT-qPCR analyses and western blotting.Cellular proliferation,invasion,and migration were evaluated using Transwell,wound healing,5-ethynyl-2′-deoxyuridine(EdU),and cell counting kit-8(CCK-8)assays.The extracellular acidification rate(ECAR)was measured using the XF96 Extracellular Flux Analyzer.Glucose uptake and ATP production were measured using specific assay kits.The expression ofα-smooth muscle actin(α-SMA)was determined by immunofluorescence assays.The expression levels of collagen I,α-smooth muscle actin(α-SMA),fibronectin(FN),and components of the phosphoinositide-3-kinase/protein kinase B(PI3K/AKT)signaling pathway were quantified by western blotting.Results:The expression of TRIM32 and glycolysis-related proteins was significantly elevated in KFs compared to that in NFs.TRIM32 overex-pression enhanced the proliferation,invasion,and migration of KFs,as well as extracellular matrix(ECM)deposition,glucose uptake,and ATP production,while TRIM32 silencing produced the opposite effects.The glycolysis inhibitor,2-deoxy-glucose(2-DG),significantly suppressed the biological functions of KFs;however,TRIM32 overexpression effectively counteracted the inhibitory effects of 2-DG.TRIM32 activated the PI3K/AKT signaling pathway in KFs.The PI3K inhibitor LY294002 decreased cellular glycolysis,with TRIM32 overexpression mitigated these inhibitory effects.Conclusion:This study demonstrated that TRIM32 enhances the viability of KFs by regulating glycolytic activity,potentially mediated via the PI3K/AKT signaling pathway,thereby suggesting novel therapeutic approaches for the treatment of keloids.
基金the National Natural Science Foundation of China(81872545 and 81703152)the CAMS Innovation Fund for Medical Sciences(CIFMS-2017-I2M-1-017).
文摘Introduction Keloids, a type of skin lesion that presents as patho-logically excessive dermal fibrosis and aberrant wound healing, are caused by cell proliferation and hyaline degeneration of connective tissues. The specific pathogenesis of keloids is still unknown(1-2)There are multiple therapeutic strategies for keloids, including surgery, cryotherapy, laser or light-based therapy, and intralesional corticosteroid injection. However, none of these is optimal. Surgical excision combined with adjuvant radiation is considered to be a safer and more efficacious method(3)From publicly available data, the recurrence rate of keloids after simple surgical excision amounts to 45%-100%(4)Based on published reports, postoperative radiotherapy results in a control rate of 67%- 81%, and the recurrence rate decreases to 24.5%-35%(4-12)This article reviews papers related to postoperative radiotherapy treatment for keloids, and also discusses radiation types, parameters, safety and effectiveness.
文摘Introduction Keloids are a benign proliferative disease of the skin caused by abnormal healing of physiological wounds.Keloids are similar to hypertrophic scars.However,keloids extend beyond the margin of the original wound and do not spontaneously regress,while hypertrophic scars are confined to the original wound and generally maintain their shape.1 Keloids cause pain,pruritus,restricted joint activity and cosmetic problems,and negatively affect quality of life.The bioactivity of keloids is regulated by various factors,such as transforming growth factor(TGF)-β,connective tissue growth factor(CTGF),and hypoxia inducible factor(HIF).2-4 These inflammatory factors are involved in keloid fibrosis,collagen production,and the deposition of extracellular matrix.However,the pathogenesis of keloids remain unclarified,and it is still one of the most challenging diseases in clinical practice.
文摘Keloid management has always been frustrating and challenging. The combination therapy of surgical excision and radiation therapy was deemed as the last resort for decades. The authors performed a thorough and comprehensive review over the mechanisms on how radiation therapy damages the keloid cells. The keloid cells' cellular response towards damage induced by irradiation was also studied based on original and current literatures. Mechanisms of damage generated by radiation therapy on keloid cells remained partially understood. However, direct damage was identified playing dominant role, in contrast to damage involved cancer cell apoptosis. Moreover, the p53 pathway and some inflammatory factors like interleukin-6 were believed to function in cellular response to irradiation. However, the transforming growth factor beta, which was the major dysregulated pathway involved in pathogenesis of keloid formation showed no apparent correlation with cellular response to irradiation damage. These pathways could partially explain radiation resistance in some refractory keloid lesions. The scientific basis and experimental proof in this field was still inadequate, which drove us to find more evidence to identify the key regulator response to damage engendered by radiation therapy. Further pathway identification may benefit the drug development to prevent keloid recurrence.
文摘There has been a long-standing need for guidelines on the diagnosis and treatment of keloids and hypertrophic scars that are based on an understanding of the pathomechanisms that underlie these skin fibrotic diseases.This is particularly true for clinicians who deal with Asian and African patients because these ethnicities are highly prone to these diseases.By contrast,Caucasians are less likely to develop keloids and hypertrophic scars,and if they do,the scars tend not to be severe.This ethnic disparity also means that countries vary in terms of their differential diagnostic algorithms.The lack of clear treatment guidelines also means that primary care physicians are currently applying a hotchpotch of treatments,with uneven outcomes.To overcome these issues,the Japan Scar Workshop(JSW)has created a tool that allows clinicians to objectively diagnose and distinguish between keloids,hypertrophic scars,and mature scars.This tool is called the JSW Scar Scale(JSS)and it involves scoring the risk factors of the individual patients and the affected areas.The tool is simple and easy to use.As a result,even physicians who are not accustomed to keloids and hypertrophic scars can easily diagnose them and judge their severity.The JSW has also established a committee that,in cooperation with outside experts in various fields,has prepared a Consensus Document on keloid and hypertrophic scar treatment guidelines.These guidelines are simple and will allow even inexperienced clinicians to choose the most appropriate treatment strategy.The Consensus Document is provided in this article.It describes(1)the diagnostic algorithm for pathological scars and how to differentiate them from clinically similar benign and malignant tumors,(2)the general treatment algorithms for keloids and hypertrophic scars at different medical facilities,(3)the rationale behind each treatment for keloids and hypertrophic scars,and(4)the body site-specific treatment protocols for these scars.We believe that this Consensus Document will be helpful for physicians from all over the world who treat keloids and hypertrophic scars.
文摘Numerous studies have shown that macrophages can orchestrate the microenvironment from the early stage of wound healing to the later stages of scar formation.However,few reviews have highlighted the significance of macrophages during the formation of abnormal scars.The purpose of this reviewwas to outline the polarization of macrophages from early to late stage of pathological scar formation,focusing on spatiotemporal diversity of M1 and M2 macrophages.In this review,the role of macrophages in the formation of hypertrophic scars and keloids is summarized in detail.First,an increased number of M2 cells observed before injuries are significantly associated with susceptibility to abnormal scar pathogenesis.Second,decreased expression of M1 at the early stage and delayed expression of M2 at the late stage results in pathological scar formation.Third,M2 cells are highly expressed at both the margin and the superficial region,which is consistent with the invasive property of keloids.Finally,this review helps to characterize strategies for the prediction and prevention of pathological scar formation.
基金funded by National Natural Science Foundation of China(81772098)Clinical research booster program(JYL027)+1 种基金Shanghai Health Municipal Bureau foundation(20152227)National Natural Science Foundation of China(81071569).
文摘Background:Keloids are the result of abnormal wound healing and often are subject to infections and recurrent inflammation.We present a study conducted with a 1470 nm diode laser using an intralesional optical fiber device for the treatment of inflamed keloid scars.We evaluate its efficacy as a novel alternative method to decrease keloid infection and inflammation.Methods:The patients who underwent 1470 nm laser treatment from February 2016 to February 2018 at the plastic and reconstructive surgery department of the Shanghai Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University with keloid accompanying serious local infection and fester were included.Patients took curative effect evaluation before and 1 year after the treatment.The test items included infection frequency in each year;pain,by visual analogue scale(VAS);itch,using VAS;quality of life(QOL),using QOL scale;and blood supply,using PeriCam PSI.Results:A total of 19 patients(mean age 35.21 years,range 11–66)with history of inflamed keloids with episodes of infection or abscess were enrolled.Patients underwent to a 1470 nm laser therapy for average of 1.16 times.After treatment,infection frequency and blood supply in keloids were reduced(p<0.001).Pain,itching,and QOL were improved(p<0.001).Conclusion:The present study shows that 1470 nm fiber laser treatment could improve inflamed keloids fairly well by decreasing inflammation,and a relative stabilization of collagen composition.Therefore,it is an effective minimally invasive scar therapy,but further studies are essential to confirm the present results.
