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Background:
Keloids are hard nodules or plaques formed by excessive proliferation of connective tissue. Radiotherapy, widely used in various benign and malignant skin diseases, is an effective treatment for keloids. This work evaluates Intrabeam photon radiotherapy in the management of keloids.
Methods:
Fourteen patients who have undergone Intra...
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Background:
Dimples on the cheeks can make the smile look more cheerful and attractive. Therefore, some people who do not have dimples may choose to undergo dimple creation surgery. Although dimple surgery is quite common, those desiring this procedure often lack information about it. Therefore, we conducted the present study to share our surgical...
Citations
... Surgery is one of the effective methods for treating keloids, but it needs to be combined with other treatments, otherwise the recurrence rate is high, and studies have shown that the efficacy of injection therapy is not necessarily worse than radiotherapy, and it is cheap and suitable for hospitals with limited medical conditions. Therefore, surgery combined with local injection is also a common clinical treatment method [24][25][26][27] . For multiple nodular keloids, surgical treatment is not recommended, mainly including (1) direct excision, more damage, high risk; (2) if nucleotomy is used, the incision often has to be more than half of the circumference of the keloid or even more in order to remove the keloid nucleus, and the skin trauma is also large, and the same surgical risk exists; (3) many facets, small scars, small incisions, long surgery time, and great pain, which is not easy to be accepted by the patients. ...
There are many methods to treat keloid, including various excision operations, laser, injection and radiotherapy. However, few studies have explored the effectiveness of single-hole punch excision in keloid treatment. This study aimed to investigate the efficacy and safety of lateral punch excision combined with intralesional steroid injection for keloid treatment through self-control trial. In this self-controlled trial, 50 patients meet the diagnosis of nodular keloid, and try to choose left–right symmetrical control, one skin lesion in the control group (50 skin lesionsin total) and the other in the observation group (50 skin lesions in total).The keloids in the treatment group were initially treated with punch excision combined with intralesional steroid injection, followed by injection treatment alone. Keloids in the control group received intralesional steroid injection alone. The Vancouver Scar Scale (VSS) of the keloid before and after the punch excision was evaluated; the keloid scores at different time points and the number of injection treatments required in both groups were compared, and adverse reactions were observed. The effective rate of the observation group was 86.0%, which was significantly higher than that of the control group (66.0%), and the recurrence rate of 22% was lower than that of the control group (χ² = 4.141,63417), all of which were statistically significant (all P < 0.05). At the end of treatment, the VSS and total injection times in the observation group were significantly lower than those in the control group (t = 5.900,3.361), with statistical significance (P < 0.01). The combination of single-hole punch excision and intralesional steroid injection is an effective method to treat multiple nodular keloids, shortening the treatment course of tralesional steroid injection without obvious adverse reactions.
... Studies have shown that the curative effect of injection therapy is not necessarily worse than that of radiotherapy, and it is cheap and suitable for hospitals with limited medical conditions. Therefore, surgery combined with local injection is also a common clinical treatment [12] [13] . ...
There are many methods to treat keloid, including various excision operations,laser, injection and radiotherapy.However, few studies have explored the effectiveness of single-hole punch excision in keloid treatment.This study aimed to investigate the efficacy and safety of lateral punch excision combined with intralesional steroid injection for keloid treatment through self-control experiment.In this self-controlled trial, all patients meet the diagnosis of nodular keloid, and try to choose left-right symmetrical control, one in the control group (50 in total) and the other in the observation group (50 in total).The keloids in the treatment group were initially treated with punch excision combined with intralesional steroid injection, followed by injection treatment alone. Keloids in the control group received intralesional steroid injection alone.The Vancouver Scar Scale (VSS)of the keloid before and after the punch excision wasevaluated; the keloid scores at different time points and the number of injection treatments required in both groups were compared, and adverse reactions were observed.The effective rate of the observation group was 86.0%, which was significantly higher than that of the control group (66.0%), and the recurrence rate of 22% was lower than that of the control group (χ ² = 4.141,63417), all of which were statistically significant (all P < 0.05). At the end of treatment, the VSS and total injection times in the observation group were significantly lower than those in the control group (t = 5.900,3.361), with statistical significance (P < 0.01).The combination of single-hole punch excision and intralesional steroid injection is an effective method to treat multiple nodular keloids, shortening the treatment course of tralesional steroid injection without obvious adverse reactions.
... Fourteen patients with keloids underwent radiotherapy using the Intrabeam system from November 2016 to March 2018 compared to data from this cohort to earlier their own data from keloid patients who had previously been exposed to 6 MV electron beams using conventional accelerators. At 22.5 months median follow up there was zero recurrences in the intrabeam group with statistically significant difference compared to the control group (p= 0.016) and excellent cosmetic outcome in 90% of patients [64]. ...
Treatment of keloids is usually challenging, requiring a multimodal approach with no universally accepted treatment modality among the wide range of alternative keloid treatments. Excision of keloid lesion usually eliminates symptoms and it is the main treatment with considerable recurrence rate. Recurrence rate ranges from 45-100% when surgical excision is performed as monotherapy. Furthermore, Recurrent Keloids have a higher recurrence rate after surgery. In this case we discuss a challenging case of young female presented with third recurrence in lobule of the ear with defect necessitated flap reconstruction with concern for possible damage by the flap if radiation was given as external beam postoperatively. Intraoperative electron beam therapy was utilized with high safety and efficacy. To our knowledge this is the first case in the Middle East to use this technique in treating Keloid. Conclusion Treatment of keloids is usually challenging, requiring a multimodal approach. Excision of keloid lesion usually eliminates symptoms and it is the main treatment with considerable recurrence rate .Recurrence rate ranges from 45-100% when surgical excision is performed as monotherapy. Furthermore, Recurrent Keloids have a higher recurrence rate after surgery. Radiation is a valid option for decreasing risk of recurrence in recurrent keloid with high safety and efficacy profile. In this case we discuss a challenging case of young female presented with third recurrence in lobule of the ear with defect necessitated flap reconstruction with concern for possible damage by the flap if radiation was given as external beam postoperatively. Intraoperative electron beam therapy was utilized with high safety and efficacy. To our knowledge this is the first case in the Middle East to use this technique in treating Keloid. Keywords: Keloid; Radiation; Intraoperative Radiation; IOeRT
... Priming is defined as a substance that prepares the skin for use. Priming the skin prior to an invasive intervention for achieving an optimal result has been studied (34)(35)(36)(37)(38)(39)(40). However, the concept of preemptively priming the skin prior to injury has not been thoroughly evaluated. ...
... A number of anti-inflammatory treatments for skin scarring have been evaluated for existing scars including radiotherapy, compression (pressure therapy), laser and 5-fluorouracil therapy (40)(41)(42)(43). These therapies have been thought to supress inflammation by inhibiting angiogenesis as inflammatory cells migrate through blood (5). ...
Inflammation plays an active role during the wound healing process. There is a direct association between the extent of injury as well as inflammation and the amount of subsequent cutaneous scarring. Evidence to date demonstrates that high levels of inflammation are associated with excessive dermal scarring and formation of abnormal pathological scars such as keloids and hypertrophic scars. In view of the multiple important cell types being involved in the inflammatory process and their influence on the extent of scar formation, many scar therapies should aim to target these cells in order to control inflammation and by association help improve scar outcome. However, most current treatment strategies for the management of a newly formed skin scar often adopt a watch-and-wait approach prior to commencing targeted anti-inflammatory therapy. Moreover, most of these therapies have been evaluated in the remodelling phase of wound healing and the evaluation of anti-inflammatory treatments at earlier stages of healing have not been fully explored and remain limited. Taken together, in order to minimise the risk of developing a poor scar outcome, it is clear that adopting an early intervention prior to skin injury would be optimal, however, the concept of pre-emptively priming the skin prior to injury has not yet been thoroughly evaluated. Therefore, the aim of this review was to evaluate the available literature regarding scar therapies that aim to target inflammation which are commenced prior to when a scar is formed or immediately after injury, with a particular focus on the role of pre-emptive priming of skin prior to injury in order to control inflammation for the prevention of poor scarring outcome.
... The proliferative stage consists of contraction and fibroplasia. Although the collagen produced by immature fibroblasts that occupy the wound is radiosensitive, 3,4 fibroblasts in the wound edge begin to migrate into the wound clot of the matrix approximately 4 days after injury, 5 leading to uncertainty regarding the necessity of administering radiotherapy within 24 hours. Therefore, we conducted a systematic review and meta-analysis to investigate the appropriate timing of adjuvant radiotherapy. ...
... Of the studies, 3 only considered keloids on patients' earlobes, 13,15,19 whereas the other 13 enrolled patients whose keloids were located on multiple body parts. Regarding radiotherapy, 6 studies administered brachytherapy, 14,20-23,27 3 administered electron beam therapy (EBT), 3,17,18 5 administered x-rays, 3,13,19,25,26 and 2 administered photon beam therapy. 15,16 Moreover, 2 studies compared the recurrence rate after radiotherapy using x-rays and brachytherapy administered within 24 hours after surgery with that after the same treatments administered more than 24 hours. ...
... Twelve studies reported recurrence rates, total lesion sizes, and follow-up periods. [15][16][17][18][20][21][22][23][25][26][27] For the remaining studies, 3,13,14,19 we used total patient number as the total lesion number. 13,17,23,[25][26][27] Radiotherapy was performed within 24 hours after surgery in 13 studies and after 24 hours in 5 studies. ...
Background:
No consensus exists regarding the appropriate timing of adjuvant radiotherapy administration after surgical excision of keloids.
Objective:
This study investigated the appropriate timing of adjuvant radiotherapy.
Materials and methods:
A systematic review and meta-analysis of randomized controlled trials and observational cohort studies was performed. A pooled estimate of the incidence rate was performed using a random-effects model. Subgroup analyses based on different anatomic region, biologically effective dose, keloid length, and radiotherapy regimen were also conducted.
Results:
Sixteen observational cohort studies (1,908 keloid lesions) met the inclusion criteria. The incidence rate was significantly lower in the group treated with electron beam therapy more than 24 hours after surgery (3.80%; 95% confidence interval [CI], 1.78%-8.13%) than that in the group treated with the same therapy within 24 hours of surgery (37.16%; 95% CI, 20.80%-66.37%; p < .0001), but no significant difference was observed between the groups regarding brachytherapy and x-ray treatments.
Conclusion:
Immediate adjuvant radiotherapy did not significantly reduce the incidence rate of recurrent keloids.
... [41] Newly laid unstable collagen is also sensitive to radiotherapy. [42] This results in a balance between the normal and abnormal collagen, thus preventing the development of keloid. In our study also first dose of brachytherapy was given within 24 h. ...
Background:
Keloids are dermal tumors that are due to increased production of collagen caused by abnormal and prolonged wound healing. The incidence of recurrence is extremely high if only conservative measures are used. This study was conducted to evaluate the feasibility and efficacy surgery and high dose rate brachytherapy as an adjuvant therapy for treatment of keloids.
Materials and methods:
50 patients with clinically diagnosed 71 keloids were treated with excision of keloid and post-operative high-dose rate brachytherapy were studied. Complete excision of the keloid till the healthy skin margin was excised. The wound were closed in 2 layers. Subcutaneous tissue closed using absorbable suture, over which a 6F flexible polyethylene tube was placed. High dose rate cobalt-60 brachytherapy was administered. Total of 15 Gy in divided dose, 5 Gy in 3 fractions were administered.
Results:
50 patients with 71 keloids were studied. Out of the 50 patients, 12 were male (24%) and 38 were females (76%). Age of the patients ranged between 14 and 71 years. Recurrence rate was 2% with 2 keloids recurring at 5 months interval. 4 patients scored the results as unacceptable, remaining 45 patients rated their results as excellent during their follow up at 10 days, 3 months and 6 months.
Conclusion:
Treatment of keloids in the plastic surgeon's practice even today is still challenging. Many therapies have been described, but recurrence rate is high with mono-therapy. Combination therapy especially surgical excision with postoperative radiotherapy is best in preventing recurrence.
... The millisievert (mSv) is used to define the average accumulated radiation dose to an individual for 1 year where 1 mSv is the dose produced by 1 mGy of radiation [2]. High-dose (more than 250 mSv) radiotherapy is commonly used in malignant diseases, and low-dose radiotherapy (under 100 mSv) has been used to treat benign inflammatory conditions such as keloids, eczema, and psoriasis due to its anti-inflammatory and immunomodulating effects [3][4][5][6]. ...
Background:
Hidradenitis suppurativa (HS) is a chronic inflammatory dermatosis characterized by painful nodules, abscesses, sinus tracts, and scarring mainly in the intertriginous areas. Patients with HS often experience inadequate responses to traditional treatment consisting of lifestyle modification, topical and systemic antibiotics, hormonal modulators, biologics, and procedural modalities. Low-dose radiotherapy has been used in benign cutaneous conditions, including HS; however, there is a paucity of literature summarizing its evidence. Herein, we systematically review the current literature on the efficacy of radiotherapy for patients with HS.
Summary:
This systematic review of the published literature reports the patient demographics, treatment regimens, efficacy, and adverse effects of radiotherapy in the treatment of HS. The historic timeline of these publications highlights the changes in management recommendations, introduction of more standardized outcome measures, and enhancements in treatment options. Radiotherapy appears to be an option for patients with treatment-resistant HS or who are poor surgical candidates. However, there remains a paucity of consensus on proper candidate selection, dosing, efficacy, and safety of the short- and long-term effects of radiotherapy.
... Although the study size was limited and there may have been a degree of confounding due to the adjunct use of platelet-rich plasma and a proprietary topical cream, the results are nonetheless promising [56]. Recent work comparing electron beam radiation to low-energy photon radiotherapy found significantly fewer recurrences in the low-energy photon radiotherapy group, which supports previously discussed work [57]. In summary, years of data largely support radiation as an integral component in prevention of postoperative keloid recurrence. ...
Commonly affecting those with skin of color, keloids are an aberrant wound response that leads to wound tissue expanding above and beyond the original cutaneous injury. Keloids are notoriously and particularly difficult to treat because of their tendency to recur after excision. The current standard of care is intralesional steroid (triamcinolone acetonide). However, because no therapy has yet proven to be fully curative, keloid treatments have expanded to include a number of options, from injections to multimodal approaches. This review details current treatment of keloids with injections (bleomycin, verapamil, hyaluronic acid and hyaluronidase, botulinum toxin, and collagenase), cryotherapy, laser, radiofrequency ablation, radiation, extracorporeal shockwave therapy, pentoxifylline, and dupilumab.
Keloid is a common benign skin tumor in the outpatient department, and patients are often accompanied by itching and pain. Since the pathogenesis is unknown, the effect of single method treatment is unsatisfactory, and therefore the recurrence rate is high. Therefore, comprehensive treatment is mostly used in clinical treatment. Adjuvant radiotherapy is currently one of the most effective treatments for keloid. After long-term clinical practice, brachytherapy and electron beam radiotherapy has increasingly become the gold standard of treatment, because brachytherapy provides more focused radiation treatment to focal tissue to significantly reduce recurrence rate, and better preserve normal tissue. With the development of new radiotherapy techniques, more options for the treatment of keloid. Currently, adjuvant radiotherapy has been widely recognized, but there is no consensus on the optimal protocol for adjuvant radiotherapy for keloids. This review provides a review of published treatment options and new radiotherapy techniques for adjuvant radiotherapy of keloids and gives a comprehensive evaluation for clinical treatment.
Background:
Keloid is a type of benign tumor of the skin with abnormal proliferation of fibrous tissue. We sought to observe the changes in skin microcirculation and endothelial cell function around the recurred keloid and explore the skin microcirculation characters in recurred keloid patients.
Methods:
Six patients with recurred keloid were treated with keloid surgery and radiotherapy for the second time. Microcirculation of recurred keloids and their surrounding normal skin tissue was observed with laser Doppler flowmeter before operation. Expression of vascular endothelial growth factor (VEGF), CD31, and HIF-1α were identified by several assay.
Results:
The local blood flow of group RN was enhanced. The average strength of group N is 0.87. The average strength of group RN is 2.08. The expression of VEGF, CD31, and hypoxia inducible factor-1α (HIF-1α) protein in the keloid-recurred skin (RN) group was higher than the normal skin group via immunohistochemistry (IHC) and Western blotting analysis. The relative expression of VEGF and CD31 mRNA was significantly increased in RN group samples (P < .05).
Conclusions:
There are significant differences in the expression of VEGF, CD31, and HIF-1α in the recurred keloid skin after radiotherapy and normal skin. They may be used as potential biomarkers and targets for future research on keloid recurrence.
