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Photograph of a 27‐year‐old woman with buttock keloid for 2 years which grew rapidly within 3 months. She was trying to conceive and obstetrician did not recommend radiotherapy. (left) Preoperative, (right) at 2 year postoperative. The JSW classification was 18, indicating a high tendency of keloid phenotype. VSS scores were 13 for preoperative and 2 for postoperative; JWS scores were 15 for preoperative and 0 for postoperative; VAS scores were 5 for preoperative and 95 for postoperative
Source publication
Surgical excision combined with postoperative radiotherapy is considered one of the most radical but most effective keloid therapeutic option. However, radiotherapy may not be appropriate for all keloid patients. In this study, we propose an alternate approach to prevent keloid recurrence and provide preliminary assessment in clinical efficacy of t...
Similar publications
Background: Keloids represent an aberrant, poorly understood response during wound healing. Management is still controversial. Especially when located on exposed parts of the body, keloids can seriously affect a person’s appearance and self esteem. Many different treatment modalities may be used for keloids. However, no single method alone has been...
Citations
... Wound tension has been implicated in the pathogenesis of keloid formation. Chen et al. examined the use of a tension offloading device (TOD) applied for 6 months immediately after surgical excision [115]. After 2 years of follow-up, 35 of 38 subjects achieved healing with no recurrence. ...
Background
Keloids are pathologic scars that pose a significant functional and cosmetic burden. They are challenging to treat, despite the multitude of treatment modalities currently available.
Objective
The aim of this study was to conduct an evidence-based review of all prospective data regarding keloid treatments published between 2010 and 2020.
Methods
A systematic literature search of PubMed (National Library of Medicine), Embase (Elsevier), and Cochrane Library (Wiley) was performed in November of 2020. Search strategies with the keywords “keloid” and “treatment” were performed by a medical librarian. The search was limited to prospective studies that were peer-reviewed, reported on clinical outcomes of keloid therapies, and were published in the English language between January 1, 2010, and November 24, 2020.
Results
A total of 3462 unique citations were identified, of which 108 studies met inclusion criteria. Current literature supports silicone gel or sheeting with corticosteroid injections as first-line therapy for keloids. Adjuvant intralesional 5-fluorouracil (5-FU), bleomycin, or verapamil can be considered, although mixed results have been reported with each. Laser therapy can be used in combination with intralesional corticosteroids or topical steroids with occlusion to improve drug penetration. Excision of keloids with immediate post-excision radiation therapy is an effective option for recalcitrant lesions. Finally, silicone sheeting and pressure therapy have evidence for reducing keloid recurrence.
Conclusions
This review was limited by heterogeneity of subject characteristics and study outcome measures, small sample sizes, and inconsistent study designs. Larger and more robust controlled studies are necessary to further understand the variety of existing and emerging keloid treatments, including corticosteroids, cryotherapy, intralesional injections, lasers, photodynamic therapy, excision and radiation, pressure dressings, and others.
... The literature reports several treatments for keloids, but many studies employ questionable methods and report imprecise results, which hinders the establishment of new treatment protocols. Thus, there is no consensus on the best therapy to minimize the risk of recurrence with minimal undesirable side effects [7,10,11,[17][18][19][20][21][22][23][24][25][26][27][28][29]. ...
Keloid scars are characterized by the excessive proliferation of fibroblasts and an imbalance between the production and degradation of collagen, leading to its buildup in the dermis. There is no “gold standard” treatment for this condition, and the recurrence is frequent after surgical procedures removal. In vitro studies have demonstrated that photobiomodulation (PBM) using the blue wavelength reduces the proliferation speed and the number of fibroblasts as well as the expression of TGF-β. There are no protocols studied and established for the treatment of keloids with blue LED. Therefore, the purpose of this study is to determine the effects of the combination of PBM with blue light and the intralesional administration of the corticoid triamcinolone hexacetonide on the quality of the remaining scar by Vancouver Scar Scale in the postoperative period of keloid surgery. A randomized, controlled, double-blind, clinical trial will be conducted involving two groups: 1) Sham (n = 29): intralesional administration of corticoid (IAC) and sham PBM in the preoperative and postoperative periods of keloid removal surgery; and 2) active PBM combined with IAC (n = 29) in the preoperative and postoperative periods of keloid removal surgery. Transcutaneous PBM will be performed on the keloid region in the preoperative period and on the remaining scar in the postoperative period using blue LED (470 nm, 400 mW, 4J per point on 10 linear points). The patients will answer two questionnaires: one for the assessment of quality of life (Qualifibro-UNIFESP) and one for the assessment of satisfaction with the scar (PSAQ). The team of five plastic surgeons will answer the Vancouver Scar Scale (VSS). All questionnaires will be administered one, three, six, and twelve months postoperatively. The keloids will be molded in silicone prior to the onset of treatment and prior to excision to assess pre-treatment and post-treatment size. The same will be performed for the remaining scar at one, three, six, and twelve months postoperatively. The removed keloid will be submitted to histopathological analysis for the determination of the quantity of fibroblasts, the organization and distribution of collagen (picrosirius staining), and the genic expression of TGF-β (qPCR). All data will be submitted to statistical analysis.
Trial registration: This study is registered in ClinicalTrials.gov (ID: NCT04824612 ).
... Some studies have shown that keloid formation is closely related to genetic regulation, inflammatory factors, cytokines, and immune factors [3,4]. e treatment of keloid is not ideal because of unclear pathogenesis and regulatory mechanisms underlying keloids [5]. For these reasons, the identification of hub genes involved in keloid is urgent and highly demanded for improving the clinical outcome. ...
Background:
Keloid is a benign dermal tumor characterized by abnormal proliferation and invasion of fibroblasts. The establishment of biomarkers is essential for the diagnosis and treatment of keloids.
Methods:
We systematically identified coexpression modules using the weighted gene coexpression network analysis method (WGCNA). Differential expressed genes (DEGs) in GSE145725 and genes in significant modules were integrated to identify overlapping key genes. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were then performed, as well as protein-protein interaction (PPI) network construction for hub gene screening.
Results:
Using the R package of WGCNA, 22 coexpression modules consisting of different genes were identified from the top 5,000 genes with maximum mean absolute deviation in 19 human fibroblast samples. Blue-green and yellow modules were identified as the most important modules, where genes overlapping with DEGs were identified as key genes. We identified the most critical functions and pathways as extracellular structure organization, vascular smooth muscle contraction, and the cGMP-PKG signaling pathway. Hub genes from key genes as BMP4, MSX1, HAND2, TBX2, SIX1, IRX1, EDN1, DLX5, MEF2C, and DLX2 were identified.
Conclusion:
The blue-green and yellow modules may play an important role in the pathogenesis of keloid. 10 hub genes were identified as potential biomarkers and therapeutic targets for keloid.
... [10][11][12] For tension reduction, in our previous clinical practice, we achieved good, aesthetic outcomes in keloid treatment at high-tension site with continuous tension-reduction (CTR) technique. 13 In this study, we hypothesised that the use of a scar revision technique combined with W-plasty and CTR technique would better improve the appearance of facial scars. The effectiveness was assessed with Vancouver scar scale (VSS) score, visual analogue scale (VAS) score, and patient satisfaction at 12 months postoperation. ...
... Obtaining a scarless appearance of surgical incisions has always been a challenge for plastic surgeons. 13 In this study, we demonstrated that the combined application of W-plasty and CTR could significantly reduce scar spreading and improve appearance. Compared with the linear closure with CTR and the only W-plasty group, W-plasty combined with CTR had better mean VSS and VAS scores at 12 months after surgery. ...
... The skin tension environment of the face is more complicated owing to the different movement directions of facial muscles. 1,13 Although W-plasty reorients the incision tension direction from perpendicular to RSTLs to partially parallel or oblique to RSTLs, owing to increased tension caused by the requirement of the removal of additional normal tissue, W-plasty should be performed only if there is sufficient laxity in that area of the face. 17 Because of this, some studies have reported inconsistent clinical results when comparing the W-plasty and SL techniques. ...
W‐plasty is a very popular scar excisional revision technique. The core of the technique is to break up the scar margins into small triangular components, so as to cause light scattering and make the scar less noticeable. However, due to skin tension, facial incision scars tend to spread. Applying W‐plasty alone cannot achieve the ideal repair effect of facial scars. In this study, we proposed a scar revision technique combined W‐plasty with continuous tension‐reduction (CTR) technique to improve the appearance of facial scars. Sixty patients with facial scar were comprised in this retrospective study. Scars were assessed independently using the scar scale before and at 12‐month follow‐up. Clinical results showed a significant difference in scar appearance between different groups at 12‐month follow‐up. Vancouver scar scale (VSS), visual analogue scale (VAS) scores, and patient satisfaction were significant better in W‐plasty and CTR than other groups at 12‐month follow‐up. No severe complications were reported. The application of the tension offloading device provides an environment where the tension is continuously reduced, which could greatly decrease tension on the surgical incision. Combined with W‐plasty, this technique could significantly improve the scar's aesthetic appearance.
Keloids are fibroproliferative skin disorder caused by abnormal healing of injured or irritated skin and are characterized by excessive extracellular matrix (ECM) synthesis and deposition, which results in excessive collagen disorders and calcinosis, increasing the remodeling and stiffness of keloid matrix. The pathogenesis of keloid is very complex, and may include changes in cell function, genetics, inflammation, and other factors. In this review, we aim to discuss the role of biomechanical factors in keloid formation. Mechanical stimulation can lead to excessive proliferation of wound fibroblasts, deposition of ECM, secretion of more pro-fibrosis factors, and continuous increase of keloid matrix stiffness. Matrix mechanics resulting from increased matrix stiffness further activates the fibrotic phenotype of keloid fibroblasts, thus forming a loop that continuously invades the surrounding normal tissue. In this process, mechanical force is one of the initial factors of keloid formation, and matrix mechanics leads to further keloid development. Next, we summarized the mechanotransduction pathways involved in the formation of keloids, such as TGF-β/Smad signaling pathway, integrin signaling pathway, YAP/TAZ signaling pathway, and calcium ion pathway. Finally, some potential biomechanics-based therapeutic concepts and strategies are described in detail. Taken together, these findings underscore the importance of biomechanical factors in the formation and progression of keloids and highlight their regulatory value. These findings may help facilitate the development of pharmacological interventions that can ultimately prevent and reduce keloid formation and progression.
