[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 There are many available treatment options for keloid;however,single treatments are usually less effective.Therefore,more scientifically rational and effective com-bined treatment methods should be sought t...BACKGROUND There are many available treatment options for keloid;however,single treatments are usually less effective.Therefore,more scientifically rational and effective com-bined treatment methods should be sought to solve the pain associated with keloids.AIM To explore the efficacy and safety of surgical resection and ultra-reduced tension suture combined with superficial radiation as keloid treatment.METHODS Fifteen keloid patients admitted to Qingdao Eighth People's Hospital from June 2020 to January 2022 were enrolled in this retrospective analysis.All patients underwent a comprehensive treatment approach comprising surgical resection,ultra-reduced tension suture incision,and superficial radiation therapy within 24 h postoperatively.The modified Vancouver Scar Scale(mVSS)and Patient and Observer Scar Assessment Scale(POSAS)were used to evaluate the treatment effect,whereas the efficacy,adverse effects,and recurrence rate were observed according to the 12-mo follow-up after treatment.RESULTS The mVSS and POSAS scores at 1 and 6 mo after combination treatment decreased compared to before treatment(P<0.001),and the overall response rate was 93.3%.Only one case recurred,yielding a 6.7%recurrence rate.The incidence of local chromour sedimentation rate in 1–3 mo after radiotherapy was 33.3%(5 patients),all subsiding after 6–9 mo,without complications,such as delayed wound healing or dermatitis.CONCLUSION Surgical resection,super subtraction sutures,and superficial radiotherapy are treatment methods with short courses,low recurrence rates,and good safety profiles.展开更多
Keloids,which are abnormal manifestations of wound healing,can result in significant functional impairment and aesthetic deformities.The pathogenesis of keloids is multifaceted and complex and influenced by various fa...Keloids,which are abnormal manifestations of wound healing,can result in significant functional impairment and aesthetic deformities.The pathogenesis of keloids is multifaceted and complex and influenced by various factors,such as genetics,the environment,and immune responses.The evolution of keloid treatment has progressed from traditional surgical excision to a contemporary combination of therapies including injection and radiation treatments,among others.This article provides a comprehensive review of keloid pathogenesis and treatment,emphasizing the latest advances in the field.Ultimately,this review underscores the necessity for continued research to enhance our understanding of keloid pathogenesis and to devise more effective treatments for this challenging condition.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
Keloid may induce severe impairment of life quality for the patients,although keloid is a cutaneous benign tumor.Collagen triple helix repeat containing protein 1 (Cthrc1) was identified as a novel gene that was origi...Keloid may induce severe impairment of life quality for the patients,although keloid is a cutaneous benign tumor.Collagen triple helix repeat containing protein 1 (Cthrc1) was identified as a novel gene that was originally found in adventitial fibroblasts after arterial injury.To address the role of Cthrcl in keloid,the expression level of Cthrcl was assessed in normal skin and keloid tissue,as well as in normal fibroblasts (NFs)and keloid fibroblasts (KFs)by using quantitative PCR,Western blotting and immunohistochemical analysis.The results showed that Cthrcl was increased in keloid tissue and KFs as compared with normal skin and NFs.Meanwhile,CCK8 and Transwell assays found the cellular proliferation and migration of KFs were increased as compared with NFs.Further,to verify the function of Cthrcl in NFs and K.Fs,we increased Cthrcl expression by transfecting lentivirns (LV) vectors LV-Cthrcl.The cellular proliferation and migration,collagen synthesis and the influence on TGF-β and YAP signaling were tested.The cellular proliferation and migration were increased in NFs-Cthrcl as compared with NFs-control.Meanwhile,YAP expression and nuclear-location was increased in NFs-Cthrcl.On the contrary,when Cthrcl was overexpressed in KFs,the cellular migration was suppressed and YAP expression was reduced and transferred to cytoplasm in KFs-Cthrcl as compared with KFs-control.But the expression level of collagen I was decreased and pSmad2/3 nucleus transfer was suppressed in both NFs-Cthrc1 and KFs-Cthrc1 by using Western blotting and immunofluorescence.Increased Cthrcl activated NFs by promoting YAP nucleus translocation,whereas suppressed KFs by inhibiting YAP nucleus translocation.Enhanced Cthrcl decreased collagen I in both NFs and KFs by inhibiting TGF-β/Smad pathway.In conclusion,Cthrcl may play a role in the pathogenesis of keloid by inhibiting collagen synthesis and fibroblasts migration via suppressing TGF-β/Smad pathway and YAP nucleus translocation.展开更多
The levels of hsa circular RNA_0002198(hsa_circ_0002198)have been found to be significantly upregulated in keloid dermal fibroblasts.However,the functional role of hsa_circ_0002198 in keloid fibroblasts and the underl...The levels of hsa circular RNA_0002198(hsa_circ_0002198)have been found to be significantly upregulated in keloid dermal fibroblasts.However,the functional role of hsa_circ_0002198 in keloid fibroblasts and the underlying molecular mechanism for its effects have not been reported.In this study,the levels of hsa_circ_0002198 and nucleotide-binding and oligomerization domain,leucine rich repeat and pyrin domain containing 3(NLRP3)expression in keloid scar tissues and adjacent normal skin tissues were determined by quantitative real-time PCR and western blotting,respectively.In vitro models of keloid tissue were created by culturing primary keloid fibroblasts obtained from patients.A series of functional experiments,including CCK-8 assays,Transwell assays,and ELISA assays were performed to analyze the functional role of hsa_circ_0002198/NLRP3.Our data showed that hsa_circ_0002198 and NLRP3 were upregulated in keloid scar tissues when compared with adjacent normal tissues.Knockdown of hsa_circ_0002198 expression significantly suppressed cell proliferation,migration,and invasion,and those effects could be partially reversed by forced NLRP3 overexpression in keloid fibroblasts.At the molecular level,knockdown of hsa_circ_0002198 downregulated the levels of Col I,α-SMA,and NLRP3 proteins,as well as the levels of TGF-β,IL-1ß,and IL-33,but upregulated caspase 3 expression in keloid fibroblasts.All those effects were partially reversed after NLRP3 overexpression.In conclusion,our results suggest hsa_circ_0002198 as a potential target for treating keloid lesions.展开更多
Background: A wide range of therapies exist for keloids. But despite the multiple treatment modalities available, keloids still remain a significant challenge for both the clinician and the patient. Objective: To asse...Background: A wide range of therapies exist for keloids. But despite the multiple treatment modalities available, keloids still remain a significant challenge for both the clinician and the patient. Objective: To assess the effectiveness and safety of debulking of keloid with intralesional injection of 5-flurouracil and triamcinolone in comparison to intralesional injection of 5-flurouracil and triamcinolone alone. Patient and Methods: This single blinded comparative therapeutic outpatient based study was done at the Department of Dermatology, Baghdad Teaching Hospital during the period from February 2011 to February 2013. Twenty-three patients with 52 lesions were enrolled in the study and consisted of two groups: Group A (26 lesions): Treated by intralesional injection of combination of 5-flurouracil and triamcinolone acetonide and repeated every month;Group B (26 lesions): Debulking was carried out first and then injection of combination of 5-flurouracil and triamcinolone acetonide at time of operation and then repeated injection monthly. Evaluation was performed by scoring system with 5 criteria (redness, elevation, hardness, itching and tenderness). The response was graded as no response, minimal, moderate or complete response. Results: Both modalities of treatments showed significant results in treating keloid, but the intralesional therapy alone was slightly better than debulking plus intralesional and no systemic adverse effects were noticed in both groups. Conclusion: Both modalities of therapy were effective in treatment of keloid, and there was no much difference between them.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 notorious fibroproliferative disorder that may cause cosmetic concerns and life inconvenience.Various methods such as surgery,injection,and laser have been used;however,single treatments are at risk of r...Keloids are a notorious fibroproliferative disorder that may cause cosmetic concerns and life inconvenience.Various methods such as surgery,injection,and laser have been used;however,single treatments are at risk of recurrence;therefore,comprehensive therapy is the better solution.Here,we focused on the management of different medical interventions according to subjective and objective conditions of keloid patients and summarized several clinical comprehensive strategies based on our clinical experience.One original concept of laser combined with radiotherapy was also introduced as a promising method,especially for wide-based pathological scars.展开更多
Presternal butterfly keloid management remains a clinical challenge. This case indicates, with hypo fractionated external beam electron therapy a significant symptomatic and cosmetic benefit may be achieved without an...Presternal butterfly keloid management remains a clinical challenge. This case indicates, with hypo fractionated external beam electron therapy a significant symptomatic and cosmetic benefit may be achieved without any unacceptable acute, chronic or long term toxicity.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
Aim: The sternal region, cervico-mandibular region and the intra-mammary region have been the bane of many cutaneous surgeons, with a higher propensity for poor scarring and wound complications. In this article, the a...Aim: The sternal region, cervico-mandibular region and the intra-mammary region have been the bane of many cutaneous surgeons, with a higher propensity for poor scarring and wound complications. In this article, the author undertakes a review of different methods of breaking up scars by utilizing zigs and zags, and conducts a pigskin study to measure the reduction in tension that can be achieved by using a simple zigzag technique while performing excisions. Methods: A pigskin study conducted into the use of the simple zigzag to reduce the tension (and thereby scarring) of surgical wounds is reported here, and comparison and review is undertaken of the biomechanics of elliptical excisions and traditional Z-plasties. Results: Using a simple zigzag reduces tension across the midpoint of the scar more effectively than a Z-plasty or a simple elliptical excision. Conclusion: The techniques of breaking up a scar or incision line by using zigs and zags, in a means to reduce scarring, are not new. However, each of these techniques has specific advantages and disadvantages that need consideration by the surgeon. In this paper, a pigskin study is conducted into the use of the simple zigzag to reduce the tension (and thereby reduce the risk of poor scarring) of surgical wounds.展开更多
BACKGROUND Corneal keloid is a rare clinical disease with an unknown etiology,which is easily misdiagnosed.Surgery is the most effective treatment but is rarely reported in the literature.Herein,we report the clinical...BACKGROUND Corneal keloid is a rare clinical disease with an unknown etiology,which is easily misdiagnosed.Surgery is the most effective treatment but is rarely reported in the literature.Herein,we report the clinical features,histopathology,and surgical outcome of a giant corneal keloid with trophoblastic vessels and discuss the genesis of the mass.CASE SUMMARY A 36-year-old young man was admitted to the hospital because of a large mass on the surface of the left cornea.The patient had suffered an injury to his left eye at the age of 6-years-old;however,as the injury did not cause cornea perforation,he did not undergo treatment.Slit lamp exam showed a large,elevated,opaque lesion that covered the entire cornea and protruded from the surface of the eyeball.Anterior segment optical coherence tomography(AS-OCT) revealed a lesion of irregular density involving the anterior stroma.We suspected a secondary corneal fibroproliferative mass based on the clinical history,and slit lamp and AS-OCT findings.The patient subsequently underwent a superficial keratectomy and keratoplasty,and the final diagnosis of corneal keloid was confirmed by intraoperative histopathological examination.CONCLUSION Non-penetrating corneal trauma damages corneal epithelium basement membrane,initiating stromal fibrosis and causing corneal keloids.AS-OCT and biopsy confirm diagnosis.展开更多
In this case report, we present a male patient who arrived at the hospital for the first time at the age of 8 with giant keloids in both ears and diagnosed by the Dermatology and Plastic Surgery as having the “Diseas...In this case report, we present a male patient who arrived at the hospital for the first time at the age of 8 with giant keloids in both ears and diagnosed by the Dermatology and Plastic Surgery as having the “Disease of Jorge Lobo”, which is a fungal infection due to the story of the endemic characteristics. After the first surgical intervention, he received guidance from the team for keloids and left the hospital using elastic mesh and a request to change the place where he lived to reduce his contact with the fungi. Fourteen years later, the patient returned to the Plastic Surgery Service having even larger keloids in both ears, twice the size than the first time. We did the second surgical intervention to remove it, but with the patient’s commitment that he would correctly comply with the guidelines determined by the surgical team. After finishing all the steps and a post-operative for the case, we observed the satisfaction and the increase of the patient’s mood, happier and without the embarrassment of that physical defect.展开更多
Keloids are tissue repair formed by exuberant fibrosis appearing after a skin wound, burn, vaccination or post inflammatory (folliculitis or acne lesion). This condition causes standard aesthetic prejudice to those wh...Keloids are tissue repair formed by exuberant fibrosis appearing after a skin wound, burn, vaccination or post inflammatory (folliculitis or acne lesion). This condition causes standard aesthetic prejudice to those who are affected. Its management is difficult and its evolution meshes recurrences. We report here a case of giant keloid in the right ear lobe after a piercing and its support.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
Dermatofibromas are benign soft tissue tumors that predominantly affect the limbs, and more rarely the chest.Keloidal dermatofibroma is a rare subtype with distinct clinicopathological features and an aggressive clini...Dermatofibromas are benign soft tissue tumors that predominantly affect the limbs, and more rarely the chest.Keloidal dermatofibroma is a rare subtype with distinct clinicopathological features and an aggressive clinical course. By researching the evolution of the disease in this study, we aimed to summarize our experience of managing a rare patient who underwent five surgeries for keloidal dermatofibroma that developed sequentially in the upper arm and chest and propose a novel treatment for keloidal dermatofibroma. We concluded that keloidal dermatofibroma involving larger areas, high tension sites, and multiple localizations can be treated using the principles of pathological scar management.展开更多
Objective:To study the expression of hypoxia-inducible factor-1α (HIF-1α) in keloid and its correlation with angiogenesis, inflammatory response and apoptosis.Methods:Keloid samples removed in the Third People's...Objective:To study the expression of hypoxia-inducible factor-1α (HIF-1α) in keloid and its correlation with angiogenesis, inflammatory response and apoptosis.Methods:Keloid samples removed in the Third People's Hospital of Chengdu between June 2014 and March 2017 were selected as the pathology group of the research, and normal skin tissues removed in the Third People's Hospital of Chengdu due to injury were selected as the control group of the research. The expression of HIF-1α, angiogenesis molecules, inflammatory response cytokines and apoptosis molecules in keloid samples normal skin tissues were detected.Results: HIF-1α, VEGF165, Flt-1, Flk-1, Ang-1, Tie-2, PGE2, PGF2 , MIF, Livin and Survivin mRNA expression in keloid of pathology group were significantly higher than those in normal skin tissue of control group while TSG-6, Caspase-3, Caspase-7 and Caspase-9 mRNA expression were significantly lower than those in normal skin tissue of control group;HIF-1α mRNA expression was positively correlated with VEGF165, Flt-1, Flk-1, Ang-1, Tie-2, PGE2, PGF2 , MIF, Livin and Survivin mRNA expression, and negatively correlated with TSG-6, Caspase-3, Caspase-7 and Caspase-9 mRNA expression.Conclusion:HIF-1α is highly expressed in keloid and can promote angiogenesis and inflammatory response and inhibit apoptosis.展开更多
Background:Microarray analysis is a popular tool to investigate the function of genes that are responsi-ble for the phenotype of the disease.Keloid is a intricate lesion which is probably modulated by interplay of man...Background:Microarray analysis is a popular tool to investigate the function of genes that are responsi-ble for the phenotype of the disease.Keloid is a intricate lesion which is probably modulated by interplay of manygenes.We ventured to study the differences of gene expressions between keloids and normal skins with the aid ofcDNA microarray in order to explore the molecular mechanism underlying keloid formation.Methods:The PCRproducts of 8400 human genes were spotted on a chip in array.The DNAs were t...展开更多
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.
基金This study was reviewed and approved by the Ethics Committee of Qingdao Eighth People’s Hospital(Approval no.:QBYLL-KY-2023-013).
文摘BACKGROUND There are many available treatment options for keloid;however,single treatments are usually less effective.Therefore,more scientifically rational and effective com-bined treatment methods should be sought to solve the pain associated with keloids.AIM To explore the efficacy and safety of surgical resection and ultra-reduced tension suture combined with superficial radiation as keloid treatment.METHODS Fifteen keloid patients admitted to Qingdao Eighth People's Hospital from June 2020 to January 2022 were enrolled in this retrospective analysis.All patients underwent a comprehensive treatment approach comprising surgical resection,ultra-reduced tension suture incision,and superficial radiation therapy within 24 h postoperatively.The modified Vancouver Scar Scale(mVSS)and Patient and Observer Scar Assessment Scale(POSAS)were used to evaluate the treatment effect,whereas the efficacy,adverse effects,and recurrence rate were observed according to the 12-mo follow-up after treatment.RESULTS The mVSS and POSAS scores at 1 and 6 mo after combination treatment decreased compared to before treatment(P<0.001),and the overall response rate was 93.3%.Only one case recurred,yielding a 6.7%recurrence rate.The incidence of local chromour sedimentation rate in 1–3 mo after radiotherapy was 33.3%(5 patients),all subsiding after 6–9 mo,without complications,such as delayed wound healing or dermatitis.CONCLUSION Surgical resection,super subtraction sutures,and superficial radiotherapy are treatment methods with short courses,low recurrence rates,and good safety profiles.
文摘Keloids,which are abnormal manifestations of wound healing,can result in significant functional impairment and aesthetic deformities.The pathogenesis of keloids is multifaceted and complex and influenced by various factors,such as genetics,the environment,and immune responses.The evolution of keloid treatment has progressed from traditional surgical excision to a contemporary combination of therapies including injection and radiation treatments,among others.This article provides a comprehensive review of keloid pathogenesis and treatment,emphasizing the latest advances in the field.Ultimately,this review underscores the necessity for continued research to enhance our understanding of keloid pathogenesis and to devise more effective treatments for this challenging condition.
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.
基金This work was supported by the National Natural Science Foundation of China (No.81472886 and No. 81172588).
文摘Keloid may induce severe impairment of life quality for the patients,although keloid is a cutaneous benign tumor.Collagen triple helix repeat containing protein 1 (Cthrc1) was identified as a novel gene that was originally found in adventitial fibroblasts after arterial injury.To address the role of Cthrcl in keloid,the expression level of Cthrcl was assessed in normal skin and keloid tissue,as well as in normal fibroblasts (NFs)and keloid fibroblasts (KFs)by using quantitative PCR,Western blotting and immunohistochemical analysis.The results showed that Cthrcl was increased in keloid tissue and KFs as compared with normal skin and NFs.Meanwhile,CCK8 and Transwell assays found the cellular proliferation and migration of KFs were increased as compared with NFs.Further,to verify the function of Cthrcl in NFs and K.Fs,we increased Cthrcl expression by transfecting lentivirns (LV) vectors LV-Cthrcl.The cellular proliferation and migration,collagen synthesis and the influence on TGF-β and YAP signaling were tested.The cellular proliferation and migration were increased in NFs-Cthrcl as compared with NFs-control.Meanwhile,YAP expression and nuclear-location was increased in NFs-Cthrcl.On the contrary,when Cthrcl was overexpressed in KFs,the cellular migration was suppressed and YAP expression was reduced and transferred to cytoplasm in KFs-Cthrcl as compared with KFs-control.But the expression level of collagen I was decreased and pSmad2/3 nucleus transfer was suppressed in both NFs-Cthrc1 and KFs-Cthrc1 by using Western blotting and immunofluorescence.Increased Cthrcl activated NFs by promoting YAP nucleus translocation,whereas suppressed KFs by inhibiting YAP nucleus translocation.Enhanced Cthrcl decreased collagen I in both NFs and KFs by inhibiting TGF-β/Smad pathway.In conclusion,Cthrcl may play a role in the pathogenesis of keloid by inhibiting collagen synthesis and fibroblasts migration via suppressing TGF-β/Smad pathway and YAP nucleus translocation.
基金This study was supported by The Natural Science Foundation of Hainan Province(Project No.817338)Hainan Province in 2019–2021 Provincial Key Subject Construction Project of Traditional Chinese Medicine(The Oncology Department)(No.S100111.401).
文摘The levels of hsa circular RNA_0002198(hsa_circ_0002198)have been found to be significantly upregulated in keloid dermal fibroblasts.However,the functional role of hsa_circ_0002198 in keloid fibroblasts and the underlying molecular mechanism for its effects have not been reported.In this study,the levels of hsa_circ_0002198 and nucleotide-binding and oligomerization domain,leucine rich repeat and pyrin domain containing 3(NLRP3)expression in keloid scar tissues and adjacent normal skin tissues were determined by quantitative real-time PCR and western blotting,respectively.In vitro models of keloid tissue were created by culturing primary keloid fibroblasts obtained from patients.A series of functional experiments,including CCK-8 assays,Transwell assays,and ELISA assays were performed to analyze the functional role of hsa_circ_0002198/NLRP3.Our data showed that hsa_circ_0002198 and NLRP3 were upregulated in keloid scar tissues when compared with adjacent normal tissues.Knockdown of hsa_circ_0002198 expression significantly suppressed cell proliferation,migration,and invasion,and those effects could be partially reversed by forced NLRP3 overexpression in keloid fibroblasts.At the molecular level,knockdown of hsa_circ_0002198 downregulated the levels of Col I,α-SMA,and NLRP3 proteins,as well as the levels of TGF-β,IL-1ß,and IL-33,but upregulated caspase 3 expression in keloid fibroblasts.All those effects were partially reversed after NLRP3 overexpression.In conclusion,our results suggest hsa_circ_0002198 as a potential target for treating keloid lesions.
文摘Background: A wide range of therapies exist for keloids. But despite the multiple treatment modalities available, keloids still remain a significant challenge for both the clinician and the patient. Objective: To assess the effectiveness and safety of debulking of keloid with intralesional injection of 5-flurouracil and triamcinolone in comparison to intralesional injection of 5-flurouracil and triamcinolone alone. Patient and Methods: This single blinded comparative therapeutic outpatient based study was done at the Department of Dermatology, Baghdad Teaching Hospital during the period from February 2011 to February 2013. Twenty-three patients with 52 lesions were enrolled in the study and consisted of two groups: Group A (26 lesions): Treated by intralesional injection of combination of 5-flurouracil and triamcinolone acetonide and repeated every month;Group B (26 lesions): Debulking was carried out first and then injection of combination of 5-flurouracil and triamcinolone acetonide at time of operation and then repeated injection monthly. Evaluation was performed by scoring system with 5 criteria (redness, elevation, hardness, itching and tenderness). The response was graded as no response, minimal, moderate or complete response. Results: Both modalities of treatments showed significant results in treating keloid, but the intralesional therapy alone was slightly better than debulking plus intralesional and no systemic adverse effects were noticed in both groups. Conclusion: Both modalities of therapy were effective in treatment of keloid, and there was no much difference between them.
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 is supported by the National Nature Science Foundation of China(81101432 and 81272036).
文摘Keloids are a notorious fibroproliferative disorder that may cause cosmetic concerns and life inconvenience.Various methods such as surgery,injection,and laser have been used;however,single treatments are at risk of recurrence;therefore,comprehensive therapy is the better solution.Here,we focused on the management of different medical interventions according to subjective and objective conditions of keloid patients and summarized several clinical comprehensive strategies based on our clinical experience.One original concept of laser combined with radiotherapy was also introduced as a promising method,especially for wide-based pathological scars.
文摘Presternal butterfly keloid management remains a clinical challenge. This case indicates, with hypo fractionated external beam electron therapy a significant symptomatic and cosmetic benefit may be achieved without any unacceptable acute, chronic or long term toxicity.
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Aim: The sternal region, cervico-mandibular region and the intra-mammary region have been the bane of many cutaneous surgeons, with a higher propensity for poor scarring and wound complications. In this article, the author undertakes a review of different methods of breaking up scars by utilizing zigs and zags, and conducts a pigskin study to measure the reduction in tension that can be achieved by using a simple zigzag technique while performing excisions. Methods: A pigskin study conducted into the use of the simple zigzag to reduce the tension (and thereby scarring) of surgical wounds is reported here, and comparison and review is undertaken of the biomechanics of elliptical excisions and traditional Z-plasties. Results: Using a simple zigzag reduces tension across the midpoint of the scar more effectively than a Z-plasty or a simple elliptical excision. Conclusion: The techniques of breaking up a scar or incision line by using zigs and zags, in a means to reduce scarring, are not new. However, each of these techniques has specific advantages and disadvantages that need consideration by the surgeon. In this paper, a pigskin study is conducted into the use of the simple zigzag to reduce the tension (and thereby reduce the risk of poor scarring) of surgical wounds.
文摘BACKGROUND Corneal keloid is a rare clinical disease with an unknown etiology,which is easily misdiagnosed.Surgery is the most effective treatment but is rarely reported in the literature.Herein,we report the clinical features,histopathology,and surgical outcome of a giant corneal keloid with trophoblastic vessels and discuss the genesis of the mass.CASE SUMMARY A 36-year-old young man was admitted to the hospital because of a large mass on the surface of the left cornea.The patient had suffered an injury to his left eye at the age of 6-years-old;however,as the injury did not cause cornea perforation,he did not undergo treatment.Slit lamp exam showed a large,elevated,opaque lesion that covered the entire cornea and protruded from the surface of the eyeball.Anterior segment optical coherence tomography(AS-OCT) revealed a lesion of irregular density involving the anterior stroma.We suspected a secondary corneal fibroproliferative mass based on the clinical history,and slit lamp and AS-OCT findings.The patient subsequently underwent a superficial keratectomy and keratoplasty,and the final diagnosis of corneal keloid was confirmed by intraoperative histopathological examination.CONCLUSION Non-penetrating corneal trauma damages corneal epithelium basement membrane,initiating stromal fibrosis and causing corneal keloids.AS-OCT and biopsy confirm diagnosis.
文摘In this case report, we present a male patient who arrived at the hospital for the first time at the age of 8 with giant keloids in both ears and diagnosed by the Dermatology and Plastic Surgery as having the “Disease of Jorge Lobo”, which is a fungal infection due to the story of the endemic characteristics. After the first surgical intervention, he received guidance from the team for keloids and left the hospital using elastic mesh and a request to change the place where he lived to reduce his contact with the fungi. Fourteen years later, the patient returned to the Plastic Surgery Service having even larger keloids in both ears, twice the size than the first time. We did the second surgical intervention to remove it, but with the patient’s commitment that he would correctly comply with the guidelines determined by the surgical team. After finishing all the steps and a post-operative for the case, we observed the satisfaction and the increase of the patient’s mood, happier and without the embarrassment of that physical defect.
文摘Keloids are tissue repair formed by exuberant fibrosis appearing after a skin wound, burn, vaccination or post inflammatory (folliculitis or acne lesion). This condition causes standard aesthetic prejudice to those who are affected. Its management is difficult and its evolution meshes recurrences. We report here a case of giant keloid in the right ear lobe after a piercing and its support.
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Dermatofibromas are benign soft tissue tumors that predominantly affect the limbs, and more rarely the chest.Keloidal dermatofibroma is a rare subtype with distinct clinicopathological features and an aggressive clinical course. By researching the evolution of the disease in this study, we aimed to summarize our experience of managing a rare patient who underwent five surgeries for keloidal dermatofibroma that developed sequentially in the upper arm and chest and propose a novel treatment for keloidal dermatofibroma. We concluded that keloidal dermatofibroma involving larger areas, high tension sites, and multiple localizations can be treated using the principles of pathological scar management.
文摘Objective:To study the expression of hypoxia-inducible factor-1α (HIF-1α) in keloid and its correlation with angiogenesis, inflammatory response and apoptosis.Methods:Keloid samples removed in the Third People's Hospital of Chengdu between June 2014 and March 2017 were selected as the pathology group of the research, and normal skin tissues removed in the Third People's Hospital of Chengdu due to injury were selected as the control group of the research. The expression of HIF-1α, angiogenesis molecules, inflammatory response cytokines and apoptosis molecules in keloid samples normal skin tissues were detected.Results: HIF-1α, VEGF165, Flt-1, Flk-1, Ang-1, Tie-2, PGE2, PGF2 , MIF, Livin and Survivin mRNA expression in keloid of pathology group were significantly higher than those in normal skin tissue of control group while TSG-6, Caspase-3, Caspase-7 and Caspase-9 mRNA expression were significantly lower than those in normal skin tissue of control group;HIF-1α mRNA expression was positively correlated with VEGF165, Flt-1, Flk-1, Ang-1, Tie-2, PGE2, PGF2 , MIF, Livin and Survivin mRNA expression, and negatively correlated with TSG-6, Caspase-3, Caspase-7 and Caspase-9 mRNA expression.Conclusion:HIF-1α is highly expressed in keloid and can promote angiogenesis and inflammatory response and inhibit apoptosis.
文摘Background:Microarray analysis is a popular tool to investigate the function of genes that are responsi-ble for the phenotype of the disease.Keloid is a intricate lesion which is probably modulated by interplay of manygenes.We ventured to study the differences of gene expressions between keloids and normal skins with the aid ofcDNA microarray in order to explore the molecular mechanism underlying keloid formation.Methods:The PCRproducts of 8400 human genes were spotted on a chip in array.The DNAs were t...
