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Dermoscopic examination of different keloids: (A) Before treatment; a keloid scar on the chest showing vascular pattern in the form of arborizing and linear blood vessels. (B) Marked reduction in vascular pattern of keloid on the right knee after intralesional injection of botulinum toxin‐A. (C) Marked reduction in vascular pattern of keloid on the left shoulder after intralesional injection of platelet rich plasma. (D) Moderate reduction in vascular pattern of keloid on the right ear after intralesional injection of triamcinolone acetonide
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Keloids characterize a definitely challenging type of cutaneous scars for which a diversity of therapeutic modalities has been suggested. The aim of this work was to compare the therapeutic efficacy of intralesional injection of botulinum toxin type‐A (BTX‐A), platelet rich plasma (PRP) and triamcinolone acetonide (TAC) in keloids. A total of sixty...
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Citations
... When PRP was injected intraoperatively into KD patients who did not respond to cortisone injection or radiotherapy, KD scars were completely resolved in 53% of patients and completely relapsed at 2 years in 29% of patients. The mean VSS score improved to 3.82 ± 1.98 from 8.18 ± 2.38 at 2 years, indicating PRP injection is an effective and safe method when used as an adjunctive therapy to resection for treating KD scars refractory to conventional therapy [371]. When KD scars were treated with either intralesional botulinum toxin type-A (BTX-A), PRP, or TAC, both BTX-A and PRP could yield a chance for cosmetically better outcomes in KD treatment than conventional TAC injection [372]. ...
Keloids (KD) and hypertrophic scars (HTS), which are quite raised and pigmented and have increased vascularization and cellularity, are formed due to the impaired healing process of cutaneous injuries in some individuals having family history and genetic factors. These scars decrease the quality of life (QOL) of patients greatly, due to the pain, itching, contracture, cosmetic problems, and so on, depending on the location of the scars. Treatment/prevention that will satisfy patients’ QOL is still under development. In this article, we review pharmacotherapy for treating KD and HTS, including the prevention of postsurgical recurrence (especially KD). Pharmacotherapy involves monotherapy using a single drug and combination pharmacotherapy using multiple drugs, where drugs are administered orally, topically and/or through intralesional injection. In addition, pharmacotherapy for KD/HTS is sometimes combined with surgical excision and/or with physical therapy such as cryotherapy, laser therapy, radiotherapy including brachytherapy, and silicone gel/sheeting. The results regarding the clinical effectiveness of each mono-pharmacotherapy for KD/HTS are not always consistent but rather scattered among researchers. Multimodal combination pharmacotherapy that targets multiple sites simultaneously is more effective than mono-pharmacotherapy. The literature was searched using PubMed, Google Scholar, and Online search engines.
... However, the effectiveness of these treatments can vary among individuals. [4][5][6] Regenerative medicine is an evolving field that focuses on restoring impaired function caused by congenital defects, diseases, trauma and aging through repairing, replacing or regenerating cells. 7 In recent years, regenerative medicine has gained significant recognition for its potential in treating various skin conditions such as psoriasis, vitiligo, diabetic wounds and burn scars. ...
... The VRS criterion was examined in this study, and although there was a significant improvement in all three groups (p-value <0.05), no significant difference was observed between the groups ( p-value >0.05). 5 In the third study, 50 patients with hypertrophic scar complaints were divided into two distinct groups. One group received a combined intervention of fractional ablative laser and PRP injection, while the other group received fractional ablative laser alone. ...
The primary objective of this study is to examine the efficiency of various regenerative medicine approaches, such as platelet‐rich plasma, cell therapy, stromal vascular fraction, exosomes and stem cell‐conditioned medium, in the process of healing hypertrophic and keloid scars. Major databases including PubMed, Scopus and Web of Science were systematically searched, and based on the content of the articles and the inclusion and exclusion criteria, eight articles were selected. Out of these eight articles, there were two non‐randomized clinical trial studies (25%), one randomized, single‐blinded comparative study (12.5%), one retrospective clinical observational study (12.5%) and four randomized clinical trial studies (50%). We employed EndNote X8 and Google Sheets to conduct article reviews and extract relevant data. Following the review phase, the studies underwent analysis and categorization. In all eight reviewed studies, the effectiveness of regenerative medicine in treating hypertrophic scars and keloids has been proven. Out of these studies, five (62.5%) focused on the effectiveness of platelet‐rich plasma, two study (25%) examined the effectiveness of stromal vascular fraction and one study (12.5%) explored the efficacy of stem cell‐conditioned medium. In two studies (25%), the treatment methods were added to standard treatment, while in six studies (75%), regenerative medicine was used as the sole treatment method and compared with standard treatment. The use of these treatment methods did not result in any serious side effects for the patients. Regenerative medicine is an effective method with minimal side effects for the treatment of hypertrophic scars and keloids. It can be used as a monotherapy or in combination with other treatment methods. However, further studies are needed to thoroughly evaluate the effectiveness of all sub‐branches of this method.
... Its use in the field in dermatology has expanded beyond its muscle paralyzing effect improving kinetic wrinkles giving a strong rejuvenating effect. It has shown a scar modulating effect in treating surgical and keloidal scars [20][21][22][23][24]. ...
Background
Atrophic post-acne scarring constitutes a troublesome cosmetic concern for both patients and dermatologists. Old and new therapies as well as combinations are being introduced to achieve a satisfactory response. Microneedling has been used either alone or under different combinations for its treatment. The aim was to compare its combination with topical platelet-rich plasma versus its combination with topical Botulinum Toxin-A.
Methods
30 subjects with different types and grades of atrophic post-acne scars completed the study. Right side of the face was treated with microneedling and platelet-rich plasma while the left side was treated microneedling and Botox. Response was assessed using two different scales. Patient satisfaction and pain were also assessed.
Results
Regarding response to therapy and according to the quartile grading scale, there was no statistically significant difference between the two sides where (23.4% & 13.3%) of the right and left sides, respectively, had an excellent response. Regarding the difference in the qualitative global scarring grading system before and after treatment, there was a highly statistically significant improvement on both sides with higher improvement on the right side than left side but in a non-statistically significant way.
Conclusions
Both combinations present efficacious options for treating acne scars with comparable efficacy.
Trial registration
Registered and approved prospectively by the ethical review board of the faculty of medicine, Zagazig University.
... Also, Neinaa et al. [29], showed significant reduction of VSS after treatment with botulinum toxin and platelet rich plasma (PRP) more than those treated by intralesional steroids. ...
Background: Keloid is generally accepted to be the result of prolonged and aberrant wound healing. Botulinum toxin injections are considered an efficient therapy for keloids. The current study evaluated the efficacy and safety of intralesional injection of botulinum toxin in treatment of keloids. Methods: This prospective interventional study was carried out on 20 patients presented with keloids. Patients were treated by intradermal injection at the periphery of lesions by botulinum toxin as 100 IU diluted by 2 ml normal saline (5 IU/ cm3). Vancouver Scar Scale (VSS) and Verbal Rating Scale (VRS) were used for the assessment of the therapeutic efficacy. Results: There was a statistically significant improvement in all VSS and VRS parameters. Vast majority, 18 (90%) patients, were satisfied and 2 (10%) patient was not satisfied. There was non-significant correlation between the age of patients, duration of keloid nor size of keloid in relation to degree of improvement of VSS after treatment. There was positive significant correlation between VSS before treatment and degree of improvement of VSS after treatment. Conclusions: Intralesional injection of botulinum toxin was effective and safe therapeutic techniques in inhibiting keloids regarding the statistically significant improvement on comparing between before treatment and after the end of follow up period.
BACKGROUND
The efficacy of keloid treatment in randomized studies is highly variable. However, no systematic review has been performed to evaluate the effect of different keloid properties on treatment efficacy.
OBJECTIVE
To identify clinically relevant keloid properties that may influence treatment efficacy.
MATERIALS AND METHODS
An electronic database search was conducted. Two reviewers independently selected randomized controlled trials (RCTs) and performed a methodologic quality assessment using the Cochrane risk-of-bias 2.0 tool.
RESULTS
One thousand five hundred twenty studies were screened, and 16 RCTs, involving 1,113 patients, were included. The authors found lower efficacy in older keloids ( n = 3), keloids located on the chest, extremities, pinna, and shoulder ( n = 3), larger keloids ( n = 2), lower baseline Vancouver Scar Scale score ( n = 1), and keloids with history of recurrence ( n = 1). Overall, most studies had a high risk of bias.
CONCLUSION
Only a minority of studies specifically addressed keloid properties, which makes comparisons between studies challenging. The authors' results suggest that keloid location, duration prior to treatment, size, history of recurrence, and severity are clinically relevant keloid properties that affect treatment efficacy. Further studies are crucial to corroborate the authors' findings, establish a clinically relevant keloid classification, and ultimately develop an evidence-based treatment algorithm that takes these properties into account.
Background:
Dermatologists have been looking for ways to improve wound healing and postoperative scar appearance. The safety and efficacy of botulinum toxin type A (BTXA) in the prevention and treatment on pathological scars have become the current research hotspot since it was approved by the US FDA in medical cosmetology in 2002.
Purpose:
This article aims to provide an overview of the clinical research, limitations, and application prospects of BTXA in the prevention and treatment of traumatic or postoperative pathological scars, which can provide a reference and better understanding of relevant studies.
Methods:
The current research progress was summarized and discussed, with new problems and research ideas being proposed ranging from the molecular mechanism of BTXA in preventing and treating pathological scars to its clinical application via investigation and reference research.
Results:
BTXA is effective in relieving itching and pain associated with pathological scars, limiting scar hyperplasia along with preventing scar contracture, but the specific mechanism is still not clear.
Conclusion:
Most of the clinicians have confirmed the clinical effectiveness of BTXA in the prevention and treatment of pathological scars, yet its mode of action and combination therapy need more research.
