Adjuvant single-fraction radiotherapy is safe and effective for intractable keloids

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Song, Changhoon; Wu, Honggyun; Chang, Hak; Kim, Il Han; Ha, Sung W.

2014-01-01

The aim of this study was to assess the feasibility and efficacy of high-dose, single-fraction electron beam radiotherapy for therapy-resistant keloids. Before 2010, intractable keloids were treated at our institution with post-operative irradiation of 6-15 Gy in 3-5 fractionations. For convenience and cost effectiveness, we have changed our treatment protocol to high-dose single-fraction radiotherapy. A total of 12 patients with 16 keloid lesions were treated from January 2010 to January 2013 in our department. A 10-Gy dose of electron irradiation was given within 72 h of the surgical excision. The mean follow-up period was 20 months. Treatments were well tolerated, and there was no recurrence in any of the patients. Severe adverse effects were not observed. Surgical excision of the keloid, followed by immediate, single-fraction, high-dose radiotherapy, is both safe and effective in preventing recurrence of therapy-resistant keloids. (author)

Postoperative Strontium-90 Brachytherapy in the Prevention of Keloids: Results and Prognostic Factors

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Viani, Gustavo A.; Stefano, Eduardo J.; Afonso, Sergio L.; De Fendi, Ligia I.

2009-01-01

Purpose: The aim of this study was to evaluate the results of keloidectomy and strontium 90 brachytherapy in the prevention of keloid recurrence following excision and to identify outcome and the prognostic factors that predict keloid recurrence after irradiation. Methods and Materials: Data of 612 patients with 892 keloids treated between 1992 and 2006 were evaluated retrospectively. Brachytherapy was performed using a Sr-90Y surface applicator. Total dose was 20 Gy in 10 fractions. Results: With a median follow-up of 61 months, the overall recurrence-free response rate for all keloids was 87.6%. Multivariate analysis revealed the following prognostic factors for recurrence: keloid size > 5 cm (p < 0.0001), burn scars as the keloid etiology (p < 0.0001), and previous treatment (p < 0.0001). Outcome was not found to be significantly related to the interval between surgery and radiotherapy, sex, or age. Pruritus and skin reddening were the most common symptoms of keloids, but all signs and symptoms abated with time after treatment. Cosmetic results from the keloid treatment were considered good or excellent in 70.6% of the patients. Conclusion: Our study findings show that excision plus Sr-90 brachytherapy is effective in the eradication of keloids. Sr-90 radiotherapy (20 Gy in 10 fractions) achieved a similar local control rate, as have higher doses per fraction in other series. It also resulted in a good cosmetic rate and relief of symptoms. Our data further suggest that the initiation of postoperative irradiation within hours of surgical excision is not important to therapeutic outcome.

The Management of Keloids by Radiotherapy in Nigeria | Ketiku ...

African Journals Online (AJOL)

A new method of treatment of keloid was compared with an old technique in five hundred and twenty eight Nigerian patients with 617 keloid lesions seen at the Department of Radiation Biology and Radiotherapy, Lagos University Teaching Hospital, between 1969 and 1981. The etiological factors were identified. A total of ...

Co-ordinate induction of collagen type I and biglycan expression in keloids.

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Hunzelmann, N; Anders, S; Sollberg, S; Schönherr, E; Krieg, T

1996-09-01

Proteoglycans are macromolecules displaying structural roles as well as regulatory functions in the maintenance of the extracellular matrix. Biglycan/PG-I and decorin/PG-II are two small proteoglycans that are structurally related but differ considerably in their localization in vivo and behaviour in vitro. Decorin and, to a minor extent, biglycan, can be located at the surface of type I collagen fibrils and have been shown to influence collagen fibrillogenesis. However, the physiological role of biglycan in the dermis is not known. Biopsies obtained from keloids were bisected and processed for total RNA extraction and immunohistochemistry. Northern blot analysis of total RNA obtained from keloids with high growth tendency in vivo showed a marked induction of biglycan and collagen alpha 1(I)mRNA expression in comparison with total RNA obtained from normal skin or keloids with little growth tendency. In contrast, decorin mRNA expression remained largely unaltered. Studying these biopsies by immunohistochemistry, decorin expression in the dermis was unaltered comparing normal and keloid tissue, whereas a markedly increased staining for biglycan was observed in the keloid tissue, which was most pronounced in the nodular formations, and was a characteristic feature of keloids. The altered expression of biglycan in keloid tissue might be involved in the abnormal regulation of extracellular matrix deposition either through the binding of growth factors or by influencing the three-dimensional organization of collagen fibres or associated molecules.

The effect of mitomycin-c in keloid fibroblast cultures

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Ishandono Dachlan

2016-12-01

Full Text Available ABSTRACT Keloid occurs due to hyperactivity of keloid fibroblast (KF in proliferation, migration, collagen deposition, together with low rates of collagen degradation. These are under the responsibility of TGF-b. Mitomycin C (MC is used for treating keloid by a topical application during surgery at the level of 0.02% to 0.08%. Unfortunately, the lowest effective level of MC for keloid has not been determined yet. We aimed to determine the lowest effective level of MC in the suppression of KF activities. Various levels of MC diluted in growth medium were administered on KF that were isolated from six patients. After 24 hours and 72 hours of incubation, cellular proliferation, collagen deposition, cellular migration and level of TGF-b, were analyzed. Application of 120 uM MC on KF culture for 24 hours could significantly reduce TGF-b production from 1265.74 ± 274.81 pg/mL to 265.17 ± 12.20 pg/mL; proliferation index from 100% to 84.01 ± 12.91%; inhibit cellular migration to 64.38 ± 3.66%; but reduce collagen depositions from 100% to only 91.13 ± 10.19%. The lowest MC level is on 30 uM or equal with 0.001%. In conclusion, the lowest level of MC can suppress the activities of KF is 0.001%. Moreover, due to low activity in inhibiting collagen deposition, MC would be better as an adjuvant drug for keloid surgery.

Early postoperative magnet application combined with hydrocolloid dressing for the treatment of earlobe keloids.

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Park, Tae Hwan; Chang, Choong Hyun

2013-04-01

To prevent the recurrence of earlobe keloids after surgical removal, a reliable and safe postoperative treatment method is critical. To the authors' knowledge, no studies have elucidated the most effective postoperative dressing method for preventing the recurrence of earlobe keloids. This study aimed to compare keloid recurrence rates in patients whose keloids were dressed using conventional methods (plain gauze or a polyvinyl alcohol sponge) with those of a matched cohort of patients whose keloids were dressed using magnets combined with hydrocolloid materials. This observational case-control study compared a retrospective cohort of patients whose keloids were dressed using conventional methods with a matched prospective cohort of patients whose keloids were dressed using magnets combined with hydrocolloid materials. The study included patients with pathologically confirmed earlobe keloids that were surgically excised with primary closure. Patients 8 years of age or older underwent adjuvant pressure therapy with magnets at the study hospital. Patients were excluded from the study if they were unavailable for follow-up evaluation, if they had received additional adjuvant therapy during treatment, or if histologic confirmation of a keloid was not obtained. Matched-pair analysis was performed using the McNemar test. Treatment outcome was evaluated as recurrence or nonrecurrence. Overall, 9 (11.2%) of the 80 study patients experienced recurrence. The recurrence rate was significantly lower in the matched case group (2 of 40, 5%) than in the matched control group (7 of 40, 17.5%) during the follow-up period of 18 months (p=0.0253). The authors' novel dressing of magnets and hydrocolloid materials appears to be effective in reducing earlobe keloid recurrence. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to

Treatment of keloid scars with a 1210-nm diode laser in an animal model.

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Philandrianos, Cécile; Bertrand, Baptiste; Andrac-Meyer, Lucile; Magalon, Guy; Casanova, Dominique; Kerfant, Nathalie; Mordon, Serge

2015-12-01

A temperature increase can improve wound healing by activation of heat shock protein 70 and stimulation of fibroblasts. Since keloids are a dysfunction of collagen fiber synthesis and organization, this study aimed to evaluate if a 1,210 nm diode laser could have effects in a new animal model of keloid scars. A total of 39 nude mice were used for this study. Phototypes IV and V human keloids were grafted into their backs and after 1 month of healing, the mice were divided into four groups: Control, Laser, Resection, Resection/Laser. In the Laser group, the keloids were treated with a 1,210-nm diode-laser with the following parameters: 4 W; 10 seconds; fluence: 51 J/cm(2) ; spot: 18.9 × 3.7 mm(2) . In the Resection group, surgical intra-lesional excision was performed. In the Resection/Laser group, keloids were treated with the 1,210-nm laser-diode after surgical intra-lesional excision. Temperature measurements were made during the laser treatment. Clinical examination and histological study were performed on the day of treatment and 1 month, 2 months, and 3 months later. Mean temperature measurement was of 44.8°C (42-48°) in the Laser groups. No healing complications or keloid proliferation was observed in any group. Keloid histologic characters were confirmed in all grafts. No histologic particularity was observed in the laser groups in comparison with the Control and Resection groups. First, this keloid animal model appears to be adapted for laser study. Secondly, the 1,210-nm diode laser does not induce keloid thermal damage in vivo. Further studies with different 1,210-nm laser diode parameters should be performed in order to observe significant effects on keloids. © 2015 Wiley Periodicals, Inc.

Periauricular Keloids on Face-Lift Scars in a Patient with Facial Nerve Paralysis

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Masayo Aoki, MD, PhD

2017-07-01

Full Text Available Summary:. Keloids are caused by excessive scar formation that leads to scar growth beyond the initial scar boundaries. Keloid formation and progression is promoted by mechanical stress such as skin stretch force. Consequently, keloids rarely occur in paralyzed areas and areas with little skin tension, such as the periauricular region. Therefore, periauricular incision is commonly performed for face lifts. We report a rare case of keloids that arose from face-lift scars in a patient with bilateral facial nerve paralysis. A 51-year-old Japanese man presented with abnormal proliferative skin masses in bilateral periauricular scars. Seventeen years before, he had a cerebral infarction that resulted in permanent bilateral facial nerve paralysis. Three years before presentation, the patient underwent face-lift surgery with periauricular incisions. We diagnosed multiple keloids. We removed the masses surgically, closed the wounds with sutures in the superficial musculoaponeurotic system layer to reduce tension on the wound edges, reconstructed the earlobes with local skin flaps, and provided 2 consecutive days of radiotherapy. The wounds/scars were managed with steroid plasters and injections. Histology confirmed that the lesions were keloids. Ten months after surgery, the lesions did not exhibit marked regrowth. The keloids appeared to be caused by the patient's helmet, worn during his 3-hour daily motorcycle rides, which placed repeated tension on the periauricular area. This rare case illustrates how physical force contributes to auricular and periauricular keloid development and progression. It also shows that when performing surgery with periauricular incisions, care should be taken to eliminate wound/scar stretching.

Involvement of upper torso stress amplification, tissue compression and distortion in the pathogenesis of keloids.

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Bux, Shamin; Madaree, Anil

2012-03-01

Keloids are benign tumours composed of fibrous tissue produced during excessive tissue repair triggered by minor injury, trauma or surgical incision. Although it is recognized that keloids have a propensity to form in the upper torso of the body, the predisposing factors responsible for this have not been investigated. It is crucial that the aetiopathoical factors implicated in keloid formation be established to provide guidelines for well-informed more successful treatment. We compared keloid-prone and keloid-protected skin, identified pertinent morphological differences and explored how inherent structural characteristics and intrinsic factors may promote keloid formation. It was determined that keloid prone areas were covered with high tension skin that had low stretch and a low elastic modulus when compared with skin in keloid protected areas where the skin was lax with a high elastic modulus and low pre-stress level. Factors contributing to elevated internal stress in keloid susceptible skin were the protrusion of hard connective tissue such as bony prominences or cartilage into the dermis of skin as well as inherent skin characteristics such as the bundled arrangement of collagen in the reticular dermis, the existent high tension, the low elastic modulus, low stretch ability, contractile forces exerted by wound healing fibroblastic cells and external forces. Stress promotes keloid formation by causing dermal distortion and compression which subsequently stimulate proliferation and enhanced protein synthesis in wound healing fibroblastic cells. The strain caused by stress also compresses and occludes microvessels causing ischaemic effects and reperfusion injury which stimulate growth when blood rich in growth factors returns to the tissue. The growth promoting effects of increased internal stress, primarily, and growth factors released by reperfusing blood, manifest in keloid formation. Other inherent skin characteristics promoting keloid growth during the

Heat Shock Protein 90 Inhibitor (17-AAG) Induces Apoptosis and Decreases Cell Migration/Motility of Keloid Fibroblasts.

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Yun, In Sik; Lee, Mi Hee; Rah, Dong Kyun; Lew, Dae Hyun; Park, Jong-Chul; Lee, Won Jai

2015-07-01

The regulation of apoptosis, proliferation, and migration of fibroblasts is altered in keloids. The 90-kDa heat shock protein (heat shock protein 90) is known to play a key role in such regulation. Therefore, the authors investigated whether the inhibition of heat shock protein 90 in keloid fibroblasts could induce apoptosis and attenuate keloid fibroblast proliferation and migration. The authors evaluated heat shock protein 90 expression in keloid tissues with immunohistochemistry. The authors used cell viability [3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide] assays and annexin V/propidium iodide staining for apoptosis, a wound healing model and cell tracking system to assess cell migration, and Akt Western blotting analysis in keloid fibroblasts after inhibition of heat shock protein 90 with 17-allylaminodemethoxygeldanamycin (17-AAG). The expression of heat shock protein 90 in keloid tissues was significantly increased compared with normal tissues. The 17-AAG-treated keloid fibroblasts showed significantly decreased proliferation, promotion of apoptosis, and decreased expression of Akt. Furthermore, a dose-dependent decrease in cell migration was noted after 17-AAG treatment of keloid fibroblasts. The 17-AAG-treated keloid fibroblasts had less directionality to the wound center and migrated a shorter distance. The authors confirmed that the inhibition of heat shock protein 90 in keloid fibroblasts could promote apoptosis and attenuate proliferation and migration of keloid fibroblasts. Therefore, the authors think that the inhibition of heat shock protein 90 is a key factor in the regulation of biological processes in keloids. With further preclinical study, the authors will be able to apply these results clinically for keloid treatment.

Healed corneal ulcer with keloid formation.

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Alkatan, Hind M; Al-Arfaj, Khalid M; Hantera, Mohammed; Al-Kharashi, Soliman

2012-04-01

We are reporting a 34-year-old Arabic white female patient who presented with a white mass covering her left cornea following multiple ocular surgeries and healed corneal ulcer. The lesion obscured further view of the iris, pupil and lens. The patient underwent penetrating keratoplasty and the histopathologic study of the left corneal button showed epithelial hyperplasia, absent Bowman's layer and subepithelial fibrovascular proliferation. The histopathologic appearance was suggestive of a corneal keloid which was supported by further ultrastructural study. The corneal graft remained clear 6 months after surgery and the patient was satisfied with the visual outcome. Penetrating keratoplasty may be an effective surgical option for corneal keloids in young adult patients.

Custom-made different designs of pressure clips for the management of ear lobe keloids

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Anshul Chugh

2013-01-01

Full Text Available Introduction : Keloids are frequent finding after physical trauma. Keloids of ear lobe are common complication of ear piercing, although its incidence remains unknown. The use of intrakeloid resection and a form pressure device to treat pinna keloids. The recommendation of this therapy is to maintain constant pressure and duration of pressure therapy was about 25 weeks. Clinical innovation : This article will present inexpensive custom made pressure clips of various designs. The dimensions of polymethylmethacrylate (PMMA plates in ear lobe clip presented by us though they esthetically not so good, but colored PMMA has been used to make it decorative and acceptable by most of the patients. This has been an encouraging experience to use the different designs. Discussion : Ear clip prosthesis has been developed for maintaining pressure on ear lobe keloids before and after surgical removal. The prosthesis includes an ear clip to which heat-polymerized acrylic resin is attached, which covers the keloid area. Pressure therapy is widely used to help in the early maturation of scar tissue and to prevent the recurrence of keloid. The preliminary report by Brent revealed that constant light pressure was an effective means of preventing post excision recurrence of ear lobe keloids using a decorative, spring-pressure earring.

Presentation and management of keloid scarring following median sternotomy: a case study

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Javangula Kalyana C

2010-12-01

Full Text Available Abstract Introduction Keloid scars following median sternotomy are rare and occur more frequently in pigmented skin. Different management strategies have been described with variable success. We present a case of keloid scar formation following cardiac surgery including our management and the final aesthetic result. Case description A 64 year old female of fair complexion underwent mitral valve replacement. The procedure and postoperative recovery were uncomplicated, however, during the following year, thick keloid scars formed over the incision sites. Initial non surgical measures failed to relieve pain and did not offer any tangible aesthetic benefit. Eventually surgical excision was attempted. She presented to our clinic for nine months follow up with significant improvement in pain and aesthetic result. Discussion and Evaluation Several theories have attempted to explore the pathophysiology of keloid scar formation. A number of predisposing factors have been documented however none existed in this case. A variety of invasive and non invasive approaches have been described but significant differences in success rates and methodology of investigations still precludes a standardized management protocol. Conclusions In this case study a rare presentation of keloid scar has been presented. The variety of methods used to improve pain and aesthetic result demonstrates the propensity of keloid scars to recur and the therapeutic challenges that surgeons have to face in their quest for a satisfactory patient outcome.

Hypofractionated electron-beam radiation therapy for keloids. Retrospective study of 568 cases with 834 lesions

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Shen Jie; Lian Xin; Sun Yuliang

2015-01-01

We aimed to analyze the outcomes of hypofractionated high-energy electron beam radiotherapy for the treatment of keloids. From February 1998 to January 2012, 568 patients with a total of 834 keloids underwent radiotherapy: 826 lesions with postoperative radiotherapy, and 36 with skin-grafting. Lesion size was >5 cm in 335 keloids. An electron-beam of 6 or 7 MeV was used, with a total dose of 18 Gy (two fractions with a 1-week interval) covering the lesion with a 1-cm margin. The time between surgery and radiotherapy was 24–48 h. Skin-grafted patients underwent radiotherapy 10–15 days after the operation. The median follow-up was 40 months (range: 12–160 months). The local control rate was 88.25% (736/834). The relapse rate was 9.59% (80/834), and the time to relapse was 6–28 months (median: 12 months). Univariate analyses showed that gender, age, keloid size, keloid site, skin grafting, and operation-to-irradiation interval influenced the local control rate. Multivariate analysis showed that the relapse rate was correlated with gender (P = 0.048), age (P < 0.01), operation-to-irradiation interval (P < 0.01), keloid site (P < 0.01), surgical method (P = 0.04) and keloid size (P < 0.02). Adverse effects were observed in 9.83% (82/834). No radiation-induced cancers were observed. Hypofractionated high-energy electron beam radiotherapy for keloids yielded excellent outcomes, especially in cases without skin grafting. Early postoperative radiotherapy with limited hypofractionation could be a good choice for keloid treatment. (author)

Keloidal granuloma faciale with extrafacial lesions

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Verma Rajesh

2005-01-01

Full Text Available Granuloma faciale (GF is a rare cutaneous disorder characterized by one to several soft, erythematous to livid papules, plaques or nodules, usually occurring on the face. Extrafacial lesions are uncommon. A 52-year-old lady with multiple asymptomatic, variously sized brownish-black colored, firm, sharply circumscribed plaques resembling keloids on both cheeks and extrafacial lesions on the right arm and the right breast is presented for its unusual keloidal appearance and typical histopathological findings. She failed to respond to oral dapsone 100 mg daily administered for 3 months. Local infiltration of triamcinolone combined with cryotherapy led to only partial flattening of the lesions. All the skin lesions were excised surgically followed by flap transfer grafting on both cheeks. The cosmetic outcome was highly satisfactory.

Postoperative interstitial radiotherapy of keloids. Curietherapie postoperatoire des cicatrices cheloides

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Clavere, P; Bonnafoux-Clavere, A; Roullet, B; Morzel, A; Rhein, B; Bonnetblanc, J M; Olivier, J P [Centre Hospitalier Universitaire, 87 - Limoges (France)

1993-01-01

During an 8-year period, 21 patients with keloids (27 keloids) were treated with keloidectomy and post-operative interstitial radiotherapy by an iridium 192 wire. Only one patient had been previously treated by corticoids, without results. A dose of 12 Gy (three patients) to 15 Gy (18 patients) was delivered at a point 2.5 mm from the axis of the wire. The follow-up time was from 2 - 104 months. The success rate, at 7 months, was close to 88%. Ao recurrence occurred in three patients without relation to the method used, the lesion-age or the localization of the lesions. There were no side-effects. This method represents an effective, non-constraining and safe treatment for keloids if the contra-indications are respected.

Treatment of retroauricular keloids: Revision of cases treated at the ENT service of HC/UFPR.

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Carvalho, Bettina; Ballin, Annelyse Cristine; Becker, Renata Vecentin; Ribeiro, Talita Beithum; Cavichiolo, Juliana Benthien; Ballin, Carlos Roberto; Mocellin, Marcos

2012-04-01

 Keloids are benign tumors arising from abnormal healing of the skin, and there are several procedures available for their treatment.  The objective of this study was to evaluate the outcomes of patients undergoing treatment of keloids after ear, nose, and throat (ENT) surgeries at our service center.  We conducted thorough, retrospective and prospective analysis of records of patients undergoing treatment of retroauricular keloids at our center.  Nine patients were evaluated, and 6 underwent resection and adjuvant beta-therapy, 2 underwent resection with local application of corticosteroids, and only 1 underwent resection without adjuvant therapy. There was no recurrence of keloids in patients that were treated with beta-therapy in the early postoperative period. One patient had relapsed despite corticosteroid administration and late beta-therapy.  Several techniques have been used for the treatment of retroauricular keloids, and beta-therapy is thought to yield the best results, followed by the use of intralesional corticosteroids.  Treatment of retroauricular keloids remains a challenge. While new techniques are being developed, resection followed by early beta-therapy is still the best treatment option.

Perioperative Interstitial High-Dose-Rate Brachytherapy for the Treatment of Recurrent Keloids

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Jiang, Ping; Baumann, René; Dunst, Jürgen

2016-01-01

PURPOSE: To prospectively evaluate high-dose-rate brachytherapy in the treatment of therapy-resistant keloids and report first results, with emphasis on feasibility and early treatment outcome. METHODS AND MATERIALS: From 2009 to 2014, 24 patients with 32 recurrent keloids were treated with immed...

Positive response of a recurrent keloid scar to topical methyl aminolevulinate-photodynamic therapy.

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Nie, Zhuxiang; Bayat, Ardeshir; Behzad, Farhad; Rhodes, Lesley E

2010-12-01

A 36-year-old Caucasian female of Iranian origin presented with a persistently raised dermal lesion under her chin, confirmed histologically to be a keloid scar. There was a 4-year history of a negative response to a range of conventional treatments including topical silicone gel sheets, steroid creams, steroid injections and surgical excision. In view of treatment failure and an in vitro study indicating a positive effect of photodynamic therapy (PDT)on keloid fibroblasts, we treated our patient's lesion with five sessions of methyl aminolevulinate photodynamic therapy (MAL-PDT) over a period of 5 months. Following this treatment regime, her keloid scar had considerably reduced in size and become flattened.The surface of the keloid also became smooth, with attenuation in erythema at the margin as well as an improvement in the colour of the scar, which was better matched to the surrounding skin. There was no recurrence at 1-year follow-up and this treatment resulted in an overall acceptable cosmetic outcome. This case report presents PDT as a potential treatment option for persistent keloid lesions unresponsive to conventional scar modulation therapies and suggests a need for further research in this area.

Treatment of retroauricular keloids: Revision of cases treated at the ENT service of HC/UFPR

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Carvalho, Bettina

2012-01-01

Full Text Available Introduction: Keloids are benign tumors arising from abnormal healing of the skin, and there are several procedures available for their treatment. Objective: The objective of this study was to evaluate the outcomes of patients undergoing treatment of keloids after ear, nose, and throat (ENT surgeries at our service center. Method: We conducted thorough, retrospective and prospective analysis of records of patients undergoing treatment of retroauricular keloids at our center. Results: Nine patients were evaluated, and 6 underwent resection and adjuvant beta-therapy, 2 underwent resection with local application of corticosteroids, and only 1 underwent resection without adjuvant therapy. There was no recurrence of keloids in patients that were treated with beta-therapy in the early postoperative period. One patient had relapsed despite corticosteroid administration and late beta-therapy. Discussion: Several techniques have been used for the treatment of retroauricular keloids, and beta-therapy is thought to yield the best results, followed by the use of intralesional corticosteroids. Conclusion: Treatment of retroauricular keloids remains a challenge. While new techniques are being developed, resection followed by early beta-therapy is still the best treatment option.

Epithelial-mesenchymal transition in keloid tissues and TGF-β1-induced hair follicle outer root sheath keratinocytes.

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Yan, Li; Cao, Rui; Wang, Lianzhao; Liu, Yuanbo; Pan, Bo; Yin, Yanhua; Lv, Xiaoyan; Zhuang, Qiang; Sun, Xuejian; Xiao, Ran

2015-01-01

Keloid is a skin fibrotic disease with the characteristics of recurrence and invasion, its pathogenesis still remains unrevealed. The epithelial-mesenchymal transition (EMT) is critical for wound healing, fibrosis, recurrence, and invasion of cancer. We sought to investigate the EMT in keloid and the mechanism through which the EMT regulates keloid formation. In keloid tissues, the expressions of EMT-associated markers and transforming growth factor (TGF)-β1/Smad3 signaling were examined by immunohistochemistry. In the keloid epidermis and dermal tissue, the expressions of genes related to the regulation of skin homeostasis, fibroblast growth factor receptor 2 (FGFR2) and p63, were analyzed using quantitative real-time polymerase chain reaction. The results showed that accompanying the loss of the epithelial marker E-cadherin and the gain of the mesenchymal markers fibroblast-specific protein 1 (FSP1) and vimentin in epithelial cells from epidermis and skin appendages, and in endothelial cells from dermal microvessels, enhanced TGF-β1 expression and Smad3 phosphorylation were noted in keloid tissues. Moreover, alternative splicing of the FGFR2 gene switched the predominantly expressed isoform from FGFR2-IIIb to -IIIc, concomitant with the decreased expression of ΔNp63 and TAp63, which changes might partially account for abnormal epidermis and appendages in keloids. In addition, we found that TGF-β1-induced hair follicle outer root sheath keratinocytes (ORSKs) and normal skin epithelial cells underwent EMT in vitro with ORSKs exhibiting more obvious EMT changes and more similar expression profiles for EMT-associated and skin homeostasis-related genes as in keloid tissues, suggesting that ORSKs might play crucial roles in the EMT in keloids. Our study provided insights into the molecular mechanisms mediating the EMT pathogenesis of keloids. © 2015 by the Wound Healing Society.

The management of helical rim keloids with excision, split thickness skin graft and intralesional triamcinolone acetonide

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Ibrahim Abdul Rasheed

2014-01-01

Full Text Available Keloids of the helical rim are disfiguring. A cosmetically acceptable reconstruction is difficult especially in moderate to large sized lesions because the helical rim is a 3-dimensional structure with curved and thin cartilage. We report our experience in the management of moderate (4-10 cm and large (>10 cm helical rim keloids in five patients. Six helical rim keloids were reconstructed. There were four moderate (4-10 cm and two large (>10 cm helical rim keloids. Four were on the right helix and two on the left helix. One patient had bilateral helical rim keloids. The follow-up period ranged from 6 months to 4 years. No secondary surgical revision was required to improve the contour of the reconstructed helical rim. The aesthetic results were satisfactory in all the patients.

Radiotherapy treatment of keloid scars with a kilovoltage X-ray parallel pair

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Eaton, David J.; Barber, Elizabeth; Ferguson, Leila; Mark Simpson, G.; Collis, Christopher H.

2012-01-01

An established treatment for keloids is surgery and radiotherapy, using a single applied field. However, earlobe keloids lend themselves to a parallel opposed pair approach. Delivery with a superficial X-ray unit is practicable and improves homogeneity within the treatment volume. It has been implemented in this centre since 2007.

Serum-free keloid fibroblast cell culture: an in vitro model for the study of aberrant wound healing.

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Koch, R J; Goode, R L; Simpson, G T

1997-04-01

The purpose of this study was to develop an in vitro serum-free keloid fibroblast model. Keloid formation remains a problem for every surgeon. Prior evaluations of fibroblast characteristics in vitro, especially those of growth factor measurement, have been confounded by the presence of serum-containing tissue culture media. The serum itself contains growth factors, yet has been a "necessary evil" to sustain cell growth. The design of this study is laboratory-based and uses keloid fibroblasts obtained from five patients undergoing facial (ear lobule) keloid removal in a university-affiliated clinic. Keloid fibroblasts were established in primary cell culture and then propagated in a serum-free environment. The main outcome measures included sustained keloid fibroblast growth and viability, which was comparable to serum-based models. The keloid fibroblast cell cultures exhibited logarithmic growth, sustained a high cellular viability, maintained a monolayer, and displayed contact inhibition. Demonstrating model consistency, there was no statistically significant difference between the mean cell counts of the five keloid fibroblast cell lines at each experimental time point. The in vitro growth of keloid fibroblasts in a serum-free model has not been done previous to this study. The results of this study indicate that the proliferative characteristics described are comparable to those of serum-based models. The described model will facilitate the evaluation of potential wound healing modulators, and cellular effects and collagen modifications of laser resurfacing techniques, and may serve as a harvest source for contaminant-free fibroblast autoimplants. Perhaps its greatest utility will be in the evaluation of endogenous and exogenous growth factors.

Intralesional excision with topical intralesional cryotherapy improves the treatment of keloid scarring in a paediatric patient.

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Reissis, D; Tickunas, T; Agha, R A; Greig, Avh

2017-11-01

Recurrent keloid scarring has a significant impact on quality of life. Management is complex, particularly for scars resistant to conventional treatments and in paediatric cases where radiotherapy is not a suitable adjunct to surgical excision. We present the case of a nine-year-old African Caribbean girl with multiple large and recurrent keloid scars on both ears and bilateral sensorineural deafness. Following repeated intralesional excisions, corticosteroid and botulinum toxin injections, she continued to experience rapid recurrence of her keloids, worsening pain and pruritus. She was no longer able to wear her hearing aids because of the large size of the keloids. We employed a novel technique using topical intralesional cryotherapy, applying liquid nitrogen intraoperatively to the inside of the skin flaps immediately post-intralesional keloid excision and before wound closure. At 26-month follow-up a good aesthetic and symptomatic result was achieved, with minimal hypopigmentation, significantly reduced scar volume and significantly slowed recurrence. We discuss this case and review the current literature on the use of topical intralesional cryotherapy for keloid scarring.

The use of chemotherapeutics for the treatment of keloid scars

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Christopher David Jones

2015-05-01

Full Text Available Keloid scars are pathological scars, which develop as a result of exaggerated dermal tissue proliferation following cutaneous injury and often cause physical, psychological and cosmetic problems. Various theories regarding keloidogenesis exist, however the precise pathophysiological events remain unclear. Many different treatment modalities have been implicated in their management, but currently there is no entirely satisfactory method for treating all keloid lesions. We review a number of different chemotherapeutic agents which have been proposed for the treatment of keloid and hypertrophic scars while giving insight into some of the novel chemotherapeutic drugs which are currently being investigated. Non-randomized trials evaluating the influence of different chemotherapeutic agents, such as 5-fluorouracil (5-FU; mitomycin C; bleomycin and steroid injection, either alone or in combination with other chemotherapeutic agents or alternative treatment modalities, for the treatment of keloids were identified using a predefined PubMed search strategy. Twenty seven papers were identified. Scar improvement ≥50% was found in the majority of cases treated with 5-FU, with similar results found for mitomycin C, bleomycin and steroid injection. Combined intralesional 5-FU and steroid injection produced statistically significant improvements when compared to monotherapy. Monotherapy recurrence rates ranged from 0-47% for 5-FU, 0-15% for bleomycin and 0-50% for steroid injection. However, combined therapy in the form of surgical excision and adjuvant 5-FU or steroid injections demonstrated lower recurrence rates; 19% and 6% respectively. Currently, most of the literature supports the use of combination therapy (usually surgery and adjuvant chemotherapy as the mainstay treatment of keloids, however further investigation is necessary to determine success rates over longer time frames. Furthermore, there is the potential for novel therapies, but further

Insights gained from the reverse engineering of gene networks in keloid fibroblasts

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Phan Toan

2011-05-01

Full Text Available Abstract Background Keloids are protrusive claw-like scars that have a propensity to recur even after surgery, and its molecular etiology remains elusive. The goal of reverse engineering is to infer gene networks from observational data, thus providing insight into the inner workings of a cell. However, most attempts at modeling biological networks have been done using simulated data. This study aims to highlight some of the issues involved in working with experimental data, and at the same time gain some insights into the transcriptional regulatory mechanism present in keloid fibroblasts. Methods Microarray data from our previous study was combined with microarray data obtained from the literature as well as new microarray data generated by our group. For the physical approach, we used the fREDUCE algorithm for correlating expression values to binding motifs. For the influence approach, we compared the Bayesian algorithm BANJO with the information theoretic method ARACNE in terms of performance in recovering known influence networks obtained from the KEGG database. In addition, we also compared the performance of different normalization methods as well as different types of gene networks. Results Using the physical approach, we found consensus sequences that were active in the keloid condition, as well as some sequences that were responsive to steroids, a commonly used treatment for keloids. From the influence approach, we found that BANJO was better at recovering the gene networks compared to ARACNE and that transcriptional networks were better suited for network recovery compared to cytokine-receptor interaction networks and intracellular signaling networks. We also found that the NFKB transcriptional network that was inferred from normal fibroblast data was more accurate compared to that inferred from keloid data, suggesting a more robust network in the keloid condition. Conclusions Consensus sequences that were found from this study are

Results of postoperative 90Sr radiotherapy of keloids in view of patients' subjective assessment

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Fraunholz, I.B.; Gerstenhauer, A.; Boettcher, H.D.

2005-01-01

Background and Purpose: As treatment of keloids is mainly a cosmetic indication, the authors investigated, beyond the recurrence rate, the patients' satisfaction with the result and its correlation with objective medical findings. Patients and Methods: 83 keloids of 66 patients had been irradiated after excision by a uniform protocol with 4 x 5 Gy (strontium-90 [ 90 Sr] surface applicator). A questionnaire was developed and sent out in which, above all, the satisfaction with the therapeutic and cosmetic outcome was obtained. These results were correlated with objective parameters and medical findings which were ascertained during an extra follow-up examination. Results: Among 18 of the 41 patients (44%), who had answered the questionnaire, 19 of the 53 keloids treated (36%) had relapsed. 61% of the patients were extremely or mainly satisfied with the therapeutic outcome, 51% extremely or mainly satisfied with the cosmetic outcome. The relief from former keloid-caused symptoms (therapeutic outcome: p=0.0005; cosmetic outcome: p=0.0011), the ear as keloid localization (p=0.0008 and p=0.0197), and male gender (therapeutic outcome: p=0.0423) were significantly associated with higher satisfaction. The recurrence rate as well as the extent of radiation side effects had no significant influence on patients' assessment. Conclusion: Cosmetic aspects like the dermal side effects and the patients' satisfaction should be taken into account when evaluating the results of radiotherapy in keloids. (orig.)

Blue light-irradiated human keloid fibroblasts: an in vitro study

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Magni, Giada; Rossi, Francesca; Tatini, Francesca; Pini, Roberto; Coppi, Elisabetta; Cherchi, Federica; Fusco, Irene; Pugliese, Anna Maria; Pedata, Felicita; Fraccalvieri, Marco; Gasperini, Stefano; Pavone, Francesco S.; Tripodi, Cristina; Alfieri, Domenico; Targetti, Lorenzo

2018-02-01

Blue LED light irradiation is currently under investigation because of its effect in wound healing improvement. In this context, several mechanisms of action are likely to occur at the same time, consistently with the presence of different light absorbers within the skin. In our previous studies we observed the wound healing in superficial abrasions in an in vivo murine model. The results evidenced that both inflammatory infiltrate and myofibroblasts activity increase after irradiation. In this study we focused on evaluating the consequences of light absorption in fibroblasts from human cells culture: they play a key role in wound healing, both in physiological conditions and in pathological ones, such as keloid scarring. In particular we used keloids fibroblasts as a new target in order to investigate a possible metabolic or cellular mechanism correlation. Human keloid tissues were excised during standard surgery and immediately underwent primary cell culture extraction. Fibroblasts were allowed to grow in the appropriate conditions and then exposed to blue light. A metabolic colorimetric test (WST-8) was then performed. The tests evidenced an effect in mitochondrial activity, which could be modulated by the duration of the treatment. Electrophysiology pointed out a different behavior of irradiated fibroblasts. In conclusion, the Blue LED light affects the metabolic activity of fibroblasts and thus the cellular proliferation rate. No specific effect was found on keloid fibroblasts, thus indicating a very basic intracellular component, such as cytochromes, being the target of the treatment.

The effect of tranilast on fibroblast activation protein α (FAP-α expression in normal and keloid fibroblasts in vitro

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Paweł P. Antończak

2017-07-01

Full Text Available Introduction . Tranilast (N-(3’,4’-demethoxycinnamoyl-anthranilic acid is an anti-allergic drug. Its mechanism of action is based on the inhibition of antigen-induced release of chemical mediators from mast cells and basophils. It also reveals antifibroproliferative activities. These properties of tranilast are used in the treatment of hypertrophic scars and keloids. Keloids are characterized by incorrect extracellular matrix components turnover. Fibroblasts derived from keloids reveal overproduction of collagen type I and decreased degradation of extracellular matrix in comparison with normal fibroblasts. Fibroblast activation protein α (FAP-α may play an important role in remodeling of extracellular matrix and the invasive properties of keloids. Objective . In the present study, the effect of tranilast on expression of FAP-α gene and its protein was evaluated in normal human dermal fibroblasts and fibroblasts derived from keloids cultured in vitro . Materials and methods. In the first stage of the study, the influence of tranilast on cell viability was estimated. The second stage of the study included the quantitative evaluation of FAP-α mRNA expression in normal and keloid fibroblasts treated with tranilast. The third stage of the study comprised fibroblast activation protein α expression analysis in the examined cells treated with tranilast. Results and conclusions . The expression of FAP-α gene and fibroblast activation protein α is higher in keloid fibroblasts. Tranilast at concentrations of 3 μM and 30 μM up-regulated mRNA FAP-α expression in normal fibroblasts but did not influence keloid fibroblasts. The drug, at concentrations of 30 μM and 300 μM up-regulated fibroblast activation protein α expression in normal fibroblasts and did not influence keloid fibroblasts. Tranilast antiproliferative effect is not associated with FAP-α expression in keloid fibroblasts.

Psychological stress as a risk factor for postoperative keloid recurrence.

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Furtado, Fabianne; Hochman, Bernardo; Farber, Paulo Luiz; Muller, Marisa Campio; Hayashi, Lilian Fukusima; Ferreira, Lydia Masako

2012-04-01

To investigate psychological stress on the prognosis of the postoperative recurrence of keloids. Patients with keloids (n=25), candidates for surgical resection and postoperative radiotherapy, had their psychological stress evaluated on the day before the surgical procedure. The parameters evaluated were pain and itching (Visual Numerical Scale), quality of life (Questionnaire QualiFibro/Cirurgia Plástica-UNIFESP), perceived stress (Perceived Stress Scale), depression and anxiety (Hospital Depression and Anxiety Scale), salivary cortisol and minimum and maximum galvanic skin responses (GSR) at rest and under stress (i.e., while the questionnaires were being filled out). Patients were evaluated during the 3rd, 6th, 9th and 12th months of postoperative care. During each return visit, two experts classified the lesions as non-recurrent and recurrent. The recurrence group presented the greatest values in GSR during a stressful situation. The chance of recurrence increased by 34% at each increase of 1000 arbitrary units in maximum GSR during stress. Psychological stress influenced the recurrence of keloids. Copyright © 2012 Elsevier Inc. All rights reserved.

Triamcinolone Acetonide and 5-Fluorouracil Intralesional Combination Injection in Keloid Treatment

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Jono Hadi Agusni

2017-03-01

Full Text Available Objective: To evaluate the effectiveness of steroid and 5-fluorouracil (5-FU injection combination for keloid management. Methods: A 22-year-old female patient was presented with recurrent skin lesions. The skin lesions first appeared 10 years prior to consultation, had been surgically excised, and were given triamcinolone acetonide injection. However, no improvement was observed. A decision was made to use and evaluate treatment using an intralesional 4 mg (0.1 ml of 40 mg/ml triamcinolone acetonide and 45 mg (0.9 ml of 50 mg/ml 5-FU injection combination for 5 weeks. Results: Clinical improvements were observed in the third week as the lesions softened and pruritic sensation dinimished. At the end of the fifth week, improvements in the form of keloid lesion flattening and size reduction were observed. Conclusions: Intralesional injection using a combination of triamcinolone acetonide and 5-fluorouracil is effective for keloid lesion treatment.

Impact of following self-management program for presternal keloids in combination of surgery and radiation therapy

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Miyashita, Tsuguhiro; Tateno, Atsushi; Kumazaki, Tatsuo; Hyakusoku, Hiko; Horiuchi, Junichi

1999-01-01

The combination therapy of surgical removal and the post-operative irradiation is thought as a gold standard therapy for intractable keloid. However, even when both methods were used, presternal keloids had a high incidence of recurrence. We reviewed 40 patients with presternal keloids who were treated with surgical removal and postoperative irradiation. Patients age range was 9 to 81 years (average 31.5 years, median 25 years), and the male to female ratio was 21:19. A comparative study was performed on recurrence rates by patients' age, sex, and keloid size, and with or without a self-management program that we designed. Overall relapse rate was 48%, which included minimal or partial recurrences. Of all recurrence, 57% occurred within six months and 84% within a year. The recurrence rates were 62% in male and 32% in female (P=0.057), 58% in those whose ages were less than thirty and 29% in those whose ages were thirty or greater (P=0.079), and 54% when the size of keloid was under 8 cm and 33% in 8 cm or more (P=0.240). A significant difference of recurrence rates was revealed just between the first half (67%) and the second half (32%) of therapeutic periods performed without or with the postoperative self-management program, respectively (P=0.028). It is suggested that the following application of our self-management program is useful for therapy in presternal keloids treated with surgical resection and radiation therapy. Keloids of young or male cases were exhibiting a tendency to recur. These patients should be treated with a strict self-management program. (author)

Aggressive keloid-mimicking tumor in Melanosuchus niger in captivity

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Washington Luiz Assunção Pereira

2013-07-01

Full Text Available The objective of this note is to describe a case of exuberant scarring formation, with keloid characteristics and pseudo-tumoral configuration in a male Black caiman (Melanosuchus niger, with an estimated age of 60 years, belonging to the Zoobotanical Park at the Emílio Goeldi Museum, located in Belém, Pará, Brazil. The alteration appeared on the right posterior limb involving two distal phalanges of the lateral digit and measured 12.4cm at the greatest width. The keloid tissue was surgically removed and samples were processed and analyzed histopathologically, revealing growth made up of fibrous connective tissue with the habitual morphology, which was structurally mature in the more central areas.

Techniques for Optimizing Surgical Scars, Part 2: Hypertrophic Scars and Keloids.

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Potter, Kathryn; Konda, Sailesh; Ren, Vicky Zhen; Wang, Apphia Lihan; Srinivasan, Aditya; Chilukuri, Suneel

2017-01-01

Surgical management of benign or malignant cutaneous tumors may result in noticeable scars that are of great concern to patients, regardless of sex, age, or ethnicity. Techniques to optimize surgical scars are discussed in this three-part review. Part 2 focuses on scar revision for hypertrophic and keloids scars. Scar revision options for hypertrophic and keloid scars include corticosteroids, bleomycin, fluorouracil, verapamil, avotermin, hydrogel scaffold, nonablative fractional lasers, ablative and fractional ablative lasers, pulsed dye laser (PDL), flurandrenolide tape, imiquimod, onion extract, silicone, and scar massage.

An analysis of injuries due to irradiation of keloids with Roentgen rays in children

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Kik, A.; Bachurzewski, J.; Korniszewski, L.

1975-01-01

On the basis of many years' observations of 301 children with numerous keloids irradiated with X rays of whom 216 were treated with grenz rays, 62 - with filtered Roentgen rays and 23 were treated by the indirect Gouin's method admissibility of roentgenotherapy in children is analysed. It seems that at present filtered X rays may be replaced by other methods when small or medium-sized keloids are treated in children. In addition, the indirect Gouin's method should be confined to uncommonly extensive lesions with associated contractures. Although aimed pediatrical-endocrinological investigations failed to reveal any serious radiation injuries, except for 4 cases presented in methods, should be used in the treatment of keloids in children. (author)

Comparative effect and safety of verapamil in keloid and hypertrophic scar treatment: a meta-analysis

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Li ZN

2016-11-01

Full Text Available Zhouna Li, Zhehu Jin Department of Dermatology, Yanbian University Affiliated hospital, Yanji, Jilin, People’s Republic of China Background: Keloids and hypertrophic scars are the most common types of pathological scarring. Traditionally, keloids have been considered as a result of aberrant wound healing, involving excessive fibroblast participation that is characterized by hyalinized collagen bundles. However, the usefulness of this characterization has been questioned. In recent years, studies have reported the appropriate use of verapamil for keloids and hypertrophic scars.Methods: Searches were conducted on the databases Medline, Embase, Cochrane, PubMed, and China National Knowledge Infrastructure from 2006 to July 2016. State12.0 was used for literature review, data extraction, and meta-analysis. Treatment groups were divided into verapamil and nonverapamil group. Nonverapamil group includes steroids and intense pulsed light (IPL therapy. Total effective rates include cure rate and effective rate. Cure: skin lesions were completely flattened, became soft and symptoms disappeared. Efficacy: skin lesions subsided, patient significantly reduced symptoms. Inefficient definition of skin was progression free or became worse. Random-effects model was used for the meta-analysis.Results: Six studies that included 331 patients with keloids and hypertrophic scars were analyzed. Analysis of the total effective rate of skin healing was performed. The total effective rates in the two groups were 54.07% (verapamil and 53.18% (nonverapamil, respectively. The meta-analysis showed that there was no difference between the two groups. We also compared the adverse reactions between the verapamil treatment group and the steroids treatment group in two studies, and the result indicated that the verapamil group showed less adverse reactions.Conclusion: There were no differences between the application of verapamil and nonverapamil group in keloids and

Surgical excision and immediate postoperative radiotherapy versus cryotherapy and intralesional steroids in the management of keloids: a prospective clinical trial.

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Emad, Maryam; Omidvari, Shapour; Dastgheib, Ladan; Mortazavi, Afshin; Ghaem, Haleh

2010-01-01

To compare the efficacy and tolerability of surgical excision and radiotherapy with those of cryotherapy and intralesional steroid treatment of keloids. Twenty-six patients with a total of 76 keloids were enrolled in this study. Nineteen patients with 44 keloids underwent surgical excision combined with immediate 12-Gy irradiation (group A) while the remaining 9 patients with 32 keloids received multiple sessions of intralesional steroid treatment after cryotherapy which continued until flattening of lesion(s) occurred (group B). Two patients were included in both treatment groups. All patients were followed up at regular intervals for at least 1 year. In both treatment groups, keloids responded well without any major side effect. While patients of group A were all satisfied, those of group B (with a mean number of treatment sessions of 5.84 +/- 2.51) experienced more side effects, a more prolonged course, a higher recurrence rate and less satisfaction. This study showed that surgery plus immediate postoperative irradiation was an effective and relatively safe choice for treatment of keloids. Although cryotherapy combined with intralesional steroids was associated with more side effects and higher relapse rates, it could be a good choice for small and newly formed keloids. Copyright 2010 S. Karger AG, Basel.

Comparative effect and safety of verapamil in keloid and hypertrophic scar treatment: a meta-analysis.

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Li, Zhouna; Jin, Zhehu

2016-01-01

Keloids and hypertrophic scars are the most common types of pathological scarring. Traditionally, keloids have been considered as a result of aberrant wound healing, involving excessive fibroblast participation that is characterized by hyalinized collagen bundles. However, the usefulness of this characterization has been questioned. In recent years, studies have reported the appropriate use of verapamil for keloids and hypertrophic scars. Searches were conducted on the databases Medline, Embase, Cochrane, PubMed, and China National Knowledge Infrastructure from 2006 to July 2016. State12.0 was used for literature review, data extraction, and meta-analysis. Treatment groups were divided into verapamil and nonverapamil group. Nonverapamil group includes steroids and intense pulsed light (IPL) therapy. Total effective rates include cure rate and effective rate. Cure: skin lesions were completely flattened, became soft and symptoms disappeared. Efficacy: skin lesions subsided, patient significantly reduced symptoms. Inefficient definition of skin was progression free or became worse. Random-effects model was used for the meta-analysis. Six studies that included 331 patients with keloids and hypertrophic scars were analyzed. Analysis of the total effective rate of skin healing was performed. The total effective rates in the two groups were 54.07% (verapamil) and 53.18% (nonverapamil), respectively. The meta-analysis showed that there was no difference between the two groups. We also compared the adverse reactions between the verapamil treatment group and the steroids treatment group in two studies, and the result indicated that the verapamil group showed less adverse reactions. There were no differences between the application of verapamil and nonverapamil group in keloids and hypertrophic scars treatment. Verapamil could act as an effective alternative modality in the prevention and treatment of keloid and hypertrophic scars. A larger number of studies are required to

Ear-lobe keloids: treatment by a protocol of surgical excision and immediate postoperative adjuvant radiotherapy.

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Ragoowansi, R; Cornes, P G; Glees, J P; Powell, B W; Moss, A L

2001-09-01

There is no universally agreed policy for treating keloid scars of the ear lobe following piercing. We treated 35 patients (34 women) for high-risk ear-lobe keloids; the average age was 24 years (range: 16-44 years). All had failed to respond to prior treatment with massage and silicone, and corticosteroid injection. The keloids were excised extralesionally and the defects were closed with interrupted prolene sutures. The operative scar was covered with topical 2% lignocaine-0.25% chlorhexidine sterile lubricant gel under a transparent adhesive dressing. Adjuvant postoperative radiotherapy of 10 Gy, applied as 100 kV photons (4 mm high-voltage therapy (HVT) Al), was given within 24 h of surgery. All keloid scars were controlled at 4 weeks' follow-up. At 1 year, three out of 34 cases followed up had relapsed (probability of control: 91.2%). At 5 years, a further four out of the remaining 31 patients had relapsed (cumulative probability of control at 5 years: 79.4%). There were no cases of serious toxicity. Copyright 2001 The British Association of Plastic Surgeons.

Perioperative Interstitial High-Dose-Rate Brachytherapy for the Treatment of Recurrent Keloids: Feasibility and Early Results

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Jiang, Ping, E-mail: ping.jiang@uksh.de [Department of Radiation Oncology, University Clinic Schleswig-Holstein, Campus Kiel, Kiel (Germany); Baumann, René [Department of Radiation Oncology, University Clinic Schleswig-Holstein, Campus Kiel, Kiel (Germany); Dunst, Juergen [Department of Radiation Oncology, University Clinic Schleswig-Holstein, Campus Kiel, Kiel (Germany); Department of Radiation Oncology, University of Copenhagen, Copenhagen (Denmark); Geenen, Matthias [Department of Reconstructive Surgery, Lubinus Clinic Kiel, Kiel (Germany); Siebert, Frank-André [Department of Radiation Oncology, University Clinic Schleswig-Holstein, Campus Kiel, Kiel (Germany); Niehoff, Peter [Department of Radiation Oncology, University Clinic Schleswig-Holstein, Campus Kiel, Kiel (Germany); Department of Radiation Oncology, Community Clinic Köln, Köln (Germany); Department of Radiation Oncology, University Witten/Herdecke, Witten (Germany); Bertolini, Julia; Druecke, Daniel [Department of Reconstructive Surgery, University Clinic Schleswig-Holstein, Campus Kiel, Kiel (Germany)

2016-03-01

Purpose: To prospectively evaluate high-dose-rate brachytherapy in the treatment of therapy-resistant keloids and report first results, with emphasis on feasibility and early treatment outcome. Methods and Materials: From 2009 to 2014, 24 patients with 32 recurrent keloids were treated with immediate perioperative high-dose-rate brachytherapy; 3 patients had been previously treated with adjuvant external beam radiation therapy and presented with recurrences in the pretreated areas. Two or more different treatment modalities had been tried in all patients and had failed to achieve remission. After (re-)excision of the keloids, a single brachytherapy tube was placed subcutaneously before closing the wound. The target volume covered the scar in total length. Brachytherapy was given in 3 fractions with a single dose of 6 Gy in 5 mm tissue depth. The first fraction was given within 6 hours after surgery, the other 2 fractions on the first postoperative day. Thus, a total dose of 18 Gy in 3 fractions was administered within 36 hours after the resection. Results: The treatment was feasible in all patients. No procedure-related complications (eg, secondary infections) occurred. Nineteen patients had keloid-related symptoms before treatment like pain and pruritus; disappearance of symptoms was noticed in all patients after treatment. After a median follow-up of 29.4 months (range, 7.9-72.4 months), 2 keloid recurrences and 2 mildly hypertrophied scars were observed. The local control rate was 94%. Pigmentary abnormalities were detected in 3 patients, and an additional 6 patients had a mild delay in the wound-healing process. Conclusions: The early results of this study prove the feasibility and the efficacy of brachytherapy for the prevention of keloids. The results also suggest that brachytherapy may be advantageous in the management of high-risk keloids or as salvage treatment for failure after external beam therapy.

Perioperative interstitial brachytherapy for recurrent keloid scars

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Rio, E.; Bardet, E.; Peuvrel, P.; Martinet, L.; Perrot, P.; Baraer, F.; Loirat, Y.; Sartre, J.Y.; Malard, O.; Ferron, C.; Dreno, B.

2010-01-01

Purpose: Evaluation of the results of perioperative interstitial brachytherapy with low dose-rate (L.D.R.) Ir-192 in the treatment of keloid scars. Patients and methods: We performed a retrospective analysis of 73 histologically confirmed keloids (from 58 patients) resistant to medico surgical treated by surgical excision plus early perioperative brachytherapy. All lesions were initially symptomatic. Local control was evaluated by clinical evaluation. Functional and cosmetic results were assessed in terms of patient responses to a self-administered questionnaire. Results: Median age was 28 years (range 13-71 years). Scars were located as follows: 37% on the face, 32% on the trunk or abdomen, 16% on the neck, and 15% on the arms or legs. The mean delay before loading was four hours (range, 1-6 h). The median dose was 20 Gy (range, 15-40 Gy). Sixty-four scars (from 53 patients) were evaluated. Local control was 86% (follow-up, 44.5 months; range, 14-150 months). All relapses occurred early within 2 years posttreatment. At 20 months, survival without recurrence was significantly lower when treated lengths were more than 6 cm long. The rate was 100% for treated scars below 4.5 cm in length, 95% (95% CI: 55-96) for those 4.5-6 cm long, and 75% (95% CI: 56-88) beyond 6 cm (p = 0.038). Of the 35 scars (28 patients) whose results were reassessed, six remained symptomatic and the esthetic results were considered to be good in 51% (18/35) and average in 37% (13/35) (median follow-up, 70 months; range, 16-181 months). Conclusion: Early perioperative L.D.R. brachytherapy delivering 20 Gy at 5 mm reduced the rate of recurrent keloids resistant to other treatments and gave good functional results. (authors)

Keloids in rural black South Africans. Part 2: dietary fatty acid intake and total phospholipid fatty acid profile in the blood of keloid patients.

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Louw, L; Dannhauser, A

2000-11-01

In the second part of this study, emphasis is placed on nutritional intakes (fatty acids and micronutrients) and fatty acid intake and metabolism in the blood, respectively, according to a combined 24 h recall and standardized food frequency questionnaire analyses of keloid prone patients (n=10), compared with normal black South Africans (n=80), and total phospholipid blood (plasma and red blood cell ) analyses of keloid patients (n=20), compared with normal individuals (n=20). Lipid extraction and fractionation by standard procedures, total phospholipid (TPL) separation with thin layer chromatography, and fatty acid methyl ester analyses with gas liquid chromatography techniques were used. Since nutrition may play a role in several disease disorders, the purpose of this study was to confirm or refute a role for essential fatty acids (EFAs) in the hypothesis of keloid formations stated in part 1 of this study. (1)According to the Canadian recommendation (1991), we observed that in keloid patients linoleic acid (LA) and arachidonic acid (AA) dietary intakes, as EFAs of the omega-6-series, are higher than the recommended 7-11 g/d. However, the a-linolenic acid (ALA), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) dietary intakes, as EFAs of the omega-3 series, are lower than the recommendation of 1.1-1.5 g/d. This was also the case in the control group, where a higher dietary intake of the omega-6 fatty acids and a slightly lower dietary intake of the omega-3 fatty acids occurred. Thus, we confirm a high dietary intake of LA (as a product of organ meats, diary products and many vegetable oils) and AA (as a product of meats and egg yolks), as well as lower dietary intakes of ALA (as a product of grains, green leafy vegetables, soy oil, rapeseed oil and linseed), and EPA and DHA (as products of marine oils). Lower micronutrient intakes than the recommended dietary allowances were observed in the keloid group that may influence EFA metabolism and/or collagen

Comparative effect and safety of verapamil in keloid and hypertrophic scar treatment: a meta-analysis

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Li ZN; Jin ZH

2016-01-01

Zhouna Li, Zhehu Jin Department of Dermatology, Yanbian University Affiliated hospital, Yanji, Jilin, People’s Republic of China Background: Keloids and hypertrophic scars are the most common types of pathological scarring. Traditionally, keloids have been considered as a result of aberrant wound healing, involving excessive fibroblast participation that is characterized by hyalinized collagen bundles. However, the usefulness of this characterization has been questioned. In recent yea...

Comparative effect and safety of verapamil in keloid and hypertrophic scar treatment: a meta-analysis

OpenAIRE

Li,Zhouna; Jin,Zhehu

2016-01-01

Zhouna Li, Zhehu Jin Department of Dermatology, Yanbian University Affiliated hospital, Yanji, Jilin, People’s Republic of China Background: Keloids and hypertrophic scars are the most common types of pathological scarring. Traditionally, keloids have been considered as a result of aberrant wound healing, involving excessive fibroblast participation that is characterized by hyalinized collagen bundles. However, the usefulness of this characterization has been questioned. In recent...

Evidences of autologous fat grafting for the treatment of keloids and hypertrophic scars

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VINÍCIUS ZOLEZI DA SILVA

Full Text Available SUMMARY Introduction Since the 1980s, the use of autologous fat grafting has been growing in plastic surgery. Recently, this procedure has come to be used as a treatment for keloids and hypertrophic scars mainly due to the lack of satisfactory results with other techniques. So far, however, it lacks more consistent scientific evidence to recommend its use. The aim of this study was to review the current state of autologous fat grafting for the treatment of keloids and hypertrophic scars, their benefits and scientific evidences in the literature. Method A review in the Pubmed database was performed using the keywords “fat grafting and scar”, “fat grafting and keloid scar” and “fat grafting and hypertrophic scar.” Inclusion criteria were articles written in English and published in the last 10 years, resulting in 15 studies. Results These articles indicate that autologous fat grafting carried out at sites with pathological scars leads to a reduction of the fibrosis and pain, an increased range of movement in areas of scar contraction, an increase in their flexibility, resulting in a better quality of scars. Conclusion So far, evidences suggest that autologous fat grafting for the treatment of keloids and hypertrophic scars is associated with a better quality of scars, leading to esthetic and functional benefits. However, this review has limitations and these findings should be treated with reservations, since they mostly came from studies with low levels of evidence.

Carbon Dioxide Leaser For The Treatment Of Keloids

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Verma Kaushal K

2002-01-01

Full Text Available Keloids are difficult to treat medically or surgically. Carbon dioxide (CO2 laser is considered to be a better therapeutic option due to less chances of recurrence with this modality. Fourteen patients, 4 males and 10 females, between 9 and 36 years of age having keloids for 1 to 10 years were included in this study. The lesions were present on chest, ear lobes, nape of neck, forearm, arm and shoulder. CO2 laser with a power setting of 10 to 20 watts was used in continuous mode to vaporize/excise the lesions. The patients were followed up at the end of last week, 2nd week and then every 4 weeks for 3 months to evaluate the response to treatment. Twelve patients followed up regularly and completed this study. Six patients with keliods on chest had 50 to 70% response. Remaining 6 patients with keliods on chest had 50 to 70% response. Remaining 6 patients with lesions on the ear lobes (3, showed 50 to 90% response. Nape of neck (1, shoulder, arm and forearm (2 lesions had 50 to 90% response. In all, except one patient the healing started by 4 weeks and complete healing of the treatment area occurred within 8 weeks. Four patients with poor response to CO2 laser alone were given in addition intralesional triaminolone acetonide 40mg/ml, which resulted in a better response in these patients. One patient had depigmentation of the treated area. There were no side effects in other patients. We therefore conclude that CO2 laser is a good therapeutic modality for the treatment of keloids: however recurrence on long term follow up needs to be observed.

Differential Gene Expression of Fibroblasts: Keloid versus Normal

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Michael F. Angel

2002-11-01

Full Text Available Abstract: This study investigated gene regulation and unique gene products in both keloid (KDF and normal (NDF dermal fibroblasts in established cell lines. For gene regulation, NDF versus KDF were compared using Clontech's Atlas™ Human cDNA Expression Array while unique gene products were studied using RNA Fingerprinting Kit. RNA from each sample was converted to cDNA using oligo-dT primers. Down-regulated genes using Atlas Array in KDF were 1 60 S ribosomal protein, 2 Thioredoxin dependent peroxidase, 3 Nuclease sensitive element DNA binding protein, 4 c-myc purine-binding transcription factor, 5 c-AMP dependent protein kinase, and, 6 Heat Shock Protein 90 kDa. Genes that are up regulated in KDF were 1 Tubulin and 2 Heat Shock Protein 27 kDa. With the differential display, we found 17 bands unique to both KDF and NDF. The specific gene and the manner in which they were differentially regulated have direct implications to understanding keloid fibroblast proliferation.

A new argon gas-based device for the treatment of keloid scars with the use of intralesional cryotherapy.

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van Leeuwen, Michiel C E; Bulstra, Anne-Eva J; van Leeuwen, Paul A M; Niessen, Frank B

2014-12-01

Intralesional (IL) cryotherapy is a new promising technique for the treatment of keloid scars, in which the scar is frozen from inside. Multiple devices are available, mostly based on a simple liquid nitrogen Dewar system, which have a limited freezing capacity. Argon gas-based systems ensure accurate and highly controlled freezing and have shown to be effective within the field of oncologic surgery. However, this technique has never been used for the treatment of keloid scars. This prospective study evaluates an argon gas-based system for the treatment of keloids in a patient population including all Fitzpatrick skin types with a 1-year follow-up. Twenty-five patients with 30 keloid scars were included and treated with a device called Seednet (Galil Medical, Yokneam, Israel). Scar quality and possible scar recurrence were assessed before treatment and post treatment (6 and 12 months) with objective devices determining scar color, scar elasticity, scar volume, and patient's skin type. In addition, scars were evaluated using the Patient and Observer Scar Assessment Scale. After 12 months, a significant volume reduction of 62% was obtained, p = 0.05. Moreover, complaints of pain and itching were alleviated and scar quality had improved according to the Patient and Observer Scar Assessment Scale. Scar pigmentation recovered in 62% of all keloid scars within 12 months. Five out of 30 (17%) scars recurred within 12 months, three of which had previously been treated with liquid nitrogen-based IL cryotherapy. Both recurrent and persistent hypopigmentation were mainly seen in Afro-American patients. IL cryotherapy with the use of an argon gas-based system proves to be effective in the treatment of keloid scars, yielding volume reduction and low recurrence rates. Although hypopigmentation recovered in most cases, it is strongly related to non-Caucasian patients. Finally, additional treatment of keloid scars previously unresponsive to IL cryotherapy is predisposed to a high

Association of the plasminogen activator inhibitor-1 (PAI-1) Gene -675 4G/5G and -844 A/G promoter polymorphism with risk of keloid in a Chinese Han population.

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Wang, Yongjie; Long, Jianhong; Wang, Xiaoyan; Sun, Yang

2014-10-28

A keloid is pathological scar caused by aberrant response to skin injuries, characterized by excessive accumulation of histological extracellular matrix, and occurs in genetically susceptible individuals. Plasminogen activator inhibitor-1 (PAI-1) has been implicated in the pathogenesis of keloid. We investigated the association between PAI-1 polymorphisms and plasma PAI-1 level with keloid risk. A total of 242 Chinese keloid patients and 207 controls were enrolled in this study. Polymerase chain reaction-restriction technique was used to determine PAI-1 promoter polymorphism (-675 4G/5G and -844 A/G) distribution. Plasma PAI-1 levels were detected using enzyme-linked immunosorbent assay (ELISA). There was a statistically significant difference in the distribution of PAI-1 -675 4G/5G polymorphism between keloid patients and healthy controls. 4G/4G carriers were more likely to develop keloid. In contrast, the -844 A/G polymorphism distribution did not vary significantly between keloid patients and controls. The keloid patients group had a significantly higher plasma PAI-1 level than the control group. In the -675 4G/4G carrier population, the plasma PAI-1 levels were significant higher in keloid patients compared with controls. Our study provides evidence that PAI-1 promoter polymorphism -675 4G/5G and plasma PAI-1 level are associated with keloid risk. PAI-1 -675 4G/5G polymorphism may be an important hereditary factor responsible for keloid development in the Chinese Han population.

Intralesional Cryotherapy for Treatment of Keloid Scars: A Prospective Study

NARCIS (Netherlands)

van Leeuwen, M.C.E.; van der Wal, M.B.A.; Bulstra, A.E.J.; Galindo Garre, F.; Molier, J.; van Zuijlen, P.P.M.; van Leeuwen, P.A.M.; Niessen, F.B.

2015-01-01

Background: Intralesional cryotherapy is a novel treatment for keloid scars in which the scar is frozen from inside. Published results are promising, but the treatment has only been tested in a Caucasian patient population. Therefore, the authors evaluated intralesional cryotherapy in a patient

New approach to the understanding of keloid: psychoneuroimmune–endocrine aspects

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Hochman B

2015-02-01

Full Text Available Bernardo Hochman†, Felipe Contoli Isoldi, Fabianne Furtado, Lydia Masako Ferreira Plastic Surgery Division, Federal University of São Paulo, São Paulo, Brazil †Bernardo Hochman passed away on April 21, 2014 Abstract: The skin is a dynamic and complex organ that relies on the interrelation among different cell types, macromolecules, and signaling pathways. Further, the skin has interactions with its own appendages and other organs such as the sebaceous glands and hair follicles, the kidney, and adrenal glands; systems such as the central nervous system; and axes such as the hypothalamic–pituitary–adrenal axis. These continuous connections give the skin its versatility, and when an injury is caused, some triggers start a cascade of events designed to restore its integrity. Nowadays, it is known that this psychoneuroimmune–endocrine intercommunication modulates both the homeostatic condition and the healing process. In this sense, the skin conditions before a trauma, whether of endogenous (acne or exogenous origin (injury or surgical incision, could regulate the process of tissue repair. Most skin diseases such as psoriasis and atopic dermatitis, among others, have in their pathophysiology a psychogenic component that triggers integrated actions in the nervous, immune, and endocrine systems. However, fibroproliferative disorders of wound healing, such as hypertrophic scar and keloid, are not yet included in this listing, despite showing correlation with stress, especially with the psychosocial character. This review, by understanding the "brain–skin connection", presents evidence that allows us to understand the keloid as a psychomediated disease. Keywords: keloid, stress, psychological, psychoneuroimmunology, wound healing

Adiponectin Is Involved in Connective Tissue Growth Factor-Induced Proliferation, Migration and Overproduction of the Extracellular Matrix in Keloid Fibroblasts.

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Luo, Limin; Li, Jun; Liu, Han; Jian, Xiaoqing; Zou, Qianlei; Zhao, Qing; Le, Qu; Chen, Hongdou; Gao, Xinghua; He, Chundi

2017-05-12

Adiponectin, an adipocyte-derived hormone, exerts pleiotropic biological effects on metabolism, inflammation, vascular homeostasis, apoptosis and immunity. Recently, adiponectin has been suggested to attenuate the progression of human dermal fibrosis. Connective tissue growth factor (CTGF) is induced in keloids and is thought to be participated in the formation of keloid fibrosis. However, the roles played by adiponectin in keloids remain unclear. In this study, we explored the effects of adiponectin on CTGF-induced cell proliferation, migration and the deposition of extracellular matrix (ECM) and their associated intracellular signalling pathways in keloid fibroblasts (KFs). We also explored possible mechanisms of keloid pathogenesis. Primary fibroblast cultures were established from foreskin biopsies and skin biopsies from patients with keloids. The expression of adiponectin and adiponectin receptors (adipoRs) was evaluated by reverse transcription-PCR (RT-PCR), quantitative real-time RT-PCR, immunofluorescence staining, and immunohistochemical analysis. Next, KFs and normal dermal fibroblasts (NFs) were treated with CTGF in the presence or absence of adiponectin. A cell counting kit-8 (CCK-8) and the Transwell assay were used to examine cell proliferation and migration. The level of the collagen I, fibronectin (FN) and α-smooth muscle actin (α-SMA) mRNAs and proteins were determined by quantitative real-time RT-PCR and western blotting. The effects of RNA interference (RNAi) targeting the adipoR genes were detected. Phosphorylation of adenosine 5'-monophosphate (AMP)-activated protein kinase (AMPK), mitogen-activated protein kinase (MAPK) and phosphatidylinositol 3 kinase-protein kinase (PI3K-Akt) were examined by western blotting to further investigate the signalling pathways. Furthermore, inhibitors of signal transduction pathways were investigated. The expression levels of adiponectin and adipoRs were significantly decreased in keloids compared with those

Bilateral congenital corneal keloids and anterior segment mesenchymal dysgenesis in a case of Rubinstein-Taybi syndrome.

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Rao, Srinivas K; Fan, Dorothy S P; Pang, C P; Li, Winnie W Y; Ng, Joan S K; Good, William V; Lam, Dennis S C

2002-01-01

To report the unusual association of bilateral corneal keloids and anterior segment mesenchymal dysgenesis in a child with Rubinstein-Taybi syndrome. Case report of a 2-year-old boy. Excision of the epicorneal mass in the right eye was followed by recurrence of the lesion. Multiple penetrating keratoplasties were unsuccessful in reconstructing the anterior segment because of recurrent corneal epithelial breakdown, suggesting limbal stem cell insufficiency. Histopathology and electron microscopy of the excised mass lesion showed features typical of a corneal keloid: thickened keratinized epithelium, absent Bowman's layer, and fibrovascular hyperplasia, with haphazard orientation of the collagen lamellae. Ultrasound biomicroscopy and intraoperative findings suggested a diagnosis of Peter anomaly, but genetic analysis did not show a PAX6 mutation. The findings in our patient add to the spectrum of ocular changes described in Rubinstein-Taybi syndrome and confirm earlier reports of poor ocular prognosis in corneal keloids and Rubinstein-Taybi syndrome.

Simple device to determine the pressure applied by pressure clips for the treatment of earlobe keloids

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Aashish Sasidharan

2015-01-01

Full Text Available Background: Keloids of the ear are common problems. Various treatment modalities are available for the treatment of ear keloids. Surgical excision with intralesional steroid injection along with compression therapy has the least recurrence rate. Various types of devices are available for pressure therapy. Pressure applied by these devices is uncontrolled and is associated with the risk of pressure necrosis. We describe here a simple and easy to use device to measure pressure applied by these clips for better outcome. Objectives: To devise a simple method to measure the pressure applied by various pressure clips used in ear keloid pressure therapy. Materials and Methods: By using a force sensitive resistor (FSR, the pressure applied gets converted into voltage using electrical wires, resistors, capacitors, converter, amplifier, diode, nine-volt (9V cadmium battery and the voltage is measured using a multimeter. The measured voltage is then converted into pressure using pressure voltage graph that depicts the actual pressure applied by the pressure clip. Results: The pressure applied by different clips was variable. The spring clips were adjustable by slight variation in the design whereas the pressure applied by binder clips and magnet discs was not adjustable. Conclusion: The uncontrolled/suboptimal pressure applied by certain pressure clips can be monitored to provide optimal pressure therapy in ear keloid for better outcome.

Osteopoikilosis associated with keloids formation, rheumatoid arthritis, myasthenia, Graves` disease and megaloblastic anaemia

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Irena Zimmermann-Górska

2014-06-01

Full Text Available Osteopoikilosis is an uncommon hereditary dysplasia of skeleton characterized by small sclerotic foci clustered mainly in periarticular osseus regions. The radiographic pattern is pathognomonic. The disease can be a result of the loss-of-function mutations in LEMD3 – the gene responsible for bone density which can influence also on the expression of transforming growth factor β1 (TGF-β1 signalling. TGF-β1 is a key mediator of fibrosis and a modulator of immune responses. Patients with osteopoikilosis demonstrate a higher incidence of keloid formation and autoimmune diseases. In the presented case osteopoikilosis was associated with keloids formation and autoimmune diseases: rheumatoid arthritis, myasthenia, Graves’ disease and megaloblastic anaemia.

Descriptive Study of Patients Receiving Excision and Radiotherapy for Keloids

International Nuclear Information System (INIS)

Speranza, Giovanna; Sultanem, Khalil M.D.; Muanza, Thierry

2008-01-01

Purpose: To review and describe our institution's outcomes in patients treated with external beam radiotherapy after keloid excision. Methods and Materials: This was a retrospective study. Patients who received radiotherapy between July 1994 and January 2004 after keloid excision were identified. A questionnaire was mailed regarding sociodemographic factors, early and late radiation toxicities, the need for additional therapy, and satisfaction level. All patients had received a total of 15 Gy in three daily 5-Gy fractions. Treatment started within 24 h after surgery and was delivered on a Siemens orthovoltage machine. The data were analyzed using the STATA statistical package. Results: A total of 234 patients were approached. The response rate was 41%, and 75% were female. The mean age was 36.5 years (range, 16-69 years). The patients were mainly of European (53.1%) or African (19.8%) descent. For early toxicity outcomes, 54.2% reported skin redness and 24% reported skin peeling. For late toxicity outcomes, 27% reported telangiectasia and 62% reported permanent skin color changes. No association was found with gender, skin color, or age for the late toxicity outcomes. Of the patients responding, 14.6% required adjuvant treatment. On a visual scale of 1-10 for the satisfaction level, 60% reported a satisfaction level of ≥8. Telangiectasia was the most significant predictor of a low satisfaction level (≤3, p < 0.005). Conclusion: The results of our study have shown that orthovoltage-based radiotherapy after surgical excision for keloids is a good method for the prevention of relapse. It is well tolerated, causes little toxicity, and leads to a high patient satisfaction level

Could −79 °C Spray-Type Cryotherapy Be an Effective Monotherapy for the Treatment of Keloid?

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Park, Tae Hwan; Cho, Hyeon-Ju; Lee, Jang Won; Kim, Chan Woo; Chong, Yosep; Chang, Choong Hyun; Park, Kyung-Soon

2017-01-01

Cryotherapy has been regarded as an effective modality for the treatment of keloids, and the spray-type device is one of the novel cryotherapeutic units. However, the biological mechanisms and therapeutic effects of this technique are incompletely studied. We evaluated the clinical efficacy of our cryotherapy protocol with molecular and pathologic evidence for the treatment of keloids. We evenly split each of ten keloid lesions into a non-treated (C−) and treated (C+) area; the C+ area was subjected to two freeze-thaw cycles of spray-type cryotherapy using −79 °C spray-type CryoPen™. This treatment was repeated after an interval of two weeks. The proliferation and migration abilities of the fibroblasts isolated from the dermis under the cryotherapy-treated or untreated keloid tissues (at least 5 mm deep) were compared and pathologic findings of the full layer were evaluated. Molecular analysis revealed that the number of dermal fibroblasts was significantly higher in C+ group as compared with C− group. The dermal fibroblasts from C+ group showed more than two-fold increase in the migration ability as compared with the fibroblasts from C− group. The expression of matrix metallopeptidase 9 was increased by more than two-fold and a significant increase in transforming growth factor beta 1 expression and Smad2/3 phosphorylation level was observed in C+ group. C+ group showed more extensive lymphoplasmacytic infiltration with thicker fibrosis and occasional “proliferating core collagen” as compared with C− group. Thus, −79 °C spray-type cryotherapy is ineffective as a monotherapy and should be used in combination with intralesional corticosteroids or botulinum toxin A for favourable outcomes in the treatment of thick keloids. PMID:29186868

Treatment of hypertrophic scars and keloids using intense pulsed light (IPL).

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Erol, O Onur; Gurlek, Ali; Agaoglu, Galip; Topcuoglu, Ela; Oz, Hayat

2008-11-01

Keloids and hypertrophic scars are extremely disturbing to patients, both physically and psychologically. This study prospectively assessed the safety and efficacy of intense pulsed light (IPL) on scars originating from burns, trauma, surgery, and acne. Hypertrophic scars in 109 patients, originating from surgical incisions (n = 55), traumatic cuts (traffic accidents) (n = 24), acne scars (n = 6), keloids (n = 5), and burns (n = 19), were treated using an IPL Quantum device. Treatment was administered at 2-4-week intervals, and patients received an average of 8 treatments (range = 6-24). Using digital photographs, Changes in scar appearance were assessed by two physicians who were blinded to the study patients and treatments. The photographs were graded on a scale of 0 to 4 (none, minimal, moderate, good, excellent) for improvement in overall clinical appearance and reduction in height, erythema, and hardness. An overall clinical improvement in the appearance of scars and reductions in height, erythema, and hardness were seen in the majority of the patients (92.5%). Improvement was excellent in 31.2% of the patients, good in 25.7%, moderate in 34%, and minimal in 9.1%. Over half the patients had good or excellent improvement. In the preventive IPL treatment group, 65% had good to excellent improvement in clinical appearance. Patient satisfaction was very high. This study suggests that IPL is effective not only in improving the appearance of hypertrophic scars and keloids regardless of their origin, but also in reducing the height, redness, and hardness of scars.

Hypertrophic scars and keloids: a review of the current literature on ...

African Journals Online (AJOL)

Conclusion: The growing understanding of the molecular processes of normal and abnormal wound healing is promising for discovery of novel approaches for the management of hypertrophic scars and keloids. Although optimal treatment of these lesions remains undefined, successful healing can be achieved only with ...

Hypertrophic scars and keloids in surgery: current concepts.

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Song, Colin

2014-09-01

Hypertrophic scars and keloids remain a challenge in surgery. We appreciate that our understanding of the process at cellular and molecular level, profound as it is, when it comes to the clinical evidence much is left to be desired. Although the bench to bedside conundrum remains, the science of translational research calls for an even higher level of cooperation between the scientist and the clinician for the impetus to succeed.The clinicians alerted us to the possible theories in the pathogenesis of keloid formation, inter alia, the ischemia theory, mast cell theory, immune theory, transforming growth factor β interaction, mechanical theory, and the melanocyte stimulating hormone theory. All of the above presupposed a stimulus that would result in an uncontrolled upregulation of collagen and extracellular matrix expression in the pathogenesis of the keloid. This bedside to bench initiative, as in true science, realized more ponderables than possibilities.By the same token, research into the epidermal-mesenchymal signaling, molecular biology, genomics, and stem cell research holds much promise in the bench top arena. To assess efficacy, many scar assessment scores exist in the literature. The clinical measurement of scar maturity can aid in determining end points for therapeutics. Tissue oxygen tension and color assessment of scars by standardized photography proved to be useful.In surgery, the use of dermal substitutes holds some promise as we surmise that quality scars that arise from dermal elements, molecular and enzyme behavior, and balance. Although a systematic review shows some benefit for earlier closure and healing of wounds, no such review exists at this point in time for the use of dermal substitutes in scars.Adipose-derived stem cell, as it pertains to scars, will hopefully realize the potential of skin regeneration rather than by repair in which we are familiar with as well as the undesirable scarring as a result of healing through the inflammatory

Development and Characterisation of the Imiquimod Poly(2-(2-methoxyethoxyethyl Methacrylate Hydrogel Dressing for Keloid Therapy

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Wei-Chih Lin

2017-11-01

Full Text Available The imiquimod-poly(2-(2-methoxyethoxyethyl methacrylate hydrogel (poly(MEO2MA hydrogel dressing was developed for the keloid therapy application. Four groups of the hydrogels, including the imiquimod-poly(MEO2MA hydrogel, crosslinked with 0.2 mol %, 0.4 mol %, 0.6 mol %, and 0.8 mol % of di(ethylene glycol dimethacrylate cross-linker (DEGDMA, were synthesised and characterised for fabricating the imiquimod-poly(MEO2MA hydrogel pad. The lower critical solution temperature (LCST of the poly(MEO2MA hydrogel was measured at approximately 28 °C and was used as a trigger to control the imiquimod loading and release. The loaded amounts of the imiquimod in the poly(MEO2MA hydrogel, crosslinked with 0.2 mol % and 0.8 mol % of DEGDMA, were about 27.4 μg and 14.1 μg per 1 mm3 of the hydrogel, respectively. The imiquimod-release profiles of two samples were characterised in a phosphate buffered saline (PBS solution at 37 °C and the released imiquimod amount were about 45% and 46% of the total loaded imiquimod. The Cell Counting Kit-8 (CCK-8 assay was utilised to analyse the cell viability of keloid fibroblasts cultured on the samples of imiquimod-poly(MEO2MA hydrogel, crosslinked with 0.2 mol % and 0.8 mol % of DEGDMA. There was around a 34% decrease of the cell viabilities after 2 days, compared with the pure-poly(MEO2MA hydrogel samples. Therefore, the developed imiquimod-poly(MEO2MA hydrogel dressing can affect the proliferation of keloid fibroblasts. It should be possible to utilise the hydrogel dressing for the keloid therapy application.

Bethlem myopathy: An autosomal dominant myopathy with flexion contractures, keloids, and follicular hyperkeratosis.

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Saroja, Aralikatte Onkarappa; Naik, Karkal Ravishankar; Nalini, Atcharayam; Gayathri, Narayanappa

2013-10-01

Bethlem myopathy and Ullrich congenital muscular dystrophy form a spectrum of collagenopathies caused by genetic mutations encoding for any of the three subunits of collagen VI. Bethlem phenotype is relatively benign and is characterized by proximal dominant myopathy, keloids, contractures, distal hyperextensibility, and follicular hyperkeratosis. Three patients from a single family were diagnosed to have Bethlem myopathy based on European Neuromuscular Centre Bethlem Consortium criteria. Affected father and his both sons had slowly progressive proximal dominant weakness and recurrent falls from the first decade. Both children aged 18 and 20 years were ambulant at presentation. All had flexion contractures, keloids, and follicular hyperkeratosis without muscle hypertrophy. Creatinine kinase was mildly elevated and electromyography revealed myopathic features. Muscle imaging revealed severe involvement of glutei and vasti with "central shadow" in rectus femoris. Muscle biopsy in the father showed dystrophic changes with normal immmunostaining for collagen VI, sarcoglycans, and dysferlin.

Bethlem myopathy: An autosomal dominant myopathy with flexion contractures, keloids, and follicular hyperkeratosis

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Aralikatte Onkarappa Saroja

2013-01-01

Full Text Available Bethlem myopathy and Ullrich congenital muscular dystrophy form a spectrum of collagenopathies caused by genetic mutations encoding for any of the three subunits of collagen VI. Bethlem phenotype is relatively benign and is characterized by proximal dominant myopathy, keloids, contractures, distal hyperextensibility, and follicular hyperkeratosis. Three patients from a single family were diagnosed to have Bethlem myopathy based on European Neuromuscular Centre Bethlem Consortium criteria. Affected father and his both sons had slowly progressive proximal dominant weakness and recurrent falls from the first decade. Both children aged 18 and 20 years were ambulant at presentation. All had flexion contractures, keloids, and follicular hyperkeratosis without muscle hypertrophy. Creatinine kinase was mildly elevated and electromyography revealed myopathic features. Muscle imaging revealed severe involvement of glutei and vasti with "central shadow" in rectus femoris. Muscle biopsy in the father showed dystrophic changes with normal immmunostaining for collagen VI, sarcoglycans, and dysferlin.

Up-to-date approach to manage keloids and hypertrophic scars: a useful guide.

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Arno, Anna I; Gauglitz, Gerd G; Barret, Juan P; Jeschke, Marc G

2014-11-01

Keloids and hypertrophic scars occur anywhere from 30 to 90% of patients, and are characterized by pathologically excessive dermal fibrosis and aberrant wound healing. Both entities have different clinical and histochemical characteristics, and unfortunately still represent a great challenge for clinicians due to lack of efficacious treatments. Current advances in molecular biology and genetics reveal new preventive and therapeutical options which represent a hope to manage this highly prevalent, chronic and disabling problem, with long-term beneficial outcomes and improvement of quality of life. While we wait for these translational clinical products to be marketed, however, it is imperative to know the basics of the currently existing wide array of strategies to deal with excessive scars: from the classical corticotherapy, to the most recent botulinum toxin and lasers. The main aim of this review paper is to offer a useful up-to-date guideline to prevent and treat keloids and hypertrophic scars. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

Unilateral congenital corneal keloid with anterior segment mesenchymal dysgenesis and subluxated lens: case report and review of literature.

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Vanathi, M; Sen, Seema; Panda, Anita; Dada, Tanuj; Behera, Geeta; Khokhar, Sudharshan

2007-01-01

To report the unusual association of unilateral congenital corneal keloid with anterior-segment mesenchymal dysgenesis and bilateral subluxated lens. A 20-year old man presented with a mass lesion involving the left cornea. The corneal lesion had been present since birth. On biomicroscopic examination, a well-defined vascularized, grayish-white mass occupying the whole of the left cornea was seen. The right eye showed multiple peripheral corneal opacities with iridocorneal adhesions, a poorly defined supranasal limbus, and a subluxated lens. Excision biopsy of the mass was done for histopathologic examination. Histopathologic examination of the excised corneal mass showed features consistent with that of a corneal keloid: thickened keratinized epithelium, absent Bowman membrane layer, and fibrovascular hyperplasia composed of hyalinized collagen fibers with irregular orientation of the collagen lamellae. During penetrating keratoplasty of the left eye, an anomalous iris pattern with poorly defined angle and a supranasal subluxated lens was also observed. Extraction of the subluxated lens was also done. The graft failed subsequent to a nonhealing persistent epithelial defect. Our case report highlights the rare association of a unilateral congenital corneal keloid with anterior-segment mesenchymal dysgenesis and bilateral subluxated lens.

Therapeutic results and safety of postoperative radiotherapy for keloid after repeated Cesarean section in immediate postpartum period

International Nuclear Information System (INIS)

Kim Ju Ree; Lee, Sang Hoon

2012-01-01

To evaluate the effectiveness and safety of postoperative radiotherapy for the treatment of keloid scars administered immediately after Cesarean section. A total of 26 postpartum patients with confirmed keloids resulting from previous Cesarean sections received either 12 or 15 Gy radiotherapy. The radiotherapy was divided into three 6 MeV electron beam fractions administered during the postpartum period immediately following the fi nal Cesarean section. To evaluate ovarian safety, designated doses of radiation were estimated at the calculated depth of the ovaries using a solid plate phantom and an ionization chamber with the same lead cutout as was used for the treatment of Cesarean section operative scars and a tissue equivalent bolus. In total, the control rate was 77% (20 patients), while six (23%) developed focally elevated keloids (ranging from 0.5 to 2 cm in length) in the middle of the primary abdominal scar. Five patients experienced mild hyperpigmentation. Nonetheless, most patients (96%) were satisfied with the treatment results. The estimated percentage of the applied radiation doses that reached the calculated depth of the ovaries ranged from 0.0033% to 0.0062%. When administered during the immediate postpartum period, postoperative electron beam radiotherapy for repeated Cesarean section scars is generally safe and produces good cosmetic results with minimal toxicity.

Therapeutic results and safety of postoperative radiotherapy for keloid after repeated Cesarean section in immediate postpartum period

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Kim Ju Ree; Lee, Sang Hoon [Cheil General Hospital and Women' s Healthcare Center, Kwandong University College of Medicine, Seoul (Korea, Republic of)

2012-06-15

To evaluate the effectiveness and safety of postoperative radiotherapy for the treatment of keloid scars administered immediately after Cesarean section. A total of 26 postpartum patients with confirmed keloids resulting from previous Cesarean sections received either 12 or 15 Gy radiotherapy. The radiotherapy was divided into three 6 MeV electron beam fractions administered during the postpartum period immediately following the fi nal Cesarean section. To evaluate ovarian safety, designated doses of radiation were estimated at the calculated depth of the ovaries using a solid plate phantom and an ionization chamber with the same lead cutout as was used for the treatment of Cesarean section operative scars and a tissue equivalent bolus. In total, the control rate was 77% (20 patients), while six (23%) developed focally elevated keloids (ranging from 0.5 to 2 cm in length) in the middle of the primary abdominal scar. Five patients experienced mild hyperpigmentation. Nonetheless, most patients (96%) were satisfied with the treatment results. The estimated percentage of the applied radiation doses that reached the calculated depth of the ovaries ranged from 0.0033% to 0.0062%. When administered during the immediate postpartum period, postoperative electron beam radiotherapy for repeated Cesarean section scars is generally safe and produces good cosmetic results with minimal toxicity.

Comparison of therapeutic response of keloids and hypertrophic scars to cryotherapy plus intralesional steroid and bleomycin tattoo

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Farahnaz Fatemi

2005-01-01

Full Text Available Keloids and hypertrophic scars are abnormal responses of body to skin injuries. Overproduction of compacted fibrous tissue is the basic cause of these lesions. In this study the result of treatment of these skin conditions with bleomycin tattoo are compared with cryotherapy and triamcinolone injection. This study involved 45 patients with hypertrophic scar or keloid. Patients were divided into two groups consecutively. Group A (23 patients was treated with bleomycin tattoo and the group B with cryotherapy and triamcinolone injection. There were four therapeutic sessions one month apart. All patients were followedup for three month after the end of treatment .The therapeutic response was determined as reduction of lesion size or flattening relative to initial size. Therapeutic response was 88.3±14% in group A and 67.4 ±22.5% in group B (p<0.001. In group A 69%, but in group B only 49% of patients were asymptomatic after the end of treatment. In group A there was no relation between therapeutic response and lesion size (p=0.58 but in group B lesions those were smaller (<100mm2 had better therapeutic response than larger ones (p=0.007. It was concluded that bleomycin tattoo is more effective in treatment of hypertrophic scar and keloid than traditional treatment, cryotherapy plus triamcinolone injection especially in larger ones.

Intralesional triamcinolone alone and in combination with 5-fluorouracil for the treatment of Keloid and Hypertrophic scars

International Nuclear Information System (INIS)

Khan, M. A.; Bashir, M. M.; Khan, F. A.

2014-01-01

Objective: To compare the use of intralesional triamcinolone acetonide and its combination with 5 flourouracil in the treatment of keloid and hypertrophic scars in terms of reduction in initial height of the scar. Methods: The randomised controlled trial was conducted at the Department of Plastic Surgery, King Edward Medical University, Lahore, from March 2011 to December 2012. It comprised patients of both genders having keloids or hypertrophic scars (1 cm to 5 cm in size) having no history of treatment for the scars in preceding 6 months. Those who were pregnant, planning pregnancy or lactating were excluded. The subjects were divided into two groups: Group A received intralesional triamcinolone acetonide alone; and Group B received triamcinolone acetonide + 5 flourouracil. Eight injections were given at weekly interval. Scars were assessed 4 weeks after the completion of treatment on a five-point scale. SPSS 16 was used for statistical analysis. Results: The 150 subjects in the study were divided into two equal groups of 75(50%) each. Good to excellent results were seen in 51(68%) cases in Group A compared to 63(84%) in Group B. Frequency of complications was 18(24%) and 6(8%) in Group A and Group B respectively. Conclusion: Combination of triamcinolone acetonide and 5 flourouracil is superior to triamcinolone acetonide therapy in the treatment of keloids and hypertrophic scars. (author)

Delayed allergic dermatitis presenting as a keloid-like reaction caused by sting from an Indo-Pacific Portuguese man-o'-war (Physalia utriculus).

Science.gov (United States)

Guevara, B E K; Dayrit, J F; Haddad, V

2017-03-01

Cnidarian envenomations are common occurrences in the tropics that can affect holidaymakers. The cutaneous reactions are classified as immediate or delayed types. Delayed allergic reactions are persistently recurring dermatitis, which can occur within 1-4 weeks from the initial sting, and may last for several months. Hypertrophic scar-like or keloid-like reactions are rare, and are believed to be a type IV hypersensitivity reaction to sequestered antigens from stinging filaments. We report an unusual case of delayed allergic dermatitis with keloid-like presentation caused by Physalia utriculus. © 2017 British Association of Dermatologists.

Studying Intense Pulsed Light Method Along With Corticosteroid Injection in Treating Keloid Scars

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Shamsi Meymandi, Simin; Rezazadeh, Azadeh; Ekhlasi, Ali

2014-01-01

Background: Results of various studies suggest that the hypertrophic and keloid scars are highly prevalent in the general population and are irritating both physically and mentally. Objective: Considering the variety of existing therapies, intense pulsed light (IPL) method along with corticosteroid injection was evaluated in treating these scars. Materials and Methods: 86 subjects were included in this clinical trial. Eight sessions of therapeutic intervention were done with IPL along with co...

Expression of embryonic stem cell markers in keloid-associated lymphoid tissue.

Science.gov (United States)

Grant, Chelsea; Chudakova, Daria A; Itinteang, Tinte; Chibnall, Alice M; Brasch, Helen D; Davis, Paul F; Tan, Swee T

2016-07-01

To identify, characterise and localise the population of primitive cells in keloid scars (KS). 5-µm-thick formalin-fixed paraffin-embedded sections of KS samples from 10 patients underwent immunohistochemical (IHC) staining for the embryonic stem cell (ESC) markers OCT4, SOX2, pSTAT3 and NANOG, and keloid-associated lymphoid tissue (KALT) markers CD4 and CD20. NanoString gene expression analysis and in situ hybridisation (ISH) were used to determine the abundance and localisation of the mRNA for these ESC markers. IHC staining revealed the expression of the ESC markers OCT4, SOX2, pSTAT3 and NANOG by a population of cells within KS tissue. These are localised to the endothelium of the microvessels within the KALTs. NanoString gene expression analysis confirmed the abundance of the transcriptional expression of the same ESC markers. ISH localised the expression of the ESC transcripts to the primitive endothelium in KS tissue. This report demonstrates the expression of ESC markers OCT4, SOX2, pSTAT3 and NANOG by the endothelium of the microvessels within the KALTs. These findings show a unique niche of primitive cells within KS, expressing ESC markers, revealing a potential therapeutic target in the treatment of KS. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Studying intense pulsed light method along with corticosteroid injection in treating keloid scars.

Science.gov (United States)

Shamsi Meymandi, Simin; Rezazadeh, Azadeh; Ekhlasi, Ali

2014-02-01

Results of various studies suggest that the hypertrophic and keloid scars are highly prevalent in the general population and are irritating both physically and mentally. Considering the variety of existing therapies, intense pulsed light (IPL) method along with corticosteroid injection was evaluated in treating these scars. 86 subjects were included in this clinical trial. Eight sessions of therapeutic intervention were done with IPL along with corticosteroid intralesional injection using 450 to 1200 NM filter, Fluence 30-40 J/cm2, pulse duration of 2.1-10 ms and palsed delay 10-40 ms with an interval of three weeks. To specify the recovery consequences and complication rate and to determine features of the lesion, the criteria specified in the study of Eroll and Vancouver scar scale were used. The level of clinical improvement, color improvement and scar height was 89.1%, 88.8% and 89.1% respectively. The incidence of complications (1 telangiectasia case, 7 hyperpigmentation cases and 2 atrophy cases) following treatment with IPL was 11.6%. Moreover, the participants' satisfaction with IPL method was 88.8%. This study revealed that a combined therapy (intralesional corticosteroid injection + IPL) increases the recovery level of hypertrophic and keloid scars. It was also demonstrated that this method had no significant side effect and patients were highly satisfied with this method.

A new argon gas-based device for the treatment of keloid scars with the use of intralesional cryotherapy

NARCIS (Netherlands)

van Leeuwen, M.C.E.; Bulstra, A.E.J.; van Leeuwen, P.A.M.; Niessen, F.B.

2014-01-01

Background: Intralesional (IL) cryotherapy is a new promising technique for the treatment of keloid scars, in which the scar is frozen from inside. Multiple devices are available, mostly based on a simple liquid nitrogen Dewar system, which have a limited freezing capacity. Argon gas-based systems

Intralesional cryotherapy versus excision and corticosteroids or brachytherapy for keloid treatment: Study protocol for a randomised controlled trial

NARCIS (Netherlands)

E. Bijlard (Eveline); R. Timman (Reinier); G.M. Verduijn (Gerda); F.B. Niessen (Francisus B.); J.W. van Neck (Han); J.J. van Busschbach (Jan); M.A.M. Mureau (Marc)

2013-01-01

textabstractBackground: Keloids are a burden for patients due to physical, aesthetic and social complaints and treatment remains a challenge because of therapy resistance and high recurrence rates. The main goal of treatment is to improve the quality of life (QoL); this implies that, apart from

Intralesional cryotherapy versus excision and corticosteroids or brachytherapy for keloid treatment: study protocol for a randomised controlled trial

NARCIS (Netherlands)

Bijlard, E.; Timman, R.; Verduijn, G.M.; Niessen, F.B.; van Neck, J.W.; Busschbach, J.J.V.; Mureau, M.A.M.

2013-01-01

Background: Keloids are a burden for patients due to physical, aesthetic and social complaints and treatment remains a challenge because of therapy resistance and high recurrence rates. The main goal of treatment is to improve the quality of life (QoL); this implies that, apart from surgical

Comparison of two devices for the treatment of keloid scars with the use of intralesional cryotherapy: An experimental study

NARCIS (Netherlands)

van Leeuwen, M.C.E.; Bulstra, A.E.J.; van der Veen, A.J.; Bloem, W.B.; van Leeuwen, P.A.M.; Niessen, F.B.

2015-01-01

Background: Intralesional (IL) cryotherapy is a new technique for the treatment of keloid scars, in which the scar is frozen from inside. Two cryodevices are available, which were recently evaluated. Both devices showed promising results, but differed in clinical outcome. To explain these

The emerging role of antineoplastic agents in the treatment of keloids and hypertrophic scars: a review.

Science.gov (United States)

Shridharani, Sachin M; Magarakis, Michael; Manson, Paul N; Singh, Navin K; Basdag, Basak; Rosson, Gedge D

2010-03-01

The management of keloids and hypertrophic scars continues to challenge health-care providers. Though both forms of pathologic scarring are distinct entities at the macro and microscopic level, their etiologies and treatment are often similar. Potential treatment approaches are progressing, and combinations of treatment options have been proposed in the literature with promising outcomes. The treatment evolution has reached a level where molecular therapeutic modalities are being investigated. Currently, no gold standard treatment exists. Overall success rates and patient satisfaction seem to be slowly climbing, but additional investigational studies must continue to be performed. Several studies have investigated antineoplastic agents, and there seems to be a marked improvement in rates of recurrence, patient satisfaction, and overall quality of scar when these agents are used. Intralesional injection and/or wound irrigation with interferon-a2b, interferon-g, mitomycin-C, bleomycin, or 5-fluorouracil seems to have a positive effect on the reduction of pathologic scars. There is mounting evidence that these drugs used alone or in combination therapy, have the potential to be an integral part of the treatment paradigm for hypertrophic scars and keloids.

Perioperative interstitial brachytherapy for recurrent keloid scars; La curietherapie interstitielle perioperatoire dans le traitement des cicatrices cheloides recidivantes

Energy Technology Data Exchange (ETDEWEB)

Rio, E; Bardet, E; Peuvrel, P [CRLCC Nantes-Atlantique, Service de radiotherapie, 44 - Nantes-St-Herblain (France); Martinet, L; Perrot, P [CHU Hotel-Dieu, Service de chirurgie plastique, 44 - Nantes (France); Baraer, F; Loirat, Y [Clinique Breteche, Service de chirurgie plastique, 44 - Nantes (France); Sartre, J Y [Clinique Jules-Verne, Service de chirurgie plastique, 44 - Nantes (France); Malard, O; Ferron, C [CHU Hotel-Dieu, Service de Chirurgie ORL, 44 - Nantes (France); Dreno, B [CHU Hotel-Dieu, Service de dermatologie, 44 - Nantes (France)

2010-01-15

Purpose: Evaluation of the results of perioperative interstitial brachytherapy with low dose-rate (L.D.R.) Ir-192 in the treatment of keloid scars. Patients and methods: We performed a retrospective analysis of 73 histologically confirmed keloids (from 58 patients) resistant to medico surgical treated by surgical excision plus early perioperative brachytherapy. All lesions were initially symptomatic. Local control was evaluated by clinical evaluation. Functional and cosmetic results were assessed in terms of patient responses to a self-administered questionnaire. Results: Median age was 28 years (range 13-71 years). Scars were located as follows: 37% on the face, 32% on the trunk or abdomen, 16% on the neck, and 15% on the arms or legs. The mean delay before loading was four hours (range, 1-6 h). The median dose was 20 Gy (range, 15-40 Gy). Sixty-four scars (from 53 patients) were evaluated. Local control was 86% (follow-up, 44.5 months; range, 14-150 months). All relapses occurred early within 2 years posttreatment. At 20 months, survival without recurrence was significantly lower when treated lengths were more than 6 cm long. The rate was 100% for treated scars below 4.5 cm in length, 95% (95% CI: 55-96) for those 4.5-6 cm long, and 75% (95% CI: 56-88) beyond 6 cm (p = 0.038). Of the 35 scars (28 patients) whose results were reassessed, six remained symptomatic and the esthetic results were considered to be good in 51% (18/35) and average in 37% (13/35) (median follow-up, 70 months; range, 16-181 months). Conclusion: Early perioperative L.D.R. brachytherapy delivering 20 Gy at 5 mm reduced the rate of recurrent keloids resistant to other treatments and gave good functional results. (authors)

Efficacy of IPL device combined with intralesional corticosteroid injection for the treatment of keloids and hypertrophic scars with regards to the recovery of skin barrier function: A pilot study.

Science.gov (United States)

Kim, Dong Young; Park, Hyun Sun; Yoon, Hyun-Sun; Cho, Soyun

2015-10-01

Keloids and hypertrophic scars are prevalent and psychologically distressful dermatologic conditions. Various treatment modalities have been tried but without complete success by any one method. We evaluated the efficacy of a combination of intense pulsed light (IPL) device and intralesional corticosteroid injection for the treatment of keloids and hypertrophic scars with respect to the recovery of skin barrier function. Totally 52 Korean patients were treated by the combined treatment at 4-8-week intervals. Using digital photographs, changes in scar appearance were assessed with modified Vancouver Scar Scale (MVSS), physicians' global assessment (PGA) and patient's satisfaction score. In 12 patients, the stratum corneum (SC) barrier function was assessed by measuring transepidermal water loss (TEWL) and SC capacitance. Most scars demonstrated significant clinical improvement in MVSS, PGA and patient's satisfaction score after the combined therapy. A significant decrease of TEWL and elevation of SC capacitance were also documented after the treatment. The combination therapy (IPL + corticosteroid injection) not only improves the appearance of keloids and hypertrophic scars but also increases the recovery level of skin hydration status in terms of the skin barrier function.

A Conjunctival Mass in the Deep Superior Fornix After a Long Retained Hard Contact Lens in a Patient With Keloids

NARCIS (Netherlands)

Zola, Enrica; van der Meulen, Ivanka J. E.; Lapid-Gortzak, Ruth; van Vliet, J. Mj; Nieuwendaal, Carla P.

2008-01-01

Purpose: To report a case of an upper eyelid mass induced by a rigid contact lens retained for more than 3 years in the eye of a patient with a general history of keloids and to provide a review of the literature on retained contact lenses. Methods: Case report. Results: A 45-year-old woman with an

Dermatitis artefacta: Keloids and foreign body granuloma due to overvalued ideation of acupuncture

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Choudhary Sanjiv

2009-01-01

Full Text Available Skin is well recognized as an important somatic mirror of one′s emotion and a site for the discharge of one′s anxieties. We present a case of a 42-year-old female patient presenting with a vague history of generalized body pain and skin lesions in the form of cotton threads buried under the skin, crusted plaque, multiple keloids and rusted pin buried through the skin mostly in the easily accessible areas of the body. Histopathology from the crusted plaque revealed foreign body granuloma. To satisfy her psychological or emotional need, it is the deliberate and conscious production of self-inflicted skin lesions through overvalued ideation of acupuncture on her part.

High-Mobility Group Box 1 Mediates Fibroblast Activity via RAGE-MAPK and NF-κB Signaling in Keloid Scar Formation

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Jihee Kim

2017-12-01

Full Text Available Emerging studies have revealed the involvement of high-mobility group box 1 (HMGB1 in systemic fibrotic diseases, yet its role in the cutaneous scarring process has not yet been investigated. We hypothesized that HMGB1 may promote fibroblast activity to cause abnormal cutaneous scarring. In vitro wound healing assay with normal and keloid fibroblasts demonstrated that HMGB1 administration promoted the migration of both fibroblasts with increased speed and a greater traveling distance. Treatment of the HMGB1 inhibitor glycyrrhizic acid (GA showed an opposing effect on both activities. To analyze the downstream mechanism, the protein levels of extracellular signal-regulated kinase (ERK 1/2, protein kinase B (AKT, and nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB were measured by western blot analysis. HMGB1 increased the expression levels of ERK1/2, AKT, and NF-κB compared to the control, which was suppressed by GA. HMGB1 promoted both normal and keloid fibroblasts migration to a degree equivalent to that achieved with TGF-β. We concluded that HMGB1 activates fibroblasts via the receptor for advanced glycation end product (RAGE—mitogen-activated protein kinases (MAPK and NF-κB interaction signaling pathways. Further knowledge of the relationship of HMGB1 with skin fibrosis may lead to a promising clinical approach to manage abnormal scarring.

High-Mobility Group Box 1 Mediates Fibroblast Activity via RAGE-MAPK and NF-κB Signaling in Keloid Scar Formation.

Science.gov (United States)

Kim, Jihee; Park, Jong-Chul; Lee, Mi Hee; Yang, Chae Eun; Lee, Ju Hee; Lee, Won Jai

2017-12-28

Emerging studies have revealed the involvement of high-mobility group box 1 (HMGB1) in systemic fibrotic diseases, yet its role in the cutaneous scarring process has not yet been investigated. We hypothesized that HMGB1 may promote fibroblast activity to cause abnormal cutaneous scarring. In vitro wound healing assay with normal and keloid fibroblasts demonstrated that HMGB1 administration promoted the migration of both fibroblasts with increased speed and a greater traveling distance. Treatment of the HMGB1 inhibitor glycyrrhizic acid (GA) showed an opposing effect on both activities. To analyze the downstream mechanism, the protein levels of extracellular signal-regulated kinase (ERK) 1/2, protein kinase B (AKT), and nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) were measured by western blot analysis. HMGB1 increased the expression levels of ERK1/2, AKT, and NF-κB compared to the control, which was suppressed by GA. HMGB1 promoted both normal and keloid fibroblasts migration to a degree equivalent to that achieved with TGF-β. We concluded that HMGB1 activates fibroblasts via the receptor for advanced glycation end product (RAGE)-mitogen-activated protein kinases (MAPK) and NF-κB interaction signaling pathways. Further knowledge of the relationship of HMGB1 with skin fibrosis may lead to a promising clinical approach to manage abnormal scarring.

Verapamil is Less Effective than Triamcinolone for Prevention of Keloid Scar Recurrence After Excision in a Randomized Controlled Trial

DEFF Research Database (Denmark)

Danielsen, Patricia L; Rea, Suzanne M; Wood, Fiona M

2016-01-01

per subject and each wound half randomized to receive intralesional injections of triamcinolone (10 mg/ml) or verapamil (2.5 mg/ml) at monthly intervals (4 doses). Interim analysis was performed after 14 subjects were completed. Survival analysis demonstrated significantly higher keloid recurrence...... with verapamil compared to triamcinolone 12 months post-surgery (log-rank test, p = 0.01) and higher overall risk of recurrence with verapamil (hazard ratio 8.44, 95% CI 1.62-44.05). The study was terminated early according to the stopping guideline (p safe but not as effective...

In vitro effect of 470 nm LED (Light Emitting Diode in keloid fibroblasts Efeito in vitro do LED (Light Emitting Diode de 470 nm em fibroblastos de quelóide

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Silvilena Bonatti

2011-02-01

Full Text Available Purpose: To quantify keloid fibroblasts after irradiation with 470nm blue LED, in vitro. Methods: Fibroblasts from keloid and adjacent skin have been obtained from 6 patients. Cells have been cultivated and maintained in DMEM culture medium. In Petri dishes, they were irradiated with energy doses of 6J, 12J and 18J. After 24 h, counting was done by the average of the triplicates for each sample. Results: There were no significant differences in the number of irradiated keloid fibroblasts at the studied doses (p=0.261. In adjacent skin fibroblasts, differences were observed (p=0.025 concerning the doses of 18 J and 6 J (p=0.03. Conclusions: There was a reduction in the number of adjacent skin fibroblasts irradiated with 470nm blue LED at the energy dose of 18 J compared to the ones irradiated at the energy dose of 6 J. There were no changes in keloid fibroblasts counting at any of the doses applied, 24 h after irradiation.Objetivo: Quantificar fibroblastos de quelóide após irradiação com LED azul de 470nm, in vitro. Métodos: Foram obtidos fibroblastos de quelóide e pele adjacente, de seis pacientes. As células foram cultivadas e mantidas em meio de cultura DMEM. Em placas de Petri, receberam irradiação com doses de energia de 6J, 12J e 18J. Após 24 horas a contagem foi feita pela média da triplicata para cada amostra. Resultados: Não houve diferença na quantidade de fibroblastos de quelóide irradiados nas doses estudadas (p=0,261. Observou-se diferença nos fibroblastos de pele adjacente (p=0,025, com relação às doses de 18 J e 6 J (p=0,03. Conclusões: Houve redução dos fibroblastos de pele adjacente irradiados com LED azul de 470 nm na dose de energia de 18 J em relação à dose de 6 J. Não houve alteração na quantidade de fibroblastos de quelóide nas doses aplicadas após 24 horas da irradiação.

Comparing Two Methods of Cryotherapy and Intense Pulsed Light with Triamcinolone Injection in the Treatment of Keloid and Hypertrophic Scars: A Clinical Trial

OpenAIRE

Meymandi, Simin Shamsi; Moosazadeh, Mahmood; Rezazadeh, Azadeh

2016-01-01

Objectives Keloid and hypertrophic scars are abnormal manifestations of wounds that occur following skin injuries in the form of local proliferation of fibroblasts and increased production of collagen. There are several ways to cure these scars; treatment must be selected based on the nature of the scars. In this clinical trial, two methods?cryotherapy and intense pulsed light (IPL)?are compared in the treatment of scars, and the results are presented in terms of improvement level, complicati...

What factors affect the quality of life of patients with keloids? Quais fatores realmente afetam a qualidade de vida dos portadores de queloide?

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Fabianne Furtado

2009-01-01

Full Text Available OBJECTIVE: To evaluate factors that affect the quality of life (QoL of patients with keloids. METHODS: A study was conducted on 102 patients of both genders between 15 and 70 years old. During initial evaluation, clinical factors, such as keloid visibility, duration and evolution of the disease, previous treatments, types of treatments and recurrence were recorded. Later, patients responded to the QualiFibro questionnaire, which is specific for evaluation of the QoL of patients with keloids and comprises the physical and psychological domains, and six visual numeric scales (VNS, of which three are related to psychological factors (satisfaction with appearance, shame of the disease, and suffering experienced, and the other three are related to physical factors (pruritus, pain and movement restriction. RESULTS: Patients with keloids on non-visible areas of the body (pOBJETIVO: Avaliar quais fatores influenciam a qualidade da vida (QV dos portadores de quelóide. MÉTODOS: Estudo envolvendo 102 pacientes, de ambos os gêneros, com idade entre 15 e 70 anos. Na avaliação inicial, os fatores clínicos referentes à visibilidade do queloide, tempo de evolução da doença, tratamento prévio, tipos de tratamento e recidiva foram catalogados. Posteriormente, os pacientes responderam ao questionário QualiFibro, composto pelos domínios físico e psicológico, específico para avaliar a QV dos portadores de quelóide, e a seis escalas visuais numéricas (EVN, sendo três escalas em relação a fatores psicológico (satisfação com a aparência, vergonha da doença e sofrimento vivenciado, e três escalas em relação a fatores físicos (prurido, dor e restrição de movimentos. RESULTADOS: A pontuação do domínio físico do questionário QualiFibro foi maior para os portadores de queloide em região não-visível (p<0,01 e com tempo de evolução maior que 10 anos (p<0,049, refletindo piora em relação aos portadores com queloide em região vis

Recruitment of Yoruba families from Nigeria for genetic research: experience from a multisite keloid study.

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Olaitan, Peter B; Odesina, Victoria; Ademola, Samuel; Fadiora, Solomon O; Oluwatosin, Odunayo M; Reichenberger, Ernst J

2014-09-02

More involvement of sub-Saharan African countries in biomedical studies, specifically in genetic research, is needed to advance individualized medicine that will benefit non-European populations. Missing infrastructure, cultural and religious beliefs as well as lack of understanding of research benefits can pose a challenge to recruitment. Here we describe recruitment efforts for a large genetic study requiring three-generation pedigrees within the Yoruba homelands of Nigeria. The aim of the study was to identify genes responsible for keloids, a wound healing disorder. We also discuss ethical and logistical considerations that we encountered in preparation for this research endeavor. Protocols for this bi-national intercultural study were approved by the Institutional Review Board (IRB) in the US and the ethics committees of the Nigerian institutions for consideration of cultural differences. Principles of community based participatory research were employed throughout the recruitment process. Keloid patients (patient advisors), community leaders, kings/chiefs and medical directors were engaged to assist the research teams with recruitment strategies. Community meetings, church forums, and media outlets (study flyers, radio and TV announcements) were utilized to promote the study in Nigeria. Recruitment of research participants was conducted by trained staff from the local communities. Pedigree structures were re-analyzed on a regular basis as new family members were recruited and recruitment challenges were documented. Total recruitment surpassed 4200 study participants over a 7-year period including 79 families with complete three-generation pedigrees. In 9 families more than 20 family members participated, however, in 5 of these families, we encountered issues with pedigree structure as members from different branches presented inconsistent family histories. These issues were due to the traditional open family structure amongst the Yoruba and by beliefs in

Comparative efficacy of intralesional verapamil hydrochloride and triamcinolone acetonide in hypertrophic scars and keloids.

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Ahuja, Rajeev B; Chatterjee, Pallab

2014-06-01

There is not much level 1 evidence based literature to guide management of hypertrophic scars and keloids despite an array of therapeutic modalities at disposal. Intralesional (i/l) triamcinolone injections have remained a gold standard in non surgical management. Sporadic reports on use of i/l verapamil suggest its efficacy. Since verapamil has not found sufficient mention as an effective alternative modality, it was decided to undertake a randomized study which could also address some additional clinical parameters. A randomized, parallel group and observer blinded comparison with 40 patients (48 scars) was carried out to compare the effects of i/l triamcinolone (T) (22 scars) and verapamil injections (V) (26 scars). 1.5 ml was the maximum indicative volume decided in the study protocol for both the drugs (triamcinolone @40 mg/ml and verapamil @ 2.5 mg/ml). Patients included were aged between 15-60 years with scars ranging between 0.5-5 cm (but total area roughly scars under 2 years duration. Patients with keloidal diathesis were excluded. Injections were scheduled every three weeks until complete flattening of the scar or eight sessions, which ever came earlier. No concomitant therapies like massage, silicone gel or pressure garments were used. Scar evaluation at each stage was done by serial photographic records as well as by Vancouver Scar Scale (VSS). Comparative survival analysis between the two drugs was done using Kaplan Meier curves, and VSS scores were analyzed using Wilcoxon test and log rank test. Mean zero VSS scores were achieved with treatments in respect of scar height (T-12 weeks, V-21 weeks), vascularity (T-15 weeks, V-18 weeks) and pliability (T-15 weeks, V-21 weeks). The improvement in scar vascularity and pliability kept pace with decrease in scar height, in both the groups. There was not much difference in the rate of change of scar pigmentation with either drug but almost 60% patients in both the groups regained normal pigmentation. Our

Comparing Two Methods of Cryotherapy and Intense Pulsed Light with Triamcinolone Injection in the Treatment of Keloid and Hypertrophic Scars: A Clinical Trial.

Science.gov (United States)

Meymandi, Simin Shamsi; Moosazadeh, Mahmood; Rezazadeh, Azadeh

2016-10-01

Keloid and hypertrophic scars are abnormal manifestations of wounds that occur following skin injuries in the form of local proliferation of fibroblasts and increased production of collagen. There are several ways to cure these scars; treatment must be selected based on the nature of the scars. In this clinical trial, two methods-cryotherapy and intense pulsed light (IPL)-are compared in the treatment of scars, and the results are presented in terms of improvement level, complications, and patient satisfaction. This clinical trial was conducted in southeastern Iran. The intervention group included scars that underwent the IPL method and the control group, which consisted of scars that were subjected to cryotherapy. In both methods, intralesional corticosteroid injection was administered. To select samples, the easy sampling method was used. To determine the expected outcomes, the criteria determined in the Vancouver scar scale were used. Data were analyzed using the Mix Model, chi-square test, and t test. In this study, 166 samples of keloid and hypertrophic scars were cured using two methods (Cryotherapy, 83; IPL, 83). The recovery rate was higher in the Cryotherapy group than in the IPL group ( p  > 0.05), and the incidence of complications was also higher in the Cryotherapy group (14.5% vs. 12%). Moreover, patients were more satisfied, although not significantly so, with the cryotherapy method ( p  = 0.09). Both methods were highly successful in curing scars; participants were totally satisfied with both methods.

Protocolo de tratamiento de cicatrices queloides en el pabellón auricular del Hospital General Dr. Manuel Gea González Treatment protocol of auricular keloid scars in the General Hospital Dr. Manuel Gea González

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C. Gutiérrez Gómez

2012-03-01

Full Text Available Las cicatrices queloideas son una de las patologías de más difícil tratamiento por el alto porcentaje de recidivas que presentan, hasta un 100 % en tratamientos únicos y un 50 % en tratamientos combinados. El pabellón auricular es un blanco frecuente de esta patología. Presentamos el protocolo de tratamiento empleado en nuestro hospital en los últimos 6 años con terapia combinada en 51 pacientes y 64 pabellones auriculares afectados por queloides. Aplicamos de forma preoperatoria 3 dosis de triamcinolona o betametasona intralesional, con diferencia de 4 a 6 semanas entre dosis y 4 semanas después de la última dosis, realizamos resección de la cicatriz dejando piel suficiente para el cierre sin tensión. En los pacientes que presentaban antecedente de resección quirúrgica se añadió al tratamiento el uso de colchicina, comenzando el día de la cirugía y manteniéndolo durante 8 semanas, a dosis de 1 mg. al día, con control de pruebas de función hepática pre y postratamiento. En el 74.5 % de los casos la cicatriz queloide fue unilateral; el 56.8 % de los pacientes fueron mujeres; las edades fluctuaron entre los 8 y los 61 años con una media de 24 años de edad. En el 65 % de los casos el queloide se presentó en el pabellón auricular derecho y en cuanto a su localización dentro del mismo, el 42 % se presentó en el lóbulo. La causa en el 56 % de los casos fue por perforación. El 18.6 % de las cicatrices tratadas cedieron con la infiltración intralesional; de las 48 cicatrices que recibieron tratamiento quirúrgico, hubo recidiva en el 12.5 % (6 cicatrices, con un seguimiento de entre 8 meses a 6 años.Keloid scars are one of the most difficult pathologies to treat because its high rate of recurrence, from 100 % with single treatment to 50 % with combined therapy. The auricle is a frequent localization of keloids. We report our experience in the last 6 years with combined therapy in 51 patients and 64 auricles with keloid

Hamster (Mesocricetus auratus cheek pouch as an experimental model to investigate human skin and keloid heterologous graft Bolsa jugal no hamster (Mesocricetus auratus como modelo experimental de investigação de enxertos heterólogos de pele humana e quelóide

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Bernardo Hochman

2004-12-01

Full Text Available To describe the integration process of grafts of total human skin and keloid in hamster (Mesocricetus auratus cheek pouch, whose sub-epithelium is naturally an "Immunologically Privileged Site". Fragments of human normal skin and keloid from the breast region of mulatto female patients were transplanted into the cheek pouch subepithelium in situ. Surgical procedure and grafted pouches for microscopic exam at several time points of the transplantation were standardized. The integration of grafted fragments of human skin and keloid was seen in late periods (84 days since the microscopic assessment showed the presence of blood vases within the conjunctive tissue of grafted fragments. It was also possible to see among the grafted fragments the epithelium, the appearing of early cellular infiltrated, epithelial secretion of keratin, the presence of melanocytes, and delayed changes on the aspect of collagen fibers of conjunctive tissue. Pooled results allow to define hamster cheek pouch sub-epithelium as an experimental model to investigating heterologous graft physiology of human total skin and keloid with epithelium.Descrever a integração dos enxertos de pele total humana e quelóide na bolsa jugal do hamster (Mesocricetus auratus, cujo subepitélio é, naturalmente, um "Local de Privilégio Imunológico". Foram transplantados fragmentos, de pele humana normal e de quelóide, obtidos da região mamária de pacientes pardas, no subepitélio da bolsa jugal in situ. O procedimento operatório, e de preparo das bolsas enxertadas para exame microscópico em vários períodos de transplante, foi padronizado. Verificou-se a integração dos fragmentos enxertados de pele humana e de quelóide em períodos tardios (84 dias, uma vez que a avaliação microscópica revelou a presença de vasos sangüíneos no tecido conjuntivo dos fragmentos enxertados. Foi também possível observar, nos fragmentos enxertados, o epitélio, o aparecimento de infiltrado

Dosimetric comparison of electron beam and 90Sr+90Y applicator for keloids treatment

International Nuclear Information System (INIS)

Coelho, Talita S.; Tada, Ariane; Antonio, Patricia L.; Yoriyaz, Helio; Fernandes, Marco A.R.

2009-01-01

Studies have been shown that among several methods that have been used for the treatment of keloids the surgical excision followed by the adjuvant radiotherapy presents the lowest relapsed rate of the injury. In this work a comparative dosimetric study has been performed using a 4 MeV electron beam from a Varian Clinac 2100C linear accelerator at the radiotherapy service of the Hospital das Clinicas of UNESP-HC, Botucatu-SP and an Amershan 90 Sr+ 90 Y brachytherapy applicator with 1491 MBq of activity. Percentage depth dose curves from ionization chamber measurements and through Monte Carlo simulation have been obtained and compared. Dose measurements have been obtained using parallel plates ionization chamber (Esradin A12) and extrapolation mini-chamber developed at IPEN. The dose calculations have been obtained using the well-known Monte Carlo radiation transport code MCNP-4C. Maximum dose differences obtained between measured/calculated values for 90 Sr+ 90 Y applicator and for the electron beam were, respectively: 7.8 % and 8.0%. The profiles of the depth and superficial tissue dose distribution produced by the electron beam revealed themselves flatter and more homogeneous than those produced by the 90 Sr+ 90 Y applicator, especially to wider fields, which cannot be obtained with beta therapy applicators because of their geometric limitations. In conclusion this present work has shown that 90 Sr+ 90 Y applicators could be efficient for small and very superficial lesions but in most cases electron beam sources are more adequate especially for large and deeper lesions. (author)

Original Article

African Journals Online (AJOL)

ABSTRACT. The symptoms of keloids need to be well highlighted especially among African blacks. To outline the symptoms of keloids in Southwest Nigeria with a view to offering adequate treatment to patients by relieving these symptoms. A prospective study of 121 consecutive keloid patients managed in two teaching ...

Strategic management of keloid disease in ethnic skin: a structured approach supported by the emerging literature.

Science.gov (United States)

Ud-Din, S; Bayat, A

2013-10-01

Keloid disease (KD) is a common, benign, dermal fibroproliferative growth of unknown aetiology. Lesions tend to grow over time; they often recur following therapy and do not regress spontaneously. KD causes considerable discomfort due to pain, pruritus and inflammation, and a significant psychosocial impact with reduced quality of life. It is unique to humans and occurrence is higher in individuals with dark, pigmented, ethnic skin. There is a strong familial heritability, with a high ethnic predisposition in individuals of African, Asian and Hispanic descent. High recurrence rates and unknown resolution rates present a major problem for both the patient and clinician. Many treatment modalities exist; however, there is no single advocated therapy. Therefore, the aim of this review was to explore the most current literature regarding the range of treatment options for KD and to offer a structured approach in the management of KD, based on evidence and experience, to aid clinicians in their current practice. A focused history involving careful evaluation of the patient's symptoms, signs, quality of life and psychosocial well-being should direct targeted therapy, complemented with regular follow-up and re-evaluation. Many treatment modalities, such as intralesional steroid injection, silicone gel application, cryotherapy, lasers, 5-fluorouracil and, relatively recently, photodynamic therapy, are currently being used in clinical practice for the management of KD. Combination therapies have also been shown to be beneficial. However, there is a lack of robust, randomized, level-one, evidence-controlled trials evaluating these treatment options. Management of KD in ethnic pigmented skin remains a clinical challenge. Thus, a strategic approach with structured assessment, targeted therapy and focus on prevention of recurrence is highly recommended. Quality evidence is essential in order to tailor treatment effectively for the ethnic patient presenting with KD. © 2013 The

Nodular Morphea

OpenAIRE

Kauer, Friederike; Simon, Jan C.; Sticherling, Michael

2013-01-01

Scleroderma may present as being strictly limited to the skin, as in morphea, or within a multiorgan disease, as in systemic sclerosis. Accordingly, cutaneous manifestations vary clinically. In nodular or keloidal scleroderma, patients develop lesions that are clinically indistinguishable from a keloid; however, the histopathological findings are more variable. We describe a 16-year-old girl with morpheic lesions for 3–4 years and additional development of keloidal nodules within these lesion...

Custom Made Pressure Appliance for Presurgical Sustained ...

African Journals Online (AJOL)

was done to match the color of the appliance with that of the adjoining skin to make ... of the surface of the swelling with the gap between the two ... Figure 1: Preoperative view of keloid .... “multi model” approach for treating ear keloids. Indian J ...

Keloids

Science.gov (United States)

... Kids and Teens Pregnancy and Childbirth Women Men Seniors Your Health Resources Healthcare Management End-of-Life Issues Insurance & Bills Self Care Working With Your Doctor Drugs, Procedures & Devices Over-the- ...

Imaging of collagen deposition disorders using optical coherence tomography

DEFF Research Database (Denmark)

Ring, H C; Mogensen, M; Hussain, A A

2015-01-01

BACKGROUND: Collagen deposition disorders such as hypertrophic scars, keloids and scleroderma can be associated with significant stigma and embarrassment. These disorders often constitute considerable impairment to quality of life, with treatment posing to be a substantial challenge. Optical...... lesion type. Hypertrophic scars displayed an increased vascularity and signal-rich bands correlating to excessive collagen deposition. Keloids depicted a disarray of hyper-reflective areas primarily located in the upper dermis. Additionally, the dermis displayed a heterogeneous morphology without...... indications of any vascular supply or lymphatic network. In contrast to keloids, scleroderma displayed a more cohesive backscattering indicating a difference in density of collagen or other dermal structures. OCT images demonstrated no significant differences between mean density measurements in OCT images...

Mast cells and angiogenesis in wound healing.

Science.gov (United States)

Gaber, Mohamed A; Seliet, Iman A; Ehsan, Nermin A; Megahed, Mohamed A

2014-02-01

To investigate the role of mast cells and vascular endothelial growth factor (VEGF) as a mediator of angiogenesis to promote wound healing in surgical and pathological scars. The study was carried out on 40 patients who presented with active scar lesions. They were subdivided into 4 groups. They included granulation tissue (10 cases), surgical scar (10 cases), hypertrophic scar (10 cases), and keloid scar (10 cases). Also 10 healthy volunteers of the same age and sex were selected as a control group. Skin biopsies were taken from the patients and the control group. Skin biopsies from clinically assessed studied groups were processed for routine histology and embedded in paraffin. Four sections were prepared from each paraffin block. The first section was stained with hematoxylin and eosin for histological evaluation. The second and third sections were processed for immunostaining of mast cells that contain chymase (MCCs) and mast cells that contain tryptase (MCTs). The fourth section was processed for immunostaining of VEGF. MCCs exhibited mild expression in normal tissue, granulation tissue, and surgical, hypertrophic and keloid scars. MCTs exhibited mild expression in normal tissue, granulation tissue and keloid, whereas moderate expression was exhibited in hypertrophic and surgical scars. VEGF expression was absent in normal tissue, mild in keloid, surgical and hypertrophic scars, and moderate in keloids and granulation tissue. Mast cell expression variation among different scar types signals the pathological evolution of the lesion, and hence may guide the need for therapeutic intervention.

The Relationship between Proliferative Scars and Endothelial Function in Surgically Revascularized Patients

Directory of Open Access Journals (Sweden)

Murat Ziyrek

2015-12-01

Full Text Available Background: Proliferative scars are benign fibrotic proliferations which demonstrate abnormal wound healing in response to skin injuries. As postulated in the “response to injury hypothesis”, atherosclerosis is also triggered by an endothelial injury. Keloid and atherosclerotic processes have many pathophysiological and cytological features in common. Aims: In this study, we investigated the relationship between proliferative scars and endothelial function in surgically revascularized patients. We aimed to test the hypothesis that atherosclerosis is a wound healing abnormality. Study Design: Cross-sectional study. Methods: Consecutive patients who were admitted to the cardiology outpatient clinic with a history of coronary artery bypass grafting operation were evaluated. Thirty-three patients with proliferative scars at the median sternotomy site formed the keloid group, and 36 age- and sex-matched patients with no proliferative scar at the median sternotomy site formed the control group. Endothelial function was evaluated by flow-mediated vasodilatation of the brachial artery via ultrasonograhic examination. Results: There is no signicant difference according to the demographic data, biochemical parameters, clinical parameters and number of grafts between keloid and control groups. Endothelial-dependent vasodilatory response was lower in the keloid group than the control group (9.30±3.5 and 18.68±8.2, respectively; p=0.001. Conclusion: This study showed that endothalial dysfunction, which is strongly correlated with atherosclerosis, was more prominent in patients with proliferative scars. As proliferative scars and atherosclerosis have many features in common, we might conclude that atherosclerosis is a wound healing abnormality.

KULTUR PRIMER FIBROBLAS: PENELITIAN PENDAHULUAN

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Yuli Kurniawati

2015-05-01

Full Text Available AbstrakKultur sel fibroblas banyak digunakan untuk penelitian proses penyembuhan luka dan penuaankulit. Metode ini digunakan untuk melihat perkembangan sel, proliferasi kinetik seluler, sertabiosintesis komponen matriks ekstraseluler. Penelitian pendahuluan ini dilakukan untuk optimasiteknik laboratorium serta berbagai kendala yang didapatkan saat kultur fibroblas. Kultur primerfibroblas dibagi menjadi 2 jenis sampel yaitu sampel yang berasal dari embrio mencit usia 7,5–9,5 hari, dan kulit pasien keloid. Sampel dari embrio mencit dilakukan kultur primer denganmetode dissociated fibroblast. Sampel jaringan keloid dan kulit normal dikultur dengan metodeskin explant. Fibroblas yang berasal dari kultur primer embrio mencit tumbuh baik sehinggadapat dilakukan subkultur dan disimpan di dalam nitrogen cair suhu -198°C. Fibroblas yangberasal dari sampel keloid pertama tumbuh sesuai pola pertumbuhan fibroblas, namun padasampel kedua terdapat kontaminasi Paecilomyces sp. yang merupakan salah satu jenis jamurkontaminan. Sel fibroblas mudah untuk dikultur karena memiliki kemampuan tumbuh danmelekat yang tinggi serta regenerasi cepat, namun penelitian lebih lanjut untuk optimasi teknikkultur dan pencegahan kontaminasi masih dibutuhkan sehingga sel dapat tumbuh baik.AbstractFibroblast cell culture method has been used for wound healing and skin aging studies. Thismethod was used for cell development imaging study, celullar kinetic proliferation andextracelullar matrix component biosynthesis. This preeliminary study was done for laboratoricaltechnic optimation as well as problems appeared in fibroblast culture. Fibroblasts primary culturewas divided into 2 type of samples, from 7.5-9.5-day-mice embryo and keloid-patient skin.Primary culture with dissociated fibroblast method was done for mice embryo sample. Keloidtissue sample and normal skin were cultured with skin explant method. Fibroblasts that weretaken from mice embryo primary culture grew well

NEW MOLECULAR MEDICINE-BASED SCAR MANAGEMENT STRATEGIES

Science.gov (United States)

Arno, Anna I; Gauglitz, Gerd G; Barret, Juan P; Jeschke, Marc G

2014-01-01

Keloids and hypertrophic scars are prevalent disabling conditions with still suboptimal treatments. Basic science and molecular-based medicine research has contributed to unravel new bench-to-bedside scar therapies, and to dissect the complex signaling pathways involved. Peptides such as transforming growth factor beta (TGF-β) superfamily, with SMADs, Ski, SnoN, Fussels, endoglin, DS-Sily, Cav-1p, AZX100, thymosin-β4 and other related molecules may emerge as targets to prevent and treat keloids and hypertrophic scars. The aim of this review is to describe the basic complexity of these new molecular scar management strategies, and point out new fibrosis research lines. PMID:24438742

Keloids and Hypertrophic Scars

Science.gov (United States)

... to the skin both skin cells and connective tissue cells (fibroblasts) begin multiplying to repair the damage. A scar is made up of 'connective tissue', gristle-like fibers deposited in the skin by ...

Micropigmentation for Vitiligo

Science.gov (United States)

... E. Grimes, MD - Los Angeles, California Micropigmentation for Vitiligo Micropigmentation involves implanting small particles of natural pigment ... Keloid formation MRI complications Why choose micropigmentation for vitiligo Micropigmentation can: Help blend the color of vitiligo ...

Keratinocyte-derived growth factors play a role in the formation of hypertrophic scars

NARCIS (Netherlands)

Niessen, FB; Andriessen, MP; Schalkwijk, J; Visser, L; Timens, W

In predisposed individuals, wound healing can lead to hypertrophic scar or keloid formation, characterized by an overabundant extracellular matrix. It has recently been shown that hypertrophic scars are accompanied by abnormal keratinocyte differentiation and proliferation, and significantly

Hyperplastic corneal pannus: an immunohistochemical analysis and review.

Science.gov (United States)

Jakobiec, Frederick A; Stacy, Rebecca C; Mendoza, Pia R; Chodosh, James

2014-01-01

An exuberant corneal pannus usually develops in adults with a history of surgery or trauma in the anterior central stroma and appears as a glistening, vascularized, moderately elevated, well circumscribed white nodule. We describe a 78-year-old woman with such a pannus, which in the past has typically been referred to as keloidal or hypertrophic. The involved eye had only light perception, and she underwent a penetrating keratoplasty that improved her vision to 20/100. Histopathologic and immunohistochemical evaluations of a the specimen disclosed a reactive spindle cell stromal proliferation of myofibroblasts that were smooth muscle actin positive with a low Ki67 proliferation index. Desmin, caldesmon, and calponin were negative, in keeping with the incomplete myofilamentary differentiation of a myofibroblast. There was a generous admixture of CD68/163-positive histiocytes and dispersed C3/5-positive T-lymphocytes. An absence of CD138- and IgG4-positive plasma cells ruled out an IgG4-related disease. For a lesion to be keloidal, the collagen must have a thick hyaline character, sharp edges, and a sparsity of intervening cells and vessels. A hypertrophic pannus would be composed of large swollen cells not necessarily increased in number. We therefore recommend adoption of the term hyperplastic for lesions like that described here because of the obvious increase in cellularity from proliferating myofibroblasts and the lack of true keloidal collagen. Copyright © 2014 Elsevier Inc. All rights reserved.

An Overview of Female Genital Mutilation in Nigeria

African Journals Online (AJOL)

hanumantp

dysmenorrhea, retention cysts, and sexual difficulties with anorgasmia. Other complications are implantation dermoid cysts and keloids,[12] and sexual dysfunction.[6,10]. Obstetric complications include perineal lacerations and inevitable need for episiotomy in infibulated paturients. Others are defibulation with bleeding, ...

Nigerian Quarterly Journal of Hospital Medicine - Vol 20, No 2 (2010)

African Journals Online (AJOL)

Earlobe keloids: Emerging cosmetic complacation of ear-piercing · EMAIL FULL TEXT EMAIL FULL TEXT DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT. I.A Adigun, A.B Aderibigbe, 97-100. http://dx.doi.org/10.4314/nqjhm.v20i2.58046 ...

Nonlinear optics for the study of human scar tissue

Science.gov (United States)

Ferro, D. P.; Vieira-Damiani, G.; Adam, R. L.; Cesar, C. L.; Metze, Konradin

2012-03-01

Collagen fibers are an essential component of the dynamic process of scarring, which accompanies various diseases. Scar tissue may reveal different morphologic expressions, such as hypertrophic scars or keloids. Collagen fibers can be visualized by fluorescent light when stained with eosin. Second Harmonic Generation (SHG) creates a non linear signal that occurs only in molecules without inversion symmetry and is particularly strong in the collagen fibers arranged in triple helices. The aim of this study was to describe the methodology for the analysis of the density and texture of collagen in keloids, hypertrophic scars and conventional scars. Samples were examined in the National Institute of Science and Technology on Photonics Applied to Cell Biology (INFABIC) at the State University of Campinas. The images were acquired in a multiphoton microscopy LSM 780-NLO Zeiss 40X. Both signals, two-photon fluorescence (TPEF) and SHG, were excited by a Mai-Tai Ti:Sapphire laser at 940 nm. We used a LP490/SP485 NDD filter for SHG, and a BP565-610 NDD filter for fluorescence In each case, ten images were acquired serially (512×512 μm) in Z-stack and joined together to one patchwork-image . Image analysis was performed by a gliding-box-system with in-house made software. Keloids, hypertrophic scars and normal scar tissue show different collagen architecture. Inside an individual case differences of the scar process may be found between central and peripheral parts. In summary, the use of nonlinear optics is a helpful tool for the study of scars tissue.

Evidence-Based Scar Management: How to Improve Results with Technique and Technology.

Science.gov (United States)

Khansa, Ibrahim; Harrison, Bridget; Janis, Jeffrey E

2016-09-01

Scars represent the visible sequelae of trauma, injury, burn, or surgery. They may induce distress in the patient because of their aesthetically unpleasant appearance, especially if they are excessively raised, depressed, wide, or erythematous. They may also cause the patient symptoms of pain, tightness, and pruritus. Numerous products are marketed for scar prevention or improvement, but their efficacy is unclear. A literature review of high-level studies analyzing methods to prevent or improve hypertrophic scars, keloids, and striae distensae was performed. The evidence from these articles was analyzed to generate recommendations. Each intervention's effectiveness at preventing or reducing scars was rated as none, low, or high, depending on the strength of the evidence for that intervention. For the prevention of hypertrophic scars, silicone, tension reduction, and wound edge eversion seem to have high efficacy, whereas onion extract, pulsed-dye laser, pressure garments, and scar massage have low efficacy. For the treatment of existing hypertrophic scars, silicone, pulsed-dye laser, CO2 laser, corticosteroids, 5-fluorouracil, bleomycin, and scar massage have high efficacy, whereas onion extract and fat grafting seem to have low efficacy. For keloid scars, effective adjuncts to excision include corticosteroids, mitomycin C, bleomycin, and radiation therapy. No intervention seems to have significant efficacy in the prevention or treatment of striae distensae. Although scars can never be completely eliminated in an adult, this article presents the most commonly used, evidence-based methods to improve the quality and symptoms of hypertrophic scars, as well as keloid scars and striae distensae.

Reduced FOXO1 expression accelerates skin wound healing and attenuates scarring.

Science.gov (United States)

Mori, Ryoichi; Tanaka, Katsuya; de Kerckhove, Maiko; Okamoto, Momoko; Kashiyama, Kazuya; Tanaka, Katsumi; Kim, Sangeun; Kawata, Takuya; Komatsu, Toshimitsu; Park, Seongjoon; Ikematsu, Kazuya; Hirano, Akiyoshi; Martin, Paul; Shimokawa, Isao

2014-09-01

The forkhead box O (FOXO) family has been extensively investigated in aging and metabolism, but its role in tissue-repair processes remains largely unknown. Herein, we clarify the molecular aspect of the FOXO family in skin wound healing. We demonstrated that Foxo1 and Foxo3a were both up-regulated during murine skin wound healing. Partial knockout of Foxo1 in Foxo1(+/-) mice throughout the body led to accelerated skin wound healing with enhanced keratinocyte migration, reduced granulation tissue formation, and decreased collagen density, accompanied by an attenuated inflammatory response, but we observed no wound phenotype in Foxo3a(-/-) mice. Fibroblast growth factor 2, adiponectin, and notch1 genes were significantly increased at wound sites in Foxo1(+/-) mice, along with markedly altered extracellular signal-regulated kinase 1/2 and AKT phosphorylation. Similarly, transient knockdown of Foxo1 at the wound site by local delivery of antisense oligodeoxynucleotides enhanced skin wound healing. The link between FOXO1 and scarring extends to patients, in particular keloid scars, where we see FOXO1 expression markedly increased in fibroblasts and inflammatory cells within the otherwise normal dermis. This occurs in the immediate vicinity of the keloid by comparison to the center of the mature keloid, indicating that FOXO1 is associated with the overgrowth of this fibrotic response into adjacent normal skin. Overall, our data indicate that molecular targeting of FOXO1 may improve the quality of healing and reduce pathological scarring. Copyright © 2014 American Society for Investigative Pathology. Published by Elsevier Inc. All rights reserved.

Updated Scar Management Practical Guidelines: Non-invasive and invasive measures

NARCIS (Netherlands)

Monstrey, S.; Middelkoop, E.; Vranckx, J.J.; Bassetto, F.; Ziegler, U.E.; Meaume, S.; Teot, L.

2014-01-01

Hypertrophic scars and keloids can be aesthetically displeasing and lead to severe psychosocial impairment. Many invasive and non-invasive options are available for the plastic (and any other) surgeon both to prevent and to treat abnormal scar formation. Recently, an updated set of practical

Neurofibromatosis, Down's syndrome, and acquired abnormalities

Directory of Open Access Journals (Sweden)

Syed Yousuf Ali

2016-01-01

Full Text Available We report a patient with Down's syndrome and neurofibromatosis who presented with a keloid, sebaceous cyst and acanthosis nigricans, along with dental and ophthalmological defects. The coexistence of neurofibromatosis type 1 and Down's syndrome which are two unrelated genetic conditions is itself a rarity.

The use of silicone occlusive sheeting (Sil-K) and silicone occlusive gel (epiderm) in the prevention of hypertrophic scar formation

NARCIS (Netherlands)

Niessen, FB; Spauwen, PHM; Robinson, PH; Fidler, [No Value; Kon, M

The development of hypertrophic scars and keloids is an unsolved problem in the process of found healing. For this reason, a successful treatment to prevent excessive scar formation still has not been found. Over the last decade, however, a promising new treatment has been introduced. Silicone

Acne keloidalis nuchae: prevalence, impact, and management challenges.

Science.gov (United States)

Ogunbiyi, Adebola

2016-01-01

Acne keloidalis nuchae (AKN) also known as folliculitis keloidalis nuchae (FKN) is a chronic form of scarring folliculitis seen mostly in men of African descent. The term AKN is commonly used even though the condition is not a keloid, and the affected individuals do not have a tendency to develop keloids in other areas of the body. It is seen in post pubertal men and is rare after the age of 55 years. A few cases have been reported in females. which has been classified as a primary cicatricial alopecia since the exact cause of acne keloidalis (AK) remains unknown. However, a few inciting agents have been suggested which include androgens, inflammation, infection, trauma, genetics, and ingrowing hairs. AK shares some similar features with other forms of cicatricial alopecia and may occur together. Papules, pustules, and sometimes tumorous masses in the nuchal or occipital regions of the scalp hence the name "bumps" evolved in the environment. Despite its common occurrence, only a few seek help in hospital when lesions start to unsightly affect the individual's quality of life. The presences of the keloidal lesions are more stressful compared to the resulting alopecia. Various attempts to reduce the bumps with corrosives, acids, and car engine oils lead to larger lesions or unsightly scars. Active lesions produce bleeding during haircuts. This is worrisome as a couple of individuals with active AK share shaving instruments at the barber shop and are at risk of acquiring or transmitting blood-borne infections. There is an urgent need to encourage safe shaving habits and treatment of lesions at onset so as to prevent unsightly lesions.

Modern role and issues of radiation therapy for benign diseases

International Nuclear Information System (INIS)

Miyashita, Tsuguhiro; Tateno, Atsushi; Kumazaki, Tatsuo

1999-01-01

Cases of radiation therapy for benign diseases have diminished in number because of recent alternative methods and knowledge about radiation carcinogenesis. In contrast to this tendency, our cases of benign diseases have recently increased. The facts made us reconsider today's radiation therapy of benign diseases. We reviewed 349 patients who were diagnosed as having benign tumors or non-neoplastic conditions and treated by radiation therapy in the past sixteen years. Analyzed items were the annual transition of treatment number, sorts of diseases, patients' age and sex, and the goal of therapy. Of all radiation therapy patients, benign diseases account for 9.26%. The annual percentages were 0.5%, 6.0%, 11.2% and 13.7% at intervals of five years since 1982. The majority was 246 post-operative irradiation for keloids (71%) and 41 pituitary adenomas (12%). Compared with malignant tumors, benign disease patients were statistically younger and female-dominant. Applications of radiation therapy in keloids and pituitary adenomas had definite goals, but were unclear in other rare diseases. Benign diseases should be treated by radiation therapy as the second or third option, provided the patients have serious symptoms and their diseases do not respond to other modalities. It seems to be widely accepted that favorite cases such as keloids and pituitary adenomas are treated by radiation therapy. But, optimal radiation therapies for other rare benign diseases have not been established. Therefore, the building of databases on radiation therapy on benign diseases should be pursued. Since benign disease patients were young and female-dominant and had many remaining years, their carcinogenicity potential should be considered. (author)

[Physical therapy for scars].

Science.gov (United States)

Masanovic, Marguerite Guillot

2013-01-01

Physical therapy consists notably of hand or mechanical massages, pressure therapy using various fabrics or splints, cryotherapy, laser therapy, etc. It forms part of the range of therapies used to treat pathological scars, including medical and surgical treatment. While the results are often satisfactory for hypertrophic scars, they remain uncertain for major keloids.

Healed corneal ulcer with keloid formation

OpenAIRE

Alkatan, Hind M.; Al-Arfaj, Khalid M.; Hantera, Mohammed; Al-Kharashi, Soliman

2012-01-01

We are reporting a 34-year-old Arabic white female patient who presented with a white mass covering her left cornea following multiple ocular surgeries and healed corneal ulcer. The lesion obscured further view of the iris, pupil and lens. The patient underwent penetrating keratoplasty and the histopathologic study of the left corneal button showed epithelial hyperplasia, absent Bowman’s layer and subepithelial fibrovascular proliferation. The histopathologic appearance was suggestive of a co...

Acne keloidalis nuchae: prevalence, impact, and management challenges

Directory of Open Access Journals (Sweden)

Ogunbiyi A

2016-12-01

Full Text Available Adebola Ogunbiyi Dermatology Unit, Department of Medicine, College of Medicine, University of Ibadan, University College Hospital Ibadan, Oyo State, Nigeria Abstract: Acne keloidalis nuchae (AKN also known as folliculitis keloidalis nuchae (FKN is a chronic form of scarring folliculitis seen mostly in men of African descent. The term AKN is commonly used even though the condition is not a keloid, and the affected individuals do not have a tendency to develop keloids in other areas of the body. It is seen in post pubertal men and is rare after the age of 55 years. A few cases have been reported in females. which has been classified as a primary cicatricial alopecia since the exact cause of acne keloidalis (AK remains unknown. However, a few inciting agents have been suggested which include androgens, inflammation, infection, trauma, genetics, and ingrowing hairs. AK shares some similar features with other forms of cicatricial alopecia and may occur together. Papules, pustules, and sometimes tumorous masses in the nuchal or occipital regions of the scalp hence the name “bumps” evolved in the environment. Despite its common occurrence, only a few seek help in hospital when lesions start to unsightly affect the individual’s quality of life. The presences of the keloidal lesions are more stressful compared to the resulting alopecia. Various attempts to reduce the bumps with corrosives, acids, and car engine oils lead to larger lesions or unsightly scars. Active lesions produce bleeding during haircuts. This is worrisome as a couple of individuals with active AK share shaving instruments at the barber shop and are at risk of acquiring or transmitting blood-borne infections. There is an urgent need to encourage safe shaving habits and treatment of lesions at onset so as to prevent unsightly lesions. Keywords: scarring alopecia, clinical features, treatment challenges 

Author Details

African Journals Online (AJOL)

Aderibigbe, A.B. Vol 20, No 2 (2010) - Articles Earlobe keloids: Emerging cosmetic complacation of ear-piercing. Abstract. ISSN: 0189-2657. AJOL African Journals Online. HOW TO USE AJOL... for Researchers · for Librarians · for Authors · FAQ's · More about AJOL · AJOL's Partners · Terms and Conditions of Use · Contact ...

Custom Made Pressure Appliance for Presurgical Sustained ...

African Journals Online (AJOL)

Among the most common complications of this therapy is ulceration due to excessive pressure. A case of presurgical size reduction for a large ear keloid with a custom made pressure appliance is presented. This novel design of the appliance allows for better control over the amount and direction of the pressure applied on ...

Original Article

African Journals Online (AJOL)

intentionally or accidentally), 10 (19.3%), and burning sensation, 10 (19.3%). The chest has the most symptomatic lesions with 15 (28.8%) and 9 (17.3%) patients having painful and itching lesions respectively. Attention needs to be paid to treatment of keloid symptoms which may make life unbearable to patients in addition ...

Magnet‑retained Prophylactic Appliance for Post‑excisional ...

African Journals Online (AJOL)

Keloid is a cutaneous fibrous scar that represents disequilibrium in the dermal wound healing ... helix of right ear since 1½ years. There was history of first ear piercing of lobe of the ears at the age of 10 years ... produced as a result of aberration in the healing process. Pressure therapy, in combination with other forms of ...

Burn Wound Healing and Treatment: Review and Advancements

Science.gov (United States)

2015-06-12

burns. BMJ. 2004;328:1427–9. 26. Kowalske KJ. Burn wound care. Phys Med Rehab Clin North Am. 2011;22:213–27. 27. Tan JQ, Zhang HH, Lei ZJ, Ren P, Deng C...resulting in keloid disease. Wound Repair Regen. 2010;18:139–53. 41. Claudinot S, Nicolas M, Oshima H, Rochat A, Barrandon Y. Long-term renewal of hair

Scar modification. Techniques for revision and camouflage.

Science.gov (United States)

Horswell, B B

1998-09-01

The surgery and management of scars is a protracted and staged process that includes preparation of the skin through hygienic measures, scar softening (if indicated) with steroids, massage and pressure dressings, skilled execution of the surgical plan, and thorough postoperative wound care. This process generally covers a 1-year period for the various stages mentioned. Many general host and local skin factors will directly affect the final revision result. The two most important indirect factors that the surgeon must endeavor to control are optimal patient preparation and cutaneous health, and patient compliance with, and an ability to carry out, those wound care measures that the surgeon prescribes. Keloid and burn contracture scars represent two entities that are complicated and challenging to treat owing to their abnormal morphophysiologic features. Management of these scars is prolonged, and the patient must understand that the ultimate result will usually be a compromise. New grafting techniques, such as cultured autodermal grafts, offer improved initial management of burn wounds that may subsequently optimize scar revision in these patients. Keloids, and to a lesser extent hypertrophic scars, require steroid injections, pressure treatment, careful surgery, and protracted wound support and pressure treatment (exceeding 6 months) after surgery.

Local Injection of Triamcinolone Acetonide: A Forgotten Aetiology of Cushing’s Syndrome

OpenAIRE

Sukhumthammarat, Weera; Putthapiban, Prapaipan; Sriphrapradang, Chutintorn

2017-01-01

Many different non systemic corticosteroid administrations can cause iatrogenic Cushing’s Syndrome (CS). We herein report a case series of iatrogenic CS from keloid scars treatment and aesthetic regimen called mesotherapy. Our first patient developed CS after having exceeded recommended dose of intralesional injection of Triamcinolone Acetonide (TAC). Second case presented with CS followed by unidentified mesotherapy treatment for local fat reduction. Subcutaneous injections of dexamethasone ...

Microneedle physical contact as a therapeutic for abnormal scars

OpenAIRE

Yeo, David C.; Balmayor, Elizabeth R.; Schantz, Jan-Thorsten; Xu, Chenjie

2017-01-01

Background Abnormal (keloid and hypertrophic) scars are a significant affliction with no satisfactory single modality therapy to-date. Available options are often ineffective, painful, potentially hazardous, and require healthcare personnel involvement. Herein a self-administered microneedle device based on drug-free physical contact for inhibiting abnormal scars is reported. Its therapeutic activity through microneedle contact eliminates hazards associated with toxic anti-scarring drugs whil...

Impact of radiation therapy for benign diseases

International Nuclear Information System (INIS)

Kantor, G.; Van Houtte, P.; Beauvois, S.; Roelandts, M.

1997-01-01

Radiation therapy of benign diseases represent a wide panel of indications. Some indications are clearly identified as treatment of arteriovenous malformations (AVM), hyperthyroid ophthalmopathy, postoperative heterotopic bone formations or keloid scars. Some indications are under evaluation as complications induced by neo-vessels of age-related macular degeneration or coronary restenosis after angioplasty. Some indications remain controversial with poor evidence of efficiency as treatment of bursitis, tendinitis or Dupuytren's disease. Some indications are now obsolete such as warts, or contra-indicated as treatment of infant and children. (authors)

Keloid and Hypertrophic Scars: A Review of Recent Developments ...

African Journals Online (AJOL)

These include surgical excision, intralesional steroid injection, cryotherapy, laser therapy, irradiation, mechanical compression dressing, silicone sheet applications, intralesional interferon injection, or combination of techniques. Many of the treatment modalities have a defined biologic basis while others are based on ...

African traditional medication and keloid formation in herpes zoster ...

African Journals Online (AJOL)

wound healing following insult to the deep dermis such as seen in burn injury, lacerations abrasions and .... are stored on the device for future offline browsing. Internet connection is required to access the back issues and search facility.

Impact of radiation therapy for benign diseases; Role de la radiotherapie dans les affections benignes

Energy Technology Data Exchange (ETDEWEB)

Kantor, G. [Institut National de la Sante et de la Recherche Medicale (INSERM), Fondation Bergonie, 33 - Bordeaux (France); Van Houtte, P.; Beauvois, S.; Roelandts, M. [Institut Bordet, Brussels (Belgium)

1997-12-31

Radiation therapy of benign diseases represent a wide panel of indications. Some indications are clearly identified as treatment of arteriovenous malformations (AVM), hyperthyroid ophthalmopathy, postoperative heterotopic bone formations or keloid scars. Some indications are under evaluation as complications induced by neo-vessels of age-related macular degeneration or coronary restenosis after angioplasty. Some indications remain controversial with poor evidence of efficiency as treatment of bursitis, tendinitis or Dupuytren`s disease. Some indications are now obsolete such as warts, or contra-indicated as treatment of infant and children. (authors)

Subcutaneous Emphysema Induced by Cryotherapy: A Complication due to Previous Punctures

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Jared Martínez-Coronado

2015-01-01

Full Text Available Cryosurgery is a common therapeutic modality used in dermatology; therefore we must be aware of its possible adverse effects. We report a case of a patient with subcutaneous emphysema which occurred following the application of cryotherapy after multiple punctures of local anesthetic and intralesional steroids in a chest keloid scar. Despite the fact that this condition was gradually resolved after expectant observation, we warn about this complication when sprayed cryotherapy is preceded by multiple punctures on cutaneous lesions above bony surfaces. In similar settings, cryotherapy must be first administered or a cotton-tip applicator should be used.

Radiation therapy for the prevention of postoperative and traumatic complications

Energy Technology Data Exchange (ETDEWEB)

Kishkovskij, A.N.; DudareV, A.L. (Voenno-Meditsinskaya Akademiya, Leningrad (USSR))

1983-05-01

An analysis of the results of radiation therapy of 587 patients with postoperative and traumatic complications has shown that special ..gamma..-therapy used at early time following trauma or surgical intervention, with the first clinical signs of an incipient inflammatory process (the so-called ''anticipating'' irradiation), makes it possible to avoid the development of serious postoperative, post-traumatic complications: wound suppuration, fistulas, secondary parotitis, postamputation pain syndrome, ''needle'' osteomyelitis, keloid cicatrix, skin graft rejection, etc. In the author opinion, this promising trend in radiotherapy of nontumorous diseases is worth a wider using in clinical practice.

[Nodules on localized scleroderma or morphea].

Science.gov (United States)

Bayle, P; Bazex, J; Marguery, M-C; Lamant, L

2005-02-01

Localized scleroderma or morphea usually appears as flat or depressed lesions. We report 3 cases of morphea with atypical appearance, alternating pigmented and depigmented patches with nodules or sclerous bands, occurring in adult men. The occurrence of nodular elements on generalized or localized scleroderma, although rare, was first reported in the literature by Addisson in 1884. These nodules usually appear during evolution. These scleroderma are then described as being keloidal or nodular. We report 3 cases of nodules on localized scleroderma which appeared at the beginning of the dermatosis and where the scleroderma had a similar unusual irregularly pigmented appearance.

External branch spinal nerve paralysis on keloid scar | Frioui | Pan ...

African Journals Online (AJOL)

The paralysis of the external branch of spinal nerve is very rare. It manifests clinically by a weakness and abnormal morphology of the shoulder. We must think about it in front of any simple surgery of the cervical region. We report the case of a 20 year old patient, who consulted several doctors for pain and progressive ...

PET scanning in plastic and reconstructive surgery.

Science.gov (United States)

Liodaki, Eirini; Eirini, Liodaki; Liodakis, Emmanouil; Emmanouil, Liodakis; Papadopoulos, Othonas; Othonas, Papadopoulos; Machens, Hans-Günther; Hans-Günther, Machens; Papadopulos, Nikolaos A; Nikolaos, Papadopulos A

2012-02-01

In this report we highlight the use of PET scan in plastic and reconstructive surgery. PET scanning is a very important tool in plastic surgery oncology (melanoma, soft-tissue sarcomas and bone sarcomas, head and neck cancer, peripheral nerve sheath tumors of the extremities and breast cancer after breast esthetic surgery), as diagnosis, staging, treatment planning and follow-up of cancer patients is based on imaging. PET scanning seems also to be useful as a flap monitoring system as well as an infection's imaging tool, for example in the management of diabetic foot ulcer. PET also contributes to the understanding of pathophysiology of keloids which remain a therapeutic challenge.

Radiation therapy of benign diseases. What's new eight years after?; La radiotherapie des affections benignes: quelles indications huit ans plus tard?

Energy Technology Data Exchange (ETDEWEB)

Van Houtte, P.; Roelandts, M.; Devriendt, D. [Institut Jules-Bordet, Dept. de Radio-Oncologie, Bruxelles (Belgium); Minsat, M.; Laharie, H.; Kantor, G. [Bordeaux-2 Univ. Victor-Segalen, Dept. de Radiotherapie, Institut Bergonie, 33 - Bordeaux (France)

2005-11-15

The authors present an update version of the indications for radiotherapy in the management of benign diseases. This is based on available randomized trials and recent international meetings. Validated indications remain the prevention of resected heterotopic bone ossifications, keloids scars and pterygium and also treatment of arteriovenous malformations; the place of radiotherapy for malignant exophthalmia is more and more restricted. Randomized trials have demonstrated the efficacy of endo-brachytherapy in the prevention of restenosis after angioplasty but the use of embedded stent has replaced this indication. Macular degeneration is no more an indication of radiotherapy. Quality requirements for radiotherapy are identical for benign or malignant indications. (author)

Early outcome of minimally invasive mitral valve surgery

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Shawky Fareed

2016-08-01

Conclusion: Right anterolateral mini-thoracotomy minimally invasive technique provides excellent exposure of the mitral valve, even with a small atrium and offers a better cosmetic lateral scar which is less prone to keloid formation. In addition, minimally invasive right anterolateral mini-thoracotomy is as safe as median sternotomy for mitral valve surgery, with fewer complications and postoperative pain, less ICU and hospital stay, fast recovery to work with no movement restriction after surgery. It should be used as an initial approach for mitral valve surgery. Furthermore, it was believed that less spreading of the incision, no interference with the diaphragm and less tissue dissection might improve outcomes, particularly respiratory function.

Discrimination of collagen in normal and pathological dermis through polarization second harmonic generation

Science.gov (United States)

Su, Ping-Jung; Chen, Wei-Liang; Hong, Jin-Bon; Li, Tsung-Hsien; Wu, Ruei-Jr; Chou, Chen-Kuan; Lin, Sung-Jan; Dong, Chen-Yuan

2010-02-01

We used polarization-resolved, second harmonic generation (P-SHG) microscopy at single pixel resolution for medical diagnosis of pathological skin dermis, and found that P-SHG can be used to distinguish normal and dermal pathological conditions of keloid, morphea, and dermal elastolysis. We find that the histograms of the d33/d31 ratio for the pathological skins to contain two peak values and to be wider than that of the normal case, suggesting that the pathological dermal collagen fibers tend to be more structurally heterogeneous. Our work demonstrates that pixel-resolved, second-order susceptibility microscopy is effective for detecting heterogeneity in spatial distribution of collagen fibers.

Microneedle physical contact as a therapeutic for abnormal scars.

Science.gov (United States)

Yeo, David C; Balmayor, Elizabeth R; Schantz, Jan-Thorsten; Xu, Chenjie

2017-08-14

Abnormal (keloid and hypertrophic) scars are a significant affliction with no satisfactory single modality therapy to-date. Available options are often ineffective, painful, potentially hazardous, and require healthcare personnel involvement. Herein a self-administered microneedle device based on drug-free physical contact for inhibiting abnormal scars is reported. Its therapeutic activity through microneedle contact eliminates hazards associated with toxic anti-scarring drugs while self-treatment enables administration flexibility. The microneedle patch was fabricated with FDA-approved liquid crystalline polymer under good manufacturing practice. It was first tested to ascertain its ability to inhibit (keloid) fibroblast proliferation. Later the microneedle patch was examined on the rabbit ear hypertrophic scar model to explore its potential in inhibiting the generation of abnormal scars post-injury. Finally, the microneedle patch was applied to the caudal region of a hypertrophic scar located on a female patient's dorsum to verify clinical efficacy. On untreated control cultures, barely any non-viable fibroblasts could be seen. After 12-h treatment with the microneedle patch, the non-viable proportion increased to 83.8 ± 11.96%. In rabbit ear hypertrophic scar model, 100% of the control wounds without the presence of patches on rabbit ears generated regions of raised dermis originating from the wound site (3/3), whereas microneedle treatment prevented dermis tissue thickening in 83.33% of the wounds (15/18). In the clinical test, the microneedle patch was well tolerated by the patient. Compared to the untreated region, microneedle treatment decreased the number of infiltrated inflammatory cells, with less disrupted dermis tissue architecture and more flattened appearance. A self-administered, drug-free microneedle patch appears highly promising in reducing abnormal scarring as observed from in vitro, in vivo and clinical experiments. Larger cohort clinical

Utilización de recursos termales en la búsqueda de salud y belleza

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Maritza Pérez Loyola

2001-12-01

Full Text Available Se explican desde una óptica bioquímica los efectos terapéuticos atribuibles a la acción de cremas dermocosméticas, preparadas a partir de sustancias naturales de origen termal. Se analizaron las experiencias clínicas reportadas por un grupo de dermatólogos con la utilización de estas, en la mejora del acné y los queloides.The therapeutic effects attributable to the action of dermocosmetic creams prepared from natural substances of thermal origin are explained from the biochemical point of view. The clinical experiences reported by a group of dermatologists who used these creams to treat acne and keloids are also analyzed.

PET scanning in plastic and reconstructive surgery

International Nuclear Information System (INIS)

Eirini, L.; Emmanouil, L.; Othonas, P.; Hans-Guenther, M.; Nikolaos, P.A.

2012-01-01

In this report we highlight the use of position emission tomography (PET) scan in plastic and reconstructive surgery. PET scanning is a very important tool in plastic surgery oncology (melanoma, soft-tissue sarcomas and bone sarcomas, head and neck cancer, peripheral nerve sheath tumors of the extremities and breast cancer after breast esthetic surgery), as diagnosis, staging, treatment planning and follow-up of cancer patients is based on imaging. PET scanning seems also to be useful as a flap monitoring system as well as an infection's imaging tool, for example in the management of diabetic foot ulcer. PET also contributes to the understanding of pathophysiology of keloids which remain a therapeutic challenge. (author)

Fillers in the skin of color population.

Science.gov (United States)

Heath, Candrice R; Taylor, Susan C

2011-05-01

The skin of color population in the United States is rapidly growing and the cosmetic industry is responding to the demand for skin of color targeted treatments. The aging face in skin of color patients has a unique pattern that can be successfully augmented by dermal fillers. Though many subjects with skin of color were not included in the pre-market dermal filler clinical trials, some post-market studies have examined the safety and risks of adverse events in this population. The safety data from a selection of these studies was examined. Though pigmentary changes occurred, there have been no reports of keloid development. Developing a patient-specific care plan and instituting close follow up is emphasized.

Pharmacognostic study of Chamaecyparis lawsoniana (Murr. Parl.: A drug used in Homoeopathy

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Anshu Rathi

2015-01-01

Full Text Available The pharmacognostic profile of crude drug has a key role in standardization for quality, purity and drug identification. The present study deals with pharmacognostic evaluation of aerial part of Chamaecyparis lawsoniana (Murr. Parl. a drug used in homoeopathic system of medicine for diverse clinical uses such as terrible pain in stomach, tumors, keloid, warts and lipoma of thigh. The study includes collection, identification, macroscopy, microscopy and organoleptic characteristics of aerial part of Chamaecyparis lawsoniana. Anatomically the leaf is distinguishable into a layer of the epidermis followed by parenchymatous mesophyll and resin duct in the parenchymatous cortex. Powder microscopy shows the presence of epidermal cells, parenchymatous cells and tracheids. These observations may be used as pharmacopoeial standards for identification of Cha maecyparis lawsoniana.

Occupational Dermatoses in Some Selected Industries in India

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R Vijay Battu

1985-01-01

Full Text Available Twenty five thousand and fifty employees working in 10 industrial units around Delhi were surveyed between July, 1982 and September, 1983. The industrial units included factories manufacturing tractors, rotating machines, gaskets, leaf spring, footwear, antibiotics and dashboard instruments; units printing cotton and synthetic cloth and books and periodicals; and a copper mine. The chief industrial dermatoses encountered were callositis 108 cases, contact dermatitis 36 cases, traumatic nail dystrophy 14 cases, frictional dermatitis of finger,7tips 10 cases, oil acne 10 cases, stasis dermatitis 3 cases, traumatic leucoderma 2 cases and keloid 2 cases. A total of 146 cases had industrial dermatoses, while 1085 had non- occupational skin disorders. The over-all incidence of occupational dermatoses in these industries was considerably low.

[Cutaneous cicatrix: natural course, anomalies and prevention].

Science.gov (United States)

Bardot, J

1994-09-01

Improving scar quality has become a major concern for surgeons. Although good skin suturing is of primordial important, the healing process varies greatly from one patient to another and the risk of hypertrophic or keloid scar evolution is currently unpredictable. Local massage and above all post-operative compression using compressive garments and sheets of silicon are an efficient methods of counteracting the proliferative phase which occurs during the first few months. In severe cases, particularly in burn patients, high-pressure springwater hydrotherapy to reduce scar contracture has proved to be effective. The current trend is to decrease the risk of bad scars in the immediate post-traumatic, post-operative stage in order to obtain the best possible scar initially and thus avoid revision surgery.

Scleroderma with Nodular Scleroderma

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Chutika Srisuttiyakorn

2016-11-01

Full Text Available Background: Nodular scleroderma is a rare variant of scleroderma which can occur in connection with systemic sclerosis or morphea. A biopsy from the lesion can demonstrate the scleroderma pattern, i.e., keloid pattern or mixed type. Treatment is challenging, and several treatments modalities have been reported with unsatisfactory results. Main Observations: We present a case of systemic sclerosis in a 50-year-old female who developed nodular scleroderma in the absence of deterioration of the scleroderma condition. Although no additional treatment was given, the lesions remained stable without progression. Conclusions: Although this condition is rare, it has been reported sporadically, and clinicians should be able to recognize this variant in cases of scleroderma presenting with firm nodules or plaques.

[Contribution of botulinum toxin to maxillo-facial surgery].

Science.gov (United States)

Batifol, D; de Boutray, M; Goudot, P; Lorenzo, S

2013-04-01

Botulinum toxin has a wide range of use in maxillo-facial surgery due to its action on muscles, on the glandular system, and against pain. It already has been given several market authorizations as indicated for: blepharospasm, spasmodic stiff neck, and glabellar lines. Furthermore, several studies are ongoing to prove its effectiveness and usefulness for many other pathologies: treatment of pain following cervical spine surgery; action on salivary glands after trauma, hypertrophy, or hyper-salivation; analgesic action (acknowledged but still being experimented) on neuralgia, articular pain, and keloids scars due to its anti-inflammatory properties. Botulinum toxin injections in the cervico-facial area are more and more used and should be to be correctly assessed. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Heart failure due to severe myocardial calcification

International Nuclear Information System (INIS)

Takahashi, Shouichi; Maida, Kiyoshi; Yokoyama, Hitoshi; Tanaka, Shigeo

1993-01-01

A 28-year-old female who had had irradiation on the chest wall at the age of 5 as a remedy for keloid granulation after burn, recently developed congestive heart failure. Severe tricuspid regurgitation was demonstrated by echocardiography with a certain calcification in the cardiac shadow on chest radiogram. Calcified right ventricle and ventricular septum were noticed operatively, which disturbed ventricular motion and also caused tricuspid valve deformity. These calcified myocardium apparently corresponded with the irradiation field. After tricuspid valve replacement, she regained physical activity satisfactorily without congestive heart failure. Because she had no other known causes of cardiac calcification such as hypercalcemia, myocarditis, myocardial infarction or renal diseases, irradiation on the chest wall could be responsible for the severe myocardial calcification. (author)

Lacaziose (doença de Jorge Lobo: revisão e atualização Lacaziosis (Jorge Lobo’s disease: review and update

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Arival Cardoso de Brito

2007-10-01

Full Text Available Lacaziose ou doença de Jorge Lobo é micose crônica, granulomatosa, causada por implantação traumática do fungo Lacazia loboi - patógeno não cultivável até o presente - nos tecidos cutâneo e subcutâneo, manifestando-se clinicamente por lesões nodulares queloidianas predominantes, envolvendo sobretudo pavilhões auriculares, face, membros superiores e inferiores, e não comprometendo as mucosas. A maioria dos casos humanos está registrada em países da América do Sul. Entretanto, a enfermidade apresenta aspectos epidemiológicos destacados, como o aparecimento em tribo Caiabi, no Brasil Central e em mamíferos não humanos, golfinhos de duas espécies (Tursiops truncatus e Sotalia guianensis capturados na costa da Flórida (EUA, na foz do rio Suriname, na costa de Santa Catarina (Brasil, no golfo de Gasconha (baía de Biscaia-Europa, com manifestações cutâneas e achados histopatológicos muito similares às encontradas no homem. O artigo objetiva abordar características do fungo e sua taxonomia, e aspectos históricos, ecoepidemiológicos, clínicos, imuno-histoquímicos, histopatológicos, ultra-estruturais e terapêuticos.Lacaziosis, also known as Jorge Lobo’s disease, lobomycosis and keloidal blastomycosis, is a chronic cutaneous and subcutaneous fungal granulomatous disease, caused by Lacazia loboi - an uncultivated fungal pathogen - characterized by the development of nodular keloidal lesions, particularly on the pinnae, face, upper and lower limbs, and with no involvement of mucous membranes. Most cases in humans were reported in South America, including the Caiabi Indians, in Central Brazil. The disease was described in non-human mammals, such as two species of dolphins (Tursiops truncatus and Sotalia guianensis inhabiting the coasts of Florida (USA, South America (Suriname River estuary, Santa Catarina-Brazil coast and Gulf of Gascony (Biscaya Bay, in Europe. The histopathological findings in dolphins were very similar

Local Injection of Triamcinolone Acetonide: A Forgotten Aetiology of Cushing’s Syndrome

Science.gov (United States)

Sukhumthammarat, Weera; Putthapiban, Prapaipan

2017-01-01

Many different non systemic corticosteroid administrations can cause iatrogenic Cushing’s Syndrome (CS). We herein report a case series of iatrogenic CS from keloid scars treatment and aesthetic regimen called mesotherapy. Our first patient developed CS after having exceeded recommended dose of intralesional injection of Triamcinolone Acetonide (TAC). Second case presented with CS followed by unidentified mesotherapy treatment for local fat reduction. Subcutaneous injections of dexamethasone were found to be the part of mesotherapy regimen in one case. Physicians should be insightful in prescribing TAC especially in those patients who have high predisposing factors for developing CS. In the same way, off-label mesotherapy combine with corticosteroid can lead to iatrogenic CS and Hypothalamic-Pituitary-Adrenal (HPA) axis suppression. Currently, there are no standard guidelines for mesotherapy treatment. Therefore, further clinical trials on dosage, duration and effective combination of mesotherapy regimens are needed to increase safety uses. PMID:28764237

The use of platelet-rich plasma gel in patients with mixed tumour undergoing superficial parotidectomy: a randomized study.

Science.gov (United States)

Scala, Marco; Mereu, Paola; Spagnolo, Francesco; Massa, Michela; Barla, Annalisa; Mosci, Sofia; Forno, Gilberto; Ingenito, Andra; Strada, Paolo

2014-01-01

Salivary gland tumors are mostly benign tumors. Whether a more conservative surgical approach at greater risk of recurrence, or a more radical intervention with an increased risk of facial paralysis is warranted is still under discussion. Our study addresses the opportunity for improving surgical outcome by employing platelet-rich plasma (PRP) gel at the surgical site. Twenty consecutive patients undergoing superficial parotidectomy were randomized and assigned to two groups, one with and one without PRP gel. Many parameters were evaluated after surgery and during follow-up, such as the duration of hospitalization, facial nerve deficit, onset of Frey's syndrome, relapse, cosmetic results, presence of keloid or scar depressions, behavior of several facial muscles. Our explorative analysis suggests a positive effect of PRP on surgical outcome in patients undergoing parotidectomy, whereas no negative effects were detected. This work suggests that administration of PRP in patients undergoing parotidectomy is beneficial.

Garlic in dermatology

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Nader Pazyar

2011-04-01

Full Text Available Garlic (Allium sativum L. fam. Alliaceae is one of the best-researched, best-selling herbal remedies and is also commonly used for treating various health problems. Garlic is widely known for its biological properties and plays an important role as an antioxidant. The purpose of this review is to gather and summarize all dermatologic-oriented in vitro and in-vivo experiments and clinical trials on garlic preparations. Extensive literatures search was carried out and twenty three studies were included. The results suggest that oral administration of garlic is effective on immunologic properties, cutaneous microcirculation, protection against UVB and cancer treatment. Additionally, topical application of garlic extract can potentially be effective on psoriasis, alopecia areata, keloid scar, wound healing, cutaneous corn, viral and fungal infection, leishmaniasis, skin aging and rejuvenation. Clinical effectiveness of oral and topical garlic extract is not sufficiently and meticulously explored as so far.

Role of collagen triple helix repeat containing-1 in tumor and inflammatory diseases

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Qian Wu

2017-01-01

Full Text Available Initially, collagen triple helix repeat containing-1 (CTHRC1 is expressed mainly in adventitial fibroblasts and neointimal smooth muscle cells of balloon-injured vessels, and increases cell migration, promotes tissue repair in response to injury. A variety of studies demonstrated that over-expression of CTHRC1 in solid tumors results in enhancement of migration and invasion of tumor cells, and is associated with decreased overall survival and disease-free survival. CTHRC1 expression is elevated in hepatitis B virus-infected patients and highly correlated with hepatocellular carcinoma progression as well. Furthermore, CTHRC1 plays a pivotal role in a great many fields, including increases bone mass, prevents myelination, reverses collagen synthesis in keloid fibroblasts, and increases fibroblast-like synoviocytes migration speed and abundant production of arthritic pannus in rheumatoid arthritis. Therefore, it will provide new insight into the pathogenesis of tumor and autoimmune diseases, and will shed new light on the therapy of related clinical diseases.

Preparation of Plaster Moulage (Cast in Plastic Surgery patients

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Rana R

2003-01-01

Full Text Available The purpose of this paper is to describe the technique of making casts using alginate compound for negative and dental stone plaster for positive impressions. With certain modifications a cast could be made of any part of the body and one can make a museum of interesting cases. Casts serve as useful teaching material especially in cleft lip and palate patients to study the effect of surgery on growth and development of the cleft lip-palate-nose complex in relation to the remaining face. It also helps in planning reconstruction in cases of facial defects, recording serial changes in multistage surgery, pre-operative and post-operative comparison as in rhinoplasty, ear reconstruction, hand etc; for comparing results before and after treatment in keloid and hypertrophic scars, fabrication of implants and preparation of prosthesis. In spite of newer modalities like 3-D imaging and stereolithography, the usefulness of this old technique in certain interesting cases can not be denied.

Case Report: Molecular Confirmation of Lobomycosis in an Italian Traveler Acquired in the Amazon Region of Venezuela.

Science.gov (United States)

Beltrame, Anna; Danesi, Patrizia; Farina, Claudio; Orza, Pierantonio; Perandin, Francesca; Zanardello, Claudia; Rodari, Paola; Staffolani, Silvia; Bisoffi, Zeno

2017-12-01

Lobomycosis is a chronic skin mycosis endemic in Amazon regions characterized by chronic nodular or keloidal lesions caused by Lacazia loboi , an uncultivable fungus. Imported cases in nonendemic countries are rare and diagnosed after years. We describe a case of lobomycosis in a healthy 55-year-old Italian traveler who had acquired the infection during 5-day-honeymoon in the Amazon region of Venezuela in 1999. Several weeks after return, he recalled pruritus and papular skin lesions on the left lower limb, subsequently evolving to a plaque-like lesion. Blastomycosis and cryptococcosis were hypothesized based on microscopic morphology of yeast-like bodies found in three consecutive biopsies, although fungal cultures were always negative. In 2016, exfoliative cytology and a biopsy specimen examination showed round yeast-like organisms (6-12 μm), isolated or in a chain, connected by short tubular projections fulfilling the morphologic diagnostic criteria of Lacazia spp. The microscopic diagnosis was confirmed by molecular identification.

A case of Bowen’s disease responding well to radiotherapy

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Goknur Kalkan

2013-08-01

Full Text Available Bowen’s disease is a form of intraepidermal squamous cell carcinoma which is known as carsinoma in situ. The head, neck, and extremities are the most commonly affected anatomic locations. Treatment options for Bowen’s disease include observation, surgery, cryotherapy, electrodesiccation and curettage, topical application of 5-fluorouracil or imiquimod, Moh’s micrographic surgery, photodynamic therapy, and radiotherapy. Radiation therapy is advantageous in patients who refuse surgery, for large or multiple lesions, for lesions in cosmetically sensitive areas, and in patients who are predisposed to formation of keloids, with a high cure rate cited in the literature. Here we report a 70-year-old man who was diagnosed as Bowen’s disease and completely healed with the treatment of radiotherapy. By means of this case report, we will review the current literature and empasize that radiotherapy is an effective treatment alternative for Bowen's disease in the suitable lesions. [Cukurova Med J 2013; 38(4.000: 813-817

Dermatological changes of amputation stump

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Arora P

1993-01-01

Full Text Available Dermatological changes of stumps of 174 amputees are presented. The commonest dermatological change recorded at the site of amputation stump was hyperpigmentation in 46 (26.4% followed by callosities in 32 (18.3%, scaling in 29 (16.7%, cutaneous atrophy in 20 (11.5%, lichenification in 19(10.9%, traumatic ulcer and bacterial infections in 18 (10.3% each, hypertrophic scar in 14 (8.1%, hypopigmentation and corns in 13 (7.4% each, verrucous hypertrophy of stump in 12 (6.9%, dermatophytic infection in 5(2.9%, stump oedema and phantom limb in 4 (2.3% each, intertriginous dermatitis in 3( 1.7%, allergic contact dermatitis (resin and frictional eczema in 2(1.1% each. Epidermoid cyst, keloid formation, anaesthesia, gangrene and cutaneous horn were recorded in 1 (0.6% each. Atrophy (epidermal and derma, anaesthesia, alopecia and elephantiasis of the stump have not been documented in the literature earlier.

Radiation injuries in atomic bomb survivors, chapter 2

International Nuclear Information System (INIS)

Anon.

1979-01-01

Atomic bombs, for the first time in human history, were dropped on Hiroshima in August 6, and on Nagasaki on August 9, 1945. Though the powers of these bombs were small as compared with those of present day nuclear weapons, the atomic bombs claimed many lives instantaneously, damaged human bodies, and destroyed all objects, annihilating the urban areas. Even today, the dreadful consequences of the bombings still remain in both body and mind of the victims. Meanwhile, the experiences of atomic bomb disasters are fading constantly. In order to maintain the vivid information, in Part 2 ''Bodily injuries'', the following matters are described: early bodily injuries such as burns, (blast) external wounds, radiation injuries, and pathology in bodily injuries; later bodily injuries such as keloids, injuries to blood and eyes, injuries in exposed women, injuries in growth, aging and life, injuries in mental/nervous system, malignant tumors, and changes in chromosomes; and genetic effects. (J.P.N.)

New-generation radiofrequency technology.

Science.gov (United States)

Krueger, Nils; Sadick, Neil S

2013-01-01

Radiofrequency (RF) technology has become a standard treatment in aesthetic medicine with many indications due to its versatility, efficacy, and safety. It is used worldwide for cellulite reduction; acne scar revision; and treatment of hypertrophic scars and keloids, rosacea, and inflammatory acne in all skin types. However, the most common indication for RF technology is the nonablative tightening of tissue to improve skin laxity and reduce wrinkles. Radiofrequency devices are classified as unipolar, bipolar, or multipolar depending on the number of electrodes used. Additional modalities include fractional RF; sublative RF; phase-controlled RF; and combination RF therapies that apply light, massage, or pulsed electromagnetic fields (PEMFs). This article reviews studies and case series on these devices. Radiofrequency technology for aesthetic medicine has seen rapid advancements since it was used for skin tightening in 2003. Future developments will continue to keep RF technology at the forefront of the dermatologist's armamentarium for skin tightening and rejuvenation.

Methodology development for dosimetry of 90Sr + 90Y beta therapy applicators

International Nuclear Information System (INIS)

Coelho, T.S.; Yoriyaz, H.; Fernandes, M.A.R.

2009-01-01

The 9 0Sr+ 9 0Y applicators, used in beta therapy for prevention of keloids and pterigio, are imported and its dosimetric features are only illustrated by the manufacturers. The exhaustive routine of the medical physicists in the clinic do not make possible the accomplishment of procedures for the confirmation of these parameters. This work presents a methodology development for dosimetry in two 9 0Sr+ 9 0Y beta therapy applicators of the Amersham brand. The Monte Carlo code MCNP 4 C was used for the simulation of the percentage depth dose curves. The experimental measurements of the radiation attenuation had been done with a mini-extrapolation chamber. The results of the experimental measures had been compared with the simulated values. Both percentage deep dose curves, the theoretical and the experimental ones, had presented similar behavior, which may validate the use of the MCNP 4 C for these simulations, strengthening the usage of this method at procedures of dosimetry of these beta radiation sources. (author)

Report of a child with acute herpes zoster ophthalmicus induced partial third nerve palsy

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AR Suraida

2015-06-01

Full Text Available Herpes zoster is a reactivation of the varicella zoster virus (VZV, which may remain dormant in the dorsal root ganglion of the trigeminal nerve for decades after the patient's initial exposure. The ophthalmic branch of the trigeminal nerve, i.e., the innervation to the ocular structures, is one of the most commonly involved dermatomes, giving rise to herpes zoster ophthalmicus (HZO. A 10-year-old indigenous Malaysian girl presented with a complaint of painful blurring of vision in the right eye for one week. It was followed a few days later by cutaneous vesicular eruptions over the right side of her face and nose and drooping of the right upper lid, associated with double vision. In children, the disease usually follows a mild course, resolving without residual damage. However, this child achieved a best corrected visual acuity of only 6/36 in the affected eye due to corneal scarring. The rashes healed by formation of disfiguring keloids over the right nasal area. This is another rarely reported complication of HZO in immunocompetent individuals.

Unconventional use of intense pulsed light.

Science.gov (United States)

Piccolo, D; Di Marcantonio, D; Crisman, G; Cannarozzo, G; Sannino, M; Chiricozzi, A; Chimenti, S

2014-01-01

According to the literature, intense pulsed light (IPL) represents a versatile tool in the treatment of some dermatological conditions (i.e., pigmentation disorders, hair removal, and acne), due to its wide range of wavelengths. The authors herein report on 58 unconventional but effective uses of IPL in several cutaneous diseases, such as rosacea (10 cases), port-wine stain (PWS) (10 cases), disseminated porokeratosis (10 cases), pilonidal cyst (3 cases), seborrheic keratosis (10 cases), hypertrophic scar (5 cases) and keloid scar (5 cases), Becker's nevus (2 cases), hidradenitis suppurativa (2 cases), and sarcoidosis (1 case). Our results should suggest that IPL could represent a valid therapeutic support and option by providing excellent outcomes and low side effects, even though it should be underlined that the use and the effectiveness of IPL are strongly related to the operator's experience (acquired by attempting at least one specific course on the use of IPL and one-year experience in a specialized centre). Moreover, the daily use of these devices will surely increase clinical experience and provide new information, thus enhancing long-term results and improving IPL effectiveness.

Implants with 32P-foils for LDR-brachytherapy of benign stenosis in urology and gastroenterology

International Nuclear Information System (INIS)

Assmann, Walter; Becker, Ricarda; Otto, Henrike

2013-01-01

For LDR-brachytherapy, a limited number of implant geometries and materials are available. To avoid wound healing related hyper-proliferation (stenosis, keloids) a novel radioactive foil system was developed based on beta emitting 32 P, which can be easily integrated in existing implants such as urethral catheters or bile duct stents. As substrate material for these foils PEEK (polyetherethercetone) was chosen because of its radiation hardness during neutron activation of 32 P. The activity was determined by liquid scintillation counting and gamma spectroscopy, dose distributions were measured with scintillation detectors and radiochromic films. The correlation between activity and dose was checked by Monte-Carlo-simulations (Geant4). Prototypes of the 32 P-implants have shown in wash-out tests the required tightness for sealed radioactive sources. In animal tests on urethra and bile duct, the uncomplicated and save application of 32 P-foils mounted on standard implants has been demonstrated, which is almost unchanged due to the simple radiation protection with plexiglass. This concept of radioactive implants with integrated 32 P-foils could extend essentially the application possibilities of LDR-brachytherapy. (orig.)

Development of a dosimetric system for 90Sr + 90Y betatherapy applicators

International Nuclear Information System (INIS)

Coelho, Talita Salles

2010-01-01

The 90 Sr+ 90 Y applicators, used in betatherapy for prevention of keloids and pterigium, are imported and many times their dosimetric features are shown only in an illustrated form by the manufacturers. The exhaustive routine of the medical physicists in the clinic do not make possible the accomplishment of procedures for the confirmation of these parameters. This work presents the development of a methodology for the dosimetry of 90 Sr+ 90 Y betatherapy applicators. The Monte Carlo code MCNP5 was used for the simulation of the percentage depth dose curves and dose distribution profiles produced by these applicators. The experimental measurements of the radial and axial radiation attenuation, have been done with a mini-extrapolation chamber, thermoluminescent dosimeters and radiographic films. The experimental results have been compared with the simulated values. Both percentage depth dose curves and the radial dose profiles, the theoretical and the experimental ones, have presented good agreement, which may validate the use of the MCNP5 for these simulations, confirming the viability of the usage of this method in procedures of beta emitter sources dosimetry. (author)

Standard guidelines of care: Lasers for tattoos and pigmented lesions

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Aurangabadkar Sanjeev

2009-08-01

Full Text Available Introduction: Lasers have revolutionized the treatment of pigmentary disorders and have become the mainstay of therapy for many of them. Machines: Though different laser machines are used, Quality-switched (QS lasers are considered as the gold standard for treatment of pigmented lesions. Proper knowledge of the physics of laser machine, methodology, dosage schedules, etc., is mandatory. Physician Qualification: Laser may be administered by a dermatologist, who has received adequate background training in lasers during postgraduation or later at a center that provides education and training in lasers, or in focused workshops which provide such trainings. He should have adequate knowledge of the machines, parameters, cooling systems, and aftercare. Facility: The procedure may be performed in the physician′s minor procedure room. Indications: Epidermal lesions: Cafι au lait macules (CALM, lentigines, freckles, solar lentigo, nevus spilus, pigmented seborrheic keratosis, dermatosis papulosa nigra (DPN. Dermal lesions: Nevus of Ota, Blue nevus, Hori′s nevus (acquired bilateral nevus of Ota-like macules. Tattoos: Amateur, professional, cosmetic, medicinal, and traumatic. Mixed epidermal and dermal lesions: Postinflammatory hyperpigmentation (PIH, nevus spilus, periorbital and perioral pigmentation, acquired melanocytic nevi (moles, melasma and Becker′s Nevus. Contraindications: Absolute: Active local infection, photo-aggravated skin diseases and medical conditions, tattoo granuloma, allergic reactions to tattoo pigment, unstable vitiligo and psoriasis. Relative: Keloid and keloidal tendencies, patient on isotretinoin, history of herpes simplex, patient who is not co-operative or has unrealistic expectation. Patient selection: Proper patient selection is important. Investigations to identify any underlying cause for pigmentation are important; concurrent topical and systemic drug therapy may be needed. History of scarring, response to previous

Proliferative Vitreoretinopathy after Eye Injuries: An Overexpression of Growth Factors and Cytokines Leading to a Retinal Keloid

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Francesco Morescalchi

2013-01-01

Full Text Available Eye injury is a significant disabling worldwide health problem. Proliferative Vitreoretinopathy (PVR is a common complication that develops in up to 40–60% of patients with an open-globe injury. Our knowledge about the pathogenesis of PVR has improved in the last decades. It seems that the introduction of immune cells into the vitreous, like in penetrating ocular trauma, triggers the production of growth factors and cytokines that come in contact with intra-retinal cells, like Müller cells and RPE cells. Growth factors and cytokines drive the cellular responses leading to PVR’s development. Knowledge of the pathobiological and pathophysiological mechanisms involved in posttraumatic PVR is increasing the possibilities of management, and it is hoped that in the future our treatment strategies will evolve, in particular adopting a multidrug approach, and become even more effective in vision recovery. This paper reviews the current literature and clinical trial data on the pathogenesis of PVR and its correlation with ocular trauma and describes the biochemical/molecular events that will be fundamental for the development of novel treatment strategies. This literature review included PubMed articles published from 1979 through 2013. Only studies written in English were included.

Development of a dosimetric system for {sup 90}Sr + {sup 90}Y betatherapy applicators; Desenvolvimento de um sistema de dosimetria para aplicadores de betaterapia de {sup 90}Sr + {sup 90}Y

Energy Technology Data Exchange (ETDEWEB)

Coelho, Talita Salles

2010-07-01

The {sup 90}Sr+{sup 90}Y applicators, used in betatherapy for prevention of keloids and pterigium, are imported and many times their dosimetric features are shown only in an illustrated form by the manufacturers. The exhaustive routine of the medical physicists in the clinic do not make possible the accomplishment of procedures for the confirmation of these parameters. This work presents the development of a methodology for the dosimetry of {sup 90}Sr+{sup 90}Y betatherapy applicators. The Monte Carlo code MCNP5 was used for the simulation of the percentage depth dose curves and dose distribution profiles produced by these applicators. The experimental measurements of the radial and axial radiation attenuation, have been done with a mini-extrapolation chamber, thermoluminescent dosimeters and radiographic films. The experimental results have been compared with the simulated values. Both percentage depth dose curves and the radial dose profiles, the theoretical and the experimental ones, have presented good agreement, which may validate the use of the MCNP5 for these simulations, confirming the viability of the usage of this method in procedures of beta emitter sources dosimetry. (author)

Unconventional Use of Intense Pulsed Light

Directory of Open Access Journals (Sweden)

D. Piccolo

2014-01-01

Full Text Available According to the literature, intense pulsed light (IPL represents a versatile tool in the treatment of some dermatological conditions (i.e., pigmentation disorders, hair removal, and acne, due to its wide range of wavelengths. The authors herein report on 58 unconventional but effective uses of IPL in several cutaneous diseases, such as rosacea (10 cases, port-wine stain (PWS (10 cases, disseminated porokeratosis (10 cases, pilonidal cyst (3 cases, seborrheic keratosis (10 cases, hypertrophic scar (5 cases and keloid scar (5 cases, Becker’s nevus (2 cases, hidradenitis suppurativa (2 cases, and sarcoidosis (1 case. Our results should suggest that IPL could represent a valid therapeutic support and option by providing excellent outcomes and low side effects, even though it should be underlined that the use and the effectiveness of IPL are strongly related to the operator’s experience (acquired by attempting at least one specific course on the use of IPL and one-year experience in a specialized centre. Moreover, the daily use of these devices will surely increase clinical experience and provide new information, thus enhancing long-term results and improving IPL effectiveness.

Implants with {sup 32}P-foils for LDR-brachytherapy of benign stenosis in urology and gastroenterology; {sup 32}P-haltige Folien als Implantate fuer die LDR-Brachytherapie gutartiger Stenosen in der Urologie und Gastroenterologie

Energy Technology Data Exchange (ETDEWEB)

Assmann, Walter [Ludwig-Maximilians-Univ., Muenchen (Germany). Fakultaet fuer Physik; Becker, Ricarda; Otto, Henrike [Klinikum der Universitaet Muenchen, Campus Grosshadern (Germany). Laser-Forschungslabor] [and others

2013-03-01

For LDR-brachytherapy, a limited number of implant geometries and materials are available. To avoid wound healing related hyper-proliferation (stenosis, keloids) a novel radioactive foil system was developed based on beta emitting {sup 32}P, which can be easily integrated in existing implants such as urethral catheters or bile duct stents. As substrate material for these foils PEEK (polyetherethercetone) was chosen because of its radiation hardness during neutron activation of {sup 32}P. The activity was determined by liquid scintillation counting and gamma spectroscopy, dose distributions were measured with scintillation detectors and radiochromic films. The correlation between activity and dose was checked by Monte-Carlo-simulations (Geant4). Prototypes of the {sup 32}P-implants have shown in wash-out tests the required tightness for sealed radioactive sources. In animal tests on urethra and bile duct, the uncomplicated and save application of {sup 32}P-foils mounted on standard implants has been demonstrated, which is almost unchanged due to the simple radiation protection with plexiglass. This concept of radioactive implants with integrated {sup 32}P-foils could extend essentially the application possibilities of LDR-brachytherapy. (orig.)

Nocardia yamanashiensis in an immunocompromised patient presenting as an indurated nodule on the dorsal hand.

Science.gov (United States)

Anzalone, C Lane; Cohen, Philip R; Tarrand, Jeffrey J; Diwan, Abdul H; Prieto, Victor G

2013-01-01

Nocardia are ubiquitous, aerobic, gram-positive actinomycetes. Nocardiosis typically occurs in immunocompromised patients, although immunocompetent individuals can also be affected. The purpose of this case study is to review the clinical characteristics and treatments of a unique form of cutaneous nocardiosis. We retrospectively reviewed the medical literature using PubMed, searching the terms cutaneous, host, immunocompromised, Nocardia, primary, yamanashiensis. Patient reports and previous reviews of the subject were critically assessed and the salient features are presented. Cutaneous nocardiosis typically presents as pustular nodules and the lesions may progress to become abscesses, cellulitis, granulomas or keloid-like tumors. N. brasiliensis is the predominant species involved in primary cutaneous nocardiosis; other common Nocardia species involved in human disease are N. farcinica, N. abscessus, N. cyriacigeorgica, and N. nova. Only two individuals (including the patient presented here) with primary cutaneous infection by N. yamanashiensis have been described in the literature; a third clinical isolate was recovered from a lung biopsy. Nocardia yamanashiensis is a rare clinical form of primary cutaneous nocardiosis. 16S ribosomal gene sequencing, as well as Gram stain and modified Fite acid-fast stain, play a vital role in identifying this clinical variant.

Treatment of non-healing sternum wound after open-heart surgery with allogenic platelet-rich plasma and fibrin glue-preliminary outcomes

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Mohammad Abbasi Tashnizi

2013-01-01

Full Text Available Introduction: Non-healing wound in the sternal region after coronary arteries bypass graft surgery is a serious complication. For healing a chronic wound, several novel approaches have been proposed recently such as using bone marrow stem cells, platelets and fibrin glue (PFG; but a non-invasive method is highly desirable in the first approach for treatment. The current study was undertaken to evaluate the effect of the combination of PFG in one treatment. Materials and Methods: We report on the treatment of six patients with life-threatening chronic sternum wounds, which caused septicemia with multi-drug resistant pathogens. The ulcers were extensively debrided initially and were measured and photographed at weekly intervals. The combination of PFG was applied topically on the wound after every 2 days. Results: The wounds were completely closed in five patients and significantly reduced in size in one. There was no evidence of local or systemic complications and any abnormal tissue formation, keloid or hypertrophic scarring. Conclusions: Our study suggests, in the first approach, PFG can be used safely in order to heal a non healing sternum wound following coronary artery bypass surgery.

[Implants with 32P-foils for LDR-brachytherapy of benign stenosis in urology and gastroenterology].

Science.gov (United States)

Assmann, Walter; Becker, Ricarda; Otto, Henrike; Bader, Markus; Clemente, Lucas; Reinhardt, Sabine; Schäfer, Claus; Schirra, Jörg; Uschold, Stephanie; Welzmüller, Andreas; Sroka, Ronald

2013-02-01

For LDR-brachytherapy, a limited number of implant geometries and materials are available. To avoid wound healing related hyper-proliferation (stenosis, keloids) a novel radioactive foil system was developed based on beta emitting (32)P, which can be easily integrated in existing implants such as urethral catheters or bile duct stents. As substrate material for these foils PEEK (polyetherethercetone) was chosen because of its radiation hardness during neutron activation of (32)P. The activity was determined by liquid scintillation counting and gamma spectroscopy, dose distributions were measured with scintillation detectors and radiochromic films. The correlation between activity and dose was checked by Monte-Carlo-simulations (Geant4). Prototypes of the (32)P-implants have shown in wash-out tests the required tightness for sealed radioactive sources. In animal tests on urethra and bile duct, the uncomplicated and save application of (32)P-foils mounted on standard implants has been demonstrated, which is almost unchanged due to the simple radiation protection with plexiglass. This concept of radioactive implants with integrated (32)P-foils could extend essentially the application possibilities of LDR-brachytherapy. Copyright © 2012. Published by Elsevier GmbH.

Acne Scar Treatment: A Multimodality Approach Tailored to Scar Type.

Science.gov (United States)

Zaleski-Larsen, Lisa A; Fabi, Sabrina G; McGraw, Timothy; Taylor, Mark

2016-05-01

Acne scarring can be classified into atrophic icepick, boxcar, and rolling scars in addition to keloidal and hypertrophic scars. Additionally, these scars can be erythematous, hyperpigmented, and/or hypopigmented. Each scar type has a different structural cause warranting a customized approach. Many cosmetic options exist to address these changes individually, but little literature exists about the safety and efficacy of combining such procedures and devices. A Medline search was performed on combination treatments because it relates to facial acne scarring, and results are summarized. Practical applications for these combinations of procedures are also discussed. Studies examining the efficacy and safety of ablative, nonablative, fractionated, and nonfractionated lasers, dermabrasion, chemical peels, needling, subcision, radiofrequency, stem cell therapy, fat transplantation, platelet-rich plasma, and hyaluronic acid dermal fillers for acne scars were found. The authors review their experience in combining these techniques. Review of the literature revealed multiple single options for facial acne scarring treatment with minimal evidence in the literature found on the safety and efficacy of combining such procedures and devices. The authors' experience is that combining acne scar treatment techniques can be performed safely and synergistically with optimal patient outcomes.

Successful treatment of acne keloidalis nuchae with erbium:YAG laser: a comparative study.

Science.gov (United States)

Gamil, Hend D; Khater, Elsayed M; Khattab, Fathia M; Khalil, Mona A

2018-05-14

Acne keloidalis nuchae (AKN) is a chronic inflammatory disease involving hair follicles of the neck. It is a form of keloidal scarring alopecia that is often refractory to medical or surgical management. To evaluate the efficacy of Er:YAG laser in the treatment of AKN as compared to long pulsed Nd:YAG laser. This study was conducted on 30 male patients with AKN. Their ages ranged from 19 to 47 years with a mean age of 36.87 ± 7.8 years. Patients were divided randomly into two groups of 15 patients, each receiving six sessions of either Er:YAG or long-pulsed Nd:YAG laser therapy. A statistically significant decrease in the number of papules was detected at the end of therapy in both groups, with a mean of 91.8% improvement in the Er:YAG group versus 88% in the Nd:YAG group. A significant decrease in plaques count was detected only in the Er: YAG group while a significant decrease in plaques size and consistency was recorded in both groups. The Er: YAG laser proved to be a potentially effective and safe modality both in the early and late AKN lesions.

Toward the abolition of nuclear arms, part 4

International Nuclear Information System (INIS)

Anon.

1981-01-01

The activities of various survey and relief groups in the period immediately after the atomic bombings are reported. The researches on atomic bombing casualties and the publication of the results by Japanese scientists were greatly restricted during the occupation period, but the conditions improved in 1951, when the San Francisco Peace Treaty was signed. In 1954, a Japanese fishing boat was exposed to the fallout from the hydrogen bomb test carried out by the U.S. in Bikini atoll. Thereafter, many national and international works concerning the use of radiation have been carried out in Japan. The status of Hiroshima and Nagasaki in 1945 is reported. Especially the medical care soon after the bombings, and keloid treatment and A-bomb disease treatment thereafter are described. The guidelines for medical treatment of A-bomb aftereffects was drafted, and the A-bomb victims medical care law was enacted. The policies of the government and local governments for A-bomb victims, and the movements of citizens against atomic weapons, especially peace education, are described. The tests of the Peace Declaration in Hiroshima and Nagasaki on August 6 and 9, 1980, respectively, are reprinted as the appendix. Also the chronology from 1945 to 1978 on the events related to atomic bombing damages is given. (Kako, I.)

A Supernumerary Nipple-Like Clinical Presentation of Lymphangioma Circumscriptum.

Science.gov (United States)

Taylor, Dustin; Kash, Natalie; Silapunt, Sirunya

2018-01-01

Lymphangioma circumscriptum is a superficially localized variant of lymphangioma. The characteristic clinical presentation is a "frogspawn" grouping of vesicles or papulovesicles on the proximal limb or limb girdle areas. Though most lymphangiomas develop congenitally, the lymphangioma circumscriptum subtype is known to present in adults. We report a case of lymphangioma circumscriptum on the left inframammary area of an African American female with an unusual supernumerary nipple-like clinical presentation. Our patient presented with a firm, smooth, hypopigmented papule, and the clinical diagnosis of keloid was made initially. However, she returned reporting growth of the lesion and was noted to have a firm, exophytic, lobulated, pink to skin-colored nodule. Histopathological examination demonstrated dilated lymphatic vessels, consistent with the diagnosis of lymphangioma. The presentation as a firm, hypopigmented papule and later exophytic, lobulated, skin-colored nodule in our case represents a clinical presentation of lymphangioma circumscriptum not previously described in the literature. Correct diagnosis in lymphangioma circumscriptum is vital, as recurrence following surgical resection and secondary development of lymphangiosarcoma and squamous cell carcinoma following treatment with radiation have been reported. Thus, it is important to consider lymphangioma circumscriptum in the differential of similar lesions in the future to allow appropriate diagnosis, treatment, and monitoring.

Potential advantages of treatment of transplanted saphenous vein aorto-coronary artery bypass grafts with beta irradiation to prevent graft occlusion.

Science.gov (United States)

Smith, R G

1997-01-01

Intimal proliferation or Neointimal hyperplasia (NIH) is a vascular lesion that often arises in arteries after balloon angioplasty or other vessel wall injuries. FIH is a vascular lesion that develops in autologous saphenous vein grafts (SVG) after transplantation into the aorto-coronary circulation or the peripheral vascular circulation. FIH shares elements of smooth muscle migration, proliferation and fibrous tissue deposition in common with nibrointimal proliferation (NIH). Either NIH of a coronary artery or FIH of a SVG obstruct the vascular lumen and result in myocardial dysfunction. Local radiotherapy has been used for several decades to reduce the post-operative recurrence of the fibrovascular proliferations of pterygia and keloids. Similarly, in animal and human experiments, endovascular radiotherapy has been shown to reduce arterial smooth muscle proliferation. Consideration of the similarities of vascular smooth muscle cell proliferation in NIH and FIH leads one to suggest that endovascular beta irradiation can reduce FIH as well as it reduces NIH. The goal of such treatment is to achieve a clinically significant decrease in the morbidity and mortality resulting from SVG occlusions. The potential for large reduction of the consequences of SVG occlusion, the very large number of patients at risk, and the simplicity of the proposed intervention encourages prompt scientific evaluation of this technique.

Overview of surgical scar prevention and management.

Science.gov (United States)

Son, Daegu; Harijan, Aram

2014-06-01

Management of incisional scar is intimately connected to stages of wound healing. The management of an elective surgery patient begins with a thorough informed consent process in which the patient is made aware of personal and clinical circumstances that cannot be modified, such as age, ethnicity, and previous history of hypertrophic scars. In scar prevention, the single most important modifiable factor is wound tension during the proliferative and remodeling phases, and this is determined by the choice of incision design. Traditional incisions most often follow relaxed skin tension lines, but no such lines exist in high surface tension areas. If such incisions are unavoidable, the patient must be informed of this ahead of time. The management of a surgical incision does not end when the sutures are removed. Surgical scar care should be continued for one year. Patient participation is paramount in obtaining the optimal outcome. Postoperative visits should screen for signs of scar hypertrophy and has a dual purpose of continued patient education and reinforcement of proper care. Early intervention is a key to control hyperplastic response. Hypertrophic scars that do not improve by 6 months are keloids and should be managed aggressively with intralesional steroid injections and alternate modalities.

Surgical Excision with Forehead Flap as Single Modality Treatment for Basal Cell Cancer of Central Face: Single Institutional Experience of 50 Cases

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Jagdeep Rao

2014-01-01

Full Text Available Basal cell carcinoma (BCC is the most common skin cancer worldwide. The WHO has defined it as “a locally invasive, slowly spreading tumor which rarely metastasizes, arising in the epidermis or hair follicles and in which the peripheral cells usually simulate the basal cells of the epidermis.” Here we discuss the management of BCCs of central face with surgical excision and reconstruction with forehead flap as single modality treatment. Material and Methods. This is a retrospective review of 50 patients who underwent surgical excision of BCC involving the facial region followed by primary reconstruction using forehead flaps at a single institution. There were 20 males and 30 females, mean age of 59 years. Results. No recurrence at primary site was observed during the follow-up of 1–4 yrs. There was no ectropion or exposure sequela. However, epiphora was evident. Size of lesions ranged from 2 to 6 cm. Keloid formation was seen in 2 (4% patients. Functional and cosmetic outcomes were satisfactory. Conclusion. For the face, the best reconstructive effort eventually fails in the face of tumor recurrence. The forehead flap represents one of the best methods for repair of extensive facial defects. Complete tumor extirpation, the primary event, is the key.

Basics of Radiation Biology When Treating Hyperproliferative Benign Diseases

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Franz Rödel

2017-05-01

Full Text Available For decades, low- and moderate-dose radiation therapy (RT has been shown to exert a beneficial therapeutic effect in a multitude of non-malignant conditions including painful degenerative muscoloskeletal and hyperproliferative disorders. Dupuytren and Ledderhose diseases are benign fibroproliferative diseases of the hand/foot with fibrotic nodules and fascial cords, which determine debilitating contractures and deformities of fingers/toes, while keloids are exuberant scar formations following burn damage, surgery, and trauma. Although RT has become an established and effective option in the management of these diseases, experimental studies to illustrate cellular composites and factors involved remain to be elucidated. More recent findings, however, indicate the involvement of radiation-sensitive targets like mitotic fibroblasts/myofibroblasts as well as inflammatory cells. Radiation-related molecular mechanisms affecting these target cells include the production of free radicals to hamper proliferative activity and interference with growth factors and cytokines. Moreover, an impairment of activated immune cells involved in both myofibroblast proliferative and inflammatory processes may further contribute to the clinical effects. We here aim at briefly describing mechanisms contributing to a modulation of proliferative and inflammatory processes and to summarize current concepts of treating hyperproliferative diseases by low and moderate doses of ionizing radiation.

Radiation therapy of benign diseases: patterns of care study in Germany; Strahlentherapie von gutartigen Erkrankungen: eine Bestandsaufnahme fuer Deutschland

Energy Technology Data Exchange (ETDEWEB)

Seegenschmiedt, M.H. [Alfried Krupp Krankenhaus Essen (Germany). Klinik fuer Radioonkologie, Strahlentherapie und Nuklearmedizin; Katalinic, A. [Erlangen-Nuernberg Univ., Erlangen (Germany). Inst. fuer Medizinische Statistik und Dokumentation; Makoski, H.B. [Staedtische Kliniken Duisburg (Germany). Strahlenklinik; Haase, W. [St. Vincentius Krankenhaus Karlsruhe (Germany). Klinik fuer Radioonkologie und Strahlentherapie; Gademann, G. [Magdeburg Univ. (Germany). Klinik fuer Strahlentherapie; Hassenstein, E. [Krankenhaus Nordwest, Frankfurt am Main (Germany). Radioonkologische Klinik

1999-11-01

A questionnaire was mailed in 3 years (1994, 1995, 1996) to all radiation facilities in Germany, which assessed equipment, indications, number of patients and treatment concepts. A total of 134 (88%) institutions returned all requested data: 22 in East and 112 in West Germany; 30 in university and 104 in community/private hospitals. The average data of each institution and of all institutions were analyzed for frequencies and ratios between different regions and institutions. A mean of 2 (range 1 to 7) megavoltage (Linac/Cobalt 60) and 1.4 (range 0 to 4) orthovoltage units were available per institution; 32 (24%) institutions had no orthovoltage equipment. A mean of 20,082 patients were treated per year: 456 (2%) for inflammatory diseases (221 hidradenitis, 78 nail bed infection, 23 parotitis, 134 not specified), 12,600 (63%) for degenerative diseases (2,711 peritendinitis humeroscapularis, 1,555 epicondylitis humeri, 1,382 heel spur, 2,434 degenerative osteoarthritis, 4,518 not specified), 927 (5%) for hypertrophic diseases (146 Dupuytren's contracture, 382 keloids, 155 Peyronie's disease, 244 not specified), 1,210 (6%) for functional disorders (853 Graves' orbitopathy, 357 not specified), and 4,889 (24%) for other disorders (e.g. 3,680 heterotopic ossification prophylaxis). In univariate analysis, there were significant geographical (West vs East Germany) differences in the use of radiotherapy for inflammatory and degenerative disorders and institutional differences (university vs community/private hospitals) in the use of radiotherapy for hypertrophic and functional disorders (p<0.05). The prescribed dose concepts were mostly in the low dose range (<10 Gy), but varied widely and inconsistently within geographic regions and institution types. (orig./MG) [German] 1994, 1995 und 1996 wurde an alle strahlentherapeutischen Institutionen in Deutschland ein Fragebogen verschickt, mit dem technische Ausstattung, Indikationsspektrum, Patientenzahl und

Current options for the treatment of pathological scarring.

Science.gov (United States)

Poetschke, Julian; Gauglitz, Gerd G

2016-05-01

Scarring is the consequence of surgery, trauma or different skin diseases. Apart from fresh, immature scars,that transform into mature scars over the course of would healing and that do not require further treatment,linear hypertrophic scars, widespread hypertrophic scars, keloids and atrophic scars exist. Symptoms like pruritusand pain, stigmatization as well as functional and aesthetic impairments that are very disturbing for the affected patients can bethe basis for the desire for treatment. Today, a multitude of options for the treatment and prevention of scars exists. Topical agents based on silicone or onion extract, intralesional injections of cristalline glucocorticoids (oftentimes in combinationwith cryotherapy) or 5-Fluorouracil as well as ablative and nonablative laser treatment are used. Current guidelines summarize the multitude of available treatment options and the currently available datafor the treating physicians, allowing them to make clear therapy recommendations for every single scar type. Relieving patients of their discomfort and doing their aesthetic demands justice is thus possible. Apart from scar prevention becoming more and more important, the increased use of modernlaser treatment options constitutes a key point in clinical scar treatment. At the same time the attention is turned to evaluating current therapeutic options with the help of contemporary study designs so as to graduallyimprove the level of evidence in scar treatment. © 2016 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Cellular and molecular pathology of HTS: basis for treatment.

Science.gov (United States)

Armour, Alexis; Scott, Paul G; Tredget, Edward E

2007-01-01

Hypertrophic scar and keloids are fibroproliferative disorders of the skin which occur often unpredictably, following trauma and inflammation that compromise cosmesis and function and commonly recur following surgical attempts for improvement. Despite decades of research in these fibrotic conditions, current non-surgical methods of treatment are slow, inconvenient and often only partially effective. Fibroblasts from these conditions are activated to produce extracellular matrix proteins such as collagen I and III, proteoglycans such as versican and biglycan and growth factors, including transforming growth factor-beta and insulin like growth factor I. However, more consistently these cells produce less remodeling enzymes including collagenase and other matrix metalloproteinases, as well as the small proteoglycan decorin which is important for normal collagen fibrillogenesis. Recently, the systemic response to injury appears to influence the local healing process whereby increases in Th2 and possibly Th3 cytokines such as IL-2, IL-4 and IL-10 and TGF-beta are present in the circulating lymphocytes in these fibrotic conditions. Finally, unique bone marrow derived cells including mesenchymal and endothelial stem cells as well as fibrocytes appear to traffic into healing wounds and influence the healing tissue. On this background, clinicians are faced with patients who require treatment and the pathophysiologic basis as currently understood is reviewed for a number of emerging modalities.

Cryosurgery in a dermatology setup: a hospital based study

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Deeptara Pathak Thapa

2018-04-01

Full Text Available Background: Cryosurgery is the well-aimed and controlled destruction of diseased tissue by application of cold. It has been shown to be effective and efficient in various skin diseases. We studied the indications and outcome of this modality of treatment in our set up. Materials and Method: All patients who were subjected to cryosurgery for different clinical indications were included in the study. Results: There were total of 133 patients. Commonest age group presentation (between 16 to 25 years constituted about 42%. 52% of patients were students. There were total of 91% who were from Kathmandu remaining 9% were from outside of Kathmandu Valley. Cryosurgery was indicated commonly in warts for 82% patients followed by 12% for keloid & hypertrophic scar, benign conditions in 4% and in premalignant conditions for 2% patients. Number to treatment (or sessions for indicated disease with resolution of disease was single in 81% patients followed by between 2 to 5 treatment session in 14% and more than 5 treatments was necessary in 5%. Side effects like pain was seen in 64% patients, erythema in 8% and blistering 4%. 24% patients did not have any side effect. Conclusion: Cryotherapy is considered as one of the effective modality of treatment for various skin conditions with various limitations. Further prospective clinical trial with large population group should be carried out.

Florence (Italy Department of Dermatology

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Piero Campolmi

2012-01-01

Full Text Available The CO2 laser has been used extensively in dermatological surgery over the past 30 years and is now recognised as the gold standard for soft tissue vaporization. Considering that the continuous wave CO2 laser delivery system and the newer “superpulsed” and scanned CO2 systems have progressively changed our practice and patient satisfaction, a long range documentation can be useful. Our experience has demonstrated that the use of CO2 laser involves a reduced healing time, an infrequent need for anaesthesia, reduced thermal damage, less bleeding, less inflammation, the possibility of intra-operative histologic and/or cytologic examination, and easy access to anatomically difficult areas. Immediate side effects have been pain, erythema, edema, typically see with older methods, using higher power. The percentage of after-treatment keloids and hypertrophic scars observed was very low (~1% especially upon the usage of lower parameters. The recurrence of viral lesions (condylomas and warts have been not more frequent than those due to other techniques. Tumor recurrence is minor compared with radiotherapy or surgery. This method is a valid alternative to surgery and/or diathermocoagulation for microsurgery of soft tissues. Our results are at times not consistent with those published in the literature, stressing the concept that multicentric studies that harmonization methodology and the patient selection are vital.

Late onset isotretinoin resistant acne conglobata in a patient with acromegaly

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Jain Kapil

2008-01-01

Full Text Available A 55 year-old male presented with multiple pus-discharging abscesses and sinuses and mutilating scarring on the gluteal region and back prevalent for the last ten years with exacerbations and remissions. Physical examination revealed acromegaly with frontal bossing, prognathism, a barrel chest and acral hypertrophy. Dermatological examination revealed cutis verticis gyrata, thick eyelids, a large triangular nose, a thickened lower lip, macroglossia, widely spaced teeth and widened skin pores with wet and oily skin. Hair was fine and nails were flat and wide. There were multiple inflammatory papules, tender nodules, draining sinuses, and grouped, polyporous comedones as well as multiple and extensive depressed and keloidal scars localized predominantly over the gluteal region with a few scattered lesions over the back. A computed tomography (CT scan showed widened sella turcica. His basal fasting growth hormone (GH levels were markedly raised (230 ng/mL; normal 1-5 ng/mL while the prolactin levels were moderately raised (87 ng/mL; normal 2-5 ng/mL. These findings were consistent with a diagnosis of acromegaly. The patient was put on antibiotics, nonsteroidal antiinflammatory drugs and isotretinoin at a dose of 1 mg/kg/day, which was increased to 1.5 mg/kg/day. Except for an initial mildly beneficial response, the skin lesions were largely resistant to high doses of isotretinoin at the end of four months.

The State of Ethnic Dermatology in Canada.

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Ogunyemi, Boluwaji; Miller-Monthrope, Yvette

Approximately 30% of Canadians will be members of a visible minority by 2031. When dermatology became an independent medical discipline in the late 18th and early 19th centuries, most residents of Canada and the United States were of Northern European descent. Morphology and descriptions of dermatoses are based on patients with light skin. Skin of colour dermatology refers to a unique field in dermatology dedicated to the diagnosis and management of disorders that are more prevalent in patients with moderately to richly pigmented skin. Important differences in the presentation of common dermatoses such as seborrheic dermatitis and acne exist in patients with darker skin types. The effect of traditional treatments for common and uncommon dermatoses is also an important consideration in managing patients with skin of colour. Such treatments may result in adverse effects such as postinflammatory hyperpigmentation or keloid scarring at a higher rate. Most respondents from a 2013 UK study of dermatology residents and consultants agreed that individuals with 'ethnic skin' had specific and unique dermatological problems. The Royal College of Physician and Surgeons of Canada's Objectives of Training in Dermatology states that residents must demonstrate the requisite knowledge, skills, and attitudes for effective patient-centred care and service to a diverse population. Future steps include creating a national society of dermatologists interested in clinical and academic aspects of ethnic dermatology. As well, presentations on skin of colour dermatology could be encouraged at major Canadian dermatology meetings.

Disintegration of collagen fibrils by Glucono-δ-lactone: An implied lead for disintegration of fibrosis.

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Jayamani, Jayaraman; Ravikanth Reddy, R; Madhan, Balaraman; Shanmugam, Ganesh

2018-02-01

Excess accumulation of collagen (fibrosis) undergoes self-aggregation, which leads to fibrillar collagen, on the extracellular matrix is the hallmark of a number of diseases such as keloids, hypertrophic scars, and systemic scleroderma. Direct inhibition or disintegration of collagen fibrils by small molecules offer a therapeutic approach to prevent or treat the diseases related to fibrosis. Herein, the anti-fibrotic property of Glucono-δ-lactone (GdL), known as acidifier, on the fibrillation and its disintegration of collagen was investigated. As collagen fibrillation is pH dependent, the pH modulation property of GdL is attractive to inhibit self-association of collagen. Optical density and microscopic data indicate that GdL elicits concentration-dependent fibril inhibition and also disintegrates pre-formed collagen fibrils. The simultaneous pH analysis showed that the modulation(lowering) of pH by GdL is the primary cause for its anti-fibrotic activity. The intact triple helical structure of collagen upon treatment of GdL suggests that collagen fibril disintegration can be achieved without affecting the native structure of collagen which is essential for any anti-fibrotic agents. Saturation transfer difference (STD) NMR result reveals that GdL is in proximity to collagen. The present results thus suggest that GdL provides a lead to design novel anti-fibrotic agents for the pathologies related to collagen deposition. Copyright © 2017 Elsevier B.V. All rights reserved.

Idiopathic tracheal stenosis: a clinicopathologic study of 63 cases and comparison of the pathology with chondromalacia.

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Mark, Eugene J; Meng, Fanqing; Kradin, Richard L; Mathisen, Douglas J; Matsubara, Osamu

2008-08-01

Tracheal stenosis in adults usually is the result of mechanical injuries either from direct trauma or intubation. Rarely do cases develop in patients without such a precedent history, and there are few reports of the pathology of idiopathic tracheal stenosis (ITS). We reviewed clinicopathologically, 63 tracheal resections for tracheal stenosis in patients who had no antecedent explanation for their stenosis. We contrasted these 63 cases with 34 cases of tracheal stenosis owing to chondromalacia (CM) after mechanical injury. All 63 cases occurred in females, with a mean age of 49 years. The most common symptom was dyspnea on exertion. The average duration of symptoms was greater than 2 years. One-third of the patients gave a history of gastroesophageal reflux. All but one of the cases occurred in the subglottic region and/or upper one-third of the trachea. Pathologically, most cases showed extensive keloidal fibrosis and dilation of mucus glands, a finding that was not obvious in most cases of CM. ITS has relatively normal cartilage with smooth inner and outer perichondrium, whereas CM has extensive degeneration of cartilage with irregular border of inner perichondrium observable at shirt sleeve magnification. Immunohistochemical staining for estrogen receptor and progesterone receptor was positive in fibroblasts cells in most cases. ITS is a rare disease and restricted to females. It may represent some form of fibromatosis. ITS can be distinguished histologically from CM in tracheal resection specimens in most cases.

Effects of the Nd:YAG laser on DNA synthesis and collagen production in human skin fibroblast cultures

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Castro, D.J.; Abergel, R.P.; Meeker, C.; Dwyer, R.M.; Lesavoy, M.A.; Uitto, J.

1983-09-01

Human skin fibroblasts were subjected to treatment with a Neodymium:YAG laser at 1060 nm with varying levels of energy determined by a reproducible method of dosimetry. DNA synthesis in the cells was measured by the incorporation of (3H)thymidine, and collagen production was monitored by the synthesis of nondialyzable (3H)hydroxyproline after incubation of cells with (3H)proline. Using energy levels equal to 1.7 X 10(3) J/cm2, a significant reduction in DNA synthesis was noted, while the cells remained viable as tested by the trypan blue exclusion test. With energy levels higher or equal to 2.3 X 10(3) J/cm2, the suppression of DNA synthesis was accompanied by cell nonviability. The collagen production, when measured immediately following the treatment with 1.7 X 10(3) J/cm2, was markedly reduced, and similar effects were observed with higher energy levels. However, when the cells were tested for collagen production at 20 hours following laser treatment, there was a significant decrease in collagen production at energy levels as low as 1.1 X 10(3) J/cm2, a dose that did not affect DNA synthesis or cell viability. Thus, the results indicate that the Nd:YAG laser can selectively suppress collagen production without affecting cell proliferation. These observations suggest that laser treatment could potentially be used to reduce collagen deposition in conditions such as keloids and hypertrophic scars.

The role of massage in scar management: a literature review.

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Shin, Thuzar M; Bordeaux, Jeremy S

2012-03-01

Many surgeons recommend postoperative scar massage to improve aesthetic outcome, although scar massage regimens vary greatly. To review the regimens and efficacy of scar massage. PubMed was searched using the following key words: "massage" in combination with "scar," or "linear," "hypertrophic," "keloid," "diasta*," "atrophic." Information on study type, scar type, number of patients, scar location, time to onset of massage therapy, treatment protocol, treatment duration, outcomes measured, and response to treatment was tabulated. Ten publications including 144 patients who received scar massage were examined in this review. Time to treatment onset ranged from after suture removal to longer than 2 years. Treatment protocols ranged from 10 minutes twice daily to 30 minutes twice weekly. Treatment duration varied from one treatment to 6 months. Overall, 65 patients (45.7%) experienced clinical improvement based on Patient Observer Scar Assessment Scale score, Vancouver Scar Scale score, range of motion, pruritus, pain, mood, depression, or anxiety. Of 30 surgical scars treated with massage, 27 (90%) had improved appearance or Patient Observer Scar Assessment Scale score. The evidence for the use of scar massage is weak, regimens used are varied, and outcomes measured are neither standardized nor reliably objective, although its efficacy appears to be greater in postsurgical scars than traumatic or postburn scars. Although scar massage is anecdotally effective, there is scarce scientific data in the literature to support it. © 2011 by the American Society for Dermatologic Surgery, Inc. Published by Wiley Periodicals, Inc.

Late and latent effects of atomic bomb on chromosomes in the exposed population

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Tanaka, R; Kamada, N [Hiroshima Univ. (Japan). Research Inst. for Nuclear Medicine and Biology

1976-09-01

Cytogenetic changes of exposed individuals, and the diseases and cytogenetic changes of the F/sub 1/ were discussed. The subjects exposed within 0.5 km. from the hypocenter revealed chromosomal aberration of the bone marrow in 83 per cent and those within 0.5 to 1.0 km. from the hypocenter revealed it in 47 per cent. The aberration was mostly the stable type, and was frequent in deletion, balanced-type translocation, unbalanced-type translocation, and inversion, in the order named. The number of abnormal clone varied with year. The chromosomes of the lymphocytes in the peripheral blood also showed high rate of stable type aberration, and the chromosomes were also aberrant in the fibroblasts of the keloid lesion. However, there were no abnormalities in the spermatogonium. Thirty seven subjects of F/sub 1/ group included 13 subjects whose father had been exposed, 19 subjects whose mother had been exposed, and 5 subjects whose both parents had been exposed. The diseases seen in the F/sub 1/ subjects were hematonosis in 28 subjects, autoimmune diseases in 5 subjects, and hypertension and lymphadenitis in 4 cases. Acute myelogenic leukemia (AML) showed normal chromosomes in all the 3 cases, the acute lymphatic leukemia (ALL), showed abnormal clones in 2 of 3 cases. Chronic myelogenic leukemia (CML) revealed abnormal chromosomes in all the 3 cases. The cytogenetic changes of abnormal clone in the F/sub 1/ of non-exposed were 60 per cent in AML, 57 per cent, in ALL and 100 per cent in CML.

Nasal base narrowing: the combined alar base excision technique.

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Foda, Hossam M T

2007-01-01

To evaluate the role of the combined alar base excision technique in narrowing the nasal base and correcting excessive alar flare. The study included 60 cases presenting with a wide nasal base and excessive alar flaring. The surgical procedure combined an external alar wedge resection with an internal vestibular floor excision. All cases were followed up for a mean of 32 (range, 12-144) months. Nasal tip modification and correction of any preexisting caudal septal deformities were always completed before the nasal base narrowing. The mean width of the external alar wedge excised was 7.2 (range, 4-11) mm, whereas the mean width of the sill excision was 3.1 (range, 2-7) mm. Completing the internal excision first resulted in a more conservative external resection, thus avoiding any blunting of the alar-facial crease. No cases of postoperative bleeding, infection, or keloid formation were encountered, and the external alar wedge excision healed with an inconspicuous scar that was well hidden in the depth of the alar-facial crease. Finally, the risk of notching of the alar rim, which can occur at the junction of the external and internal excisions, was significantly reduced by adopting a 2-layered closure of the vestibular floor (P = .01). The combined alar base excision resulted in effective narrowing of the nasal base with elimination of excessive alar flare. Commonly feared complications, such as blunting of the alar-facial crease or notching of the alar rim, were avoided by using simple modifications in the technique of excision and closure.

[External periareolar incision for subdermal mastectomy in men with gynecomastia].

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Montiel-Jarquín, Alvaro; Reyes-Páramo, Pedro; Ramos-Alvarez, Gloria; López-Colombo, Aurelio; Tinajero-Esquivel, Magdalena; Ruiz-León, Betzabé

2007-01-01

Gynecomastia describes a benign increase of the mammary gland in men. When medical treatment fails, symptoms and psychological alterations persist. Subdermal mastectomy is the definitive treatment and can be achieved by different incisions, each with potential complications. We undertook this study to present clinical characteristics of 11 patients with gynecomastia and the results obtained with subdermal mastectomy by means of external periareolar incision. A descriptive cohort study in male patients with gynecomastia was carried out in a third-level medical care hospital. Patients were treated with subdermal mastectomy by means of external periareolar incision. There were 11 male patients with an average age of 19 years (range: 11-60 years), 3 patients (27.2%) with bilateral gynecomastia and 8 patients (72.7%) with unilateral gynecomastia. Average time of evolution was 22 months (range: 16-48 months), 9 patients (81.8%) reported pain, 11 patients (100%) reported psychological alterations with cutaneous alteration, 11 patients (100%) had normal secondary sexual characteristics, 1 patient (9%) had supernumerary nipple development, and 11 patients (100%) had well-defined lesions. According to Simon's classification: seven patients (63.6%) were classified as grade 1, three patients (27.2%) as grade 2 and one patient (9.09%) as grade 3. Each patient had a subdermal mastectomy with external periareolar incision, 11 patients (100%) had a histopathological report of gynecomastia; 1 patient (9.09%) displayed keloid healing and none displayed complications inherent to the surgical procedure. Mastectomy by means of external periareolar incision is useful in the treatment of gynecomastia.

microRNA-7 down-regulation mediates excessive collagen expression in localized scleroderma.

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Etoh, Mitsuhiko; Jinnin, Masatoshi; Makino, Katsunari; Yamane, Keitaro; Nakayama, Wakana; Aoi, Jun; Honda, Noritoshi; Kajihara, Ikko; Makino, Takamitsu; Fukushima, Satoshi; Ihn, Hironobu

2013-01-01

Localized scleroderma (LSc), a connective tissue disorder restricted to the skin and subcutaneous tissue, is characterized by skin fibrosis due to an excessive deposition of types I collagen. The mechanism of such fibrosis is still unknown, but epigenetics may play some roles in the excessive collagen expression. In the present study, we investigated the mechanism of fibrosis seen in LSc, focusing on microRNA (miRNA). miRNA expression was determined by PCR array, real-time PCR, and in situ hybridization. The function of miRNA was evaluated using specific inhibitor. Immunoblotting was performed to detect α2(I) collagen protein. PCR array analysis using tissue miRNA demonstrated miR-7 level was significantly decreased in LSc skin as well as keloid tissue compared to normal skin in vivo. In situ hybridization also showed miR-7 expression in dermal fibroblasts was decreased in LSc dermis. The transfection of specific inhibitor for miR-7 into cultured normal dermal fibroblasts resulted in the up-regulation of α2(I) collagen protein in vitro. Also, the serum levels of miR-7 were significantly decreased in LSc patients compared with healthy controls, but serum miR-29a levels not. Systemic or local down-regulation of miR-7 may contribute to the pathogenesis of LSc via the overexpression of α2(I) collagen, and serum miR-7 may be useful as a disease marker. Investigation of the regulatory mechanisms of LSc by miRNA may lead to new treatments by the transfection into the lesional skin of this disease.

Late and latent effects of atomic bomb on chromosomes in the exposed population

International Nuclear Information System (INIS)

Tanaka, Ryuji; Kamada, Nanao

1976-01-01

Cytogenetic changes of exposed individuals, and the diseases and cytogenetic changes of the F 1 were discussed. The subjects exposed within 0.5 km. from the hypocenter revealed chromosomal aberration of the bone marrow in 83 per cent and those within 0.5 to 1.0 km. from the hypocenter revealed it in 47 per cent. The aberration was mostly the stable type, and was frequent in deletion, balanced-type translocation, unbalanced-type translocation, and inversion, in the order named. The number of abnormal clone varied with year. The chromosomes of the lymphocytes in the peripheral blood also showed high rate of stable type aberration, and the chromosomes were also aberrant in the fibroblasts of the keloid lesion. However, there were no abnormalities in the spermatogonium. Thirty seven subjects of F 1 group included 13 subjects whose father had been exposed, 19 subjects whose mother had been exposed, and 5 subjects whose both parents had been exposed. The diseases seen in the F 1 subjects were hematonosis in 28 subjects, autoimmune diseases in 5 subjects, and hypertension and lymphadenitis in 4 cases. Acute myelogenic leukemia (AML) showed normal chromosomes in all the 3 cases, the acute lymphatic leukemia (ALL), showed abnormal clones in 2 of 3 cases. Chronic myelogenic leukemia (CML) revealed abnormal chromosomes in all the 3 cases. The cytogenetic changes of abnormal clone in the F 1 of non-exposed were 60 per cent in AML, 57 per cent, in ALL and 100 per cent in CML. (Mukohata, S.)

Standard Guidelines of Care: Performing Procedures in Patients on or Recently Administered with Isotretinoin.

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Mysore, Venkataram; Mahadevappa, Omprakash H; Barua, Shyamanta; Majid, Imran; Viswanath, Vishalakshi; Bhat, Ramesh M; Talwar, Suresh; Thurakkal, Salim; Aurangabadkar, Sanjeev J; Chatterjee, Manas; Ganjoo, Anil

2017-01-01

Currently, the standard protocol regarding the performance of procedures on patients receiving or having recently received isotretinoin (13- cis -retinoic acid) states that the procedures should not be performed. The recommendations in standard books and drug insert require discontinuation of isotretinoin for 6 months before performing cosmetic procedures, including waxing, dermabrasion, chemical peels, laser procedures, or incisional and excisional cold-steel surgery. These recommendations have been followed for over two decades despite little evidence for the stated increased risk of scarring. The Association of Cutaneous Surgeons (I) constituted a task force to review the evidence and to recommend consensus guidelines regarding the safety of skin procedures, including resurfacing, energy-device treatments, and dermatosurgical procedures in patients with concurrent or recent isotretinoin administration. Data were extracted from the literature through a PubMed search using the keywords "isotretinoin," "safety," "scarring," "keloids," "hypertrophic scarring," and "pigmentation." The evidence was then labeled and circulated to all members of task force for review. The task force is of the opinion that there is insufficient evidence to support the current protocol of avoiding and delaying treatments in the patient group under consideration and recommends that the current practice should be discontinued. The task force concludes that performing procedures such as laser hair removal, fractional lasers for aging and acne scarring, lasers for pigmented skin lesions, fractional radio-frequency microneedling, superficial and medium-depth peels, microdermabrasion, dermaroller, biopsies, radio-frequency ablation, and superficial excisions is safe in patients with concurrent or recent isotretinoin administration.

Skin markings methods and guidelines: A reality in image guidance radiotherapy era

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Shrinivas Rathod

2012-01-01

Full Text Available Preparation of site of radiation delivery is an important process in radiation treatment planning and plays a crucial role during a course of radiotherapy to achieve reproducibility of set-up and accuracy of treatment delivery. The preparation of treatment area is done by markings of field center, field edge or other reference point of planned field. Both non-invasive (marker pen, henna and invasive methods (tattoo are available for marking with limitations of each. Tattoo with a needle pricked at angle of 30° to 1-2 mm depth to create tattoo 2-3 mm diameter in size is an ideal procedure. Visibility, permanent nature, social-religious belief, and mobility of skin are one of the main concerns about tattoo. Tattoo removal can be done performed if desirable by patients by various modern ways, which will be esthetically available. Dermabrasion, cryotherapy, surgery, QSRL (Q-switched ruby laser are common methods of tattoo removal. Esthetic dissatisfaction, allergy, dermatoses, keloids, infection, fanning/fading of tattoo are associated problems. In IMRT and IGRT treatment, delivery dependence on tattoo in reduced and use of surrogate markers including particularly for bony set-up and implanted markers (e.g. gold seeds for tumor localization and treatment verification is increasing. However, these are complex procedures and require an expertise. Ease of set-up and less time required for tattooing are one of the main advantages of tattoo as compared to external or internal marker set-up. Tattoo still remains a crucial method of positioning, especially in developing countries and in palliative treatment settings.

A STUDY ON CONTACT DERMATITIS TO HAIR DYE AND HENNA

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Neerja Puri

2013-10-01

Full Text Available P- Phenylenediamine is an oxidative chemical that is frequently used as a permanent hair-coloring agent. It is added to henna to increase the intensity and longevity of the tattoo and expedites its drying time. Henna itself is a greenish brown vegetable coloring made from the leaves of Lawsonia inermis and rarely causes allergic contact dermatitis. The addition of PPD causes the contact sensitization to black henna. Serious adverse skin reactions to permanent hair dyes and temporary black tattoos have been reported. As temporary tattoos have become fashionable among adolescents, the risk profile for p-phenylenediamine (PPD sensitization of the population has changed simultaneously with an increasing use of hair dyes in this age group. With increased popularity of body art such as body piercing and tattooing, an increase in temporary henna tattoos has also occurred. Although the appeal of non-permanence exists for henna tattoos, dermatologists have begun to see numerous cases of allergic contact dermatitis linked with a certain type of henna. We selected 50 patients using hair dye and henna for our study. Patch testing was done in all the patients using Indian standard series of antigens. Regarding to the side effects to hair dye and henna and itching was the commonest symptom seen in 16% patients, erythematous scaly plaques were seen in 10% patients, vesicular reactions were seen in 6% patients, angioneurotic oedema and contact urticaria was seen in 4% patients each and anaphylaxis and keloidal reaction was seen in 2% patients each.

Standard Guidelines of Care: Performing Procedures in Patients on or Recently Administered with Isotretinoin

Science.gov (United States)

Mysore, Venkataram; Mahadevappa, Omprakash H.; Barua, Shyamanta; Majid, Imran; Viswanath, Vishalakshi; Bhat, Ramesh M.; Talwar, Suresh; Thurakkal, Salim; Aurangabadkar, Sanjeev J.; Chatterjee, Manas; Ganjoo, Anil

2017-01-01

Background: Currently, the standard protocol regarding the performance of procedures on patients receiving or having recently received isotretinoin (13-cis-retinoic acid) states that the procedures should not be performed. The recommendations in standard books and drug insert require discontinuation of isotretinoin for 6 months before performing cosmetic procedures, including waxing, dermabrasion, chemical peels, laser procedures, or incisional and excisional cold-steel surgery. These recommendations have been followed for over two decades despite little evidence for the stated increased risk of scarring. Objective: The Association of Cutaneous Surgeons (I) constituted a task force to review the evidence and to recommend consensus guidelines regarding the safety of skin procedures, including resurfacing, energy-device treatments, and dermatosurgical procedures in patients with concurrent or recent isotretinoin administration. Materials and Methods: Data were extracted from the literature through a PubMed search using the keywords “isotretinoin,” “safety,” “scarring,” “keloids,” “hypertrophic scarring,” and “pigmentation.” The evidence was then labeled and circulated to all members of task force for review. Results: The task force is of the opinion that there is insufficient evidence to support the current protocol of avoiding and delaying treatments in the patient group under consideration and recommends that the current practice should be discontinued. The task force concludes that performing procedures such as laser hair removal, fractional lasers for aging and acne scarring, lasers for pigmented skin lesions, fractional radio-frequency microneedling, superficial and medium-depth peels, microdermabrasion, dermaroller, biopsies, radio-frequency ablation, and superficial excisions is safe in patients with concurrent or recent isotretinoin administration. PMID:29491653

Standard guidelines of care: Performing procedures in patients on or recently administered with isotretinoin

Directory of Open Access Journals (Sweden)

Venkataram Mysore

2017-01-01

Full Text Available Background: Currently, the standard protocol regarding the performance of procedures on patients receiving or having recently received isotretinoin (13-cis-retinoic acid states that the procedures should not be performed. The recommendations in standard books and drug insert require discontinuation of isotretinoin for 6 months before performing cosmetic procedures, including waxing, dermabrasion, chemical peels, laser procedures, or incisional and excisional cold-steel surgery. These recommendations have been followed for over two decades despite little evidence for the stated increased risk of scarring. Objective: The Association of Cutaneous Surgeons (I constituted a task force to review the evidence and to recommend consensus guidelines regarding the safety of skin procedures, including resurfacing, energy-device treatments, and dermatosurgical procedures in patients with concurrent or recent isotretinoin administration. Materials and Methods: Data were extracted from the literature through a PubMed search using the keywords “isotretinoin,” “safety,” “scarring,” “keloids,” “hypertrophic scarring,” and “pigmentation.” The evidence was then labeled and circulated to all members of task force for review. Results: The task force is of the opinion that there is insufficient evidence to support the current protocol of avoiding and delaying treatments in the patient group under consideration and recommends that the current practice should be discontinued.The task force concludes that performing procedures such as laser hair removal, fractional lasers for aging and acne scarring, lasers for pigmented skin lesions, fractional radio-frequency microneedling, superficial and medium-depth peels, microdermabrasion, dermaroller, biopsies, radio-frequency ablation, and superficial excisions is safe in patients with concurrent or recent isotretinoin administration.

Comparision of clinical and histopathological results of hyalomatrix usage in adult patients.

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Erbatur, Serkan; Coban, Yusuf Kenan; Aydın, Engin Nasuhi

2012-01-01

Clinical and histopathological results of the hyaluronic acid skin substitute treatment of the patients who admitted to Inonu University Medical Faculty Plastic Reconstructive and Aesthetic Surgery clinic between january 2011 and march 2012 were evaluated. The patients were divided into two groups. HA were used for treatment of Hypertrophic scar (HS) or Keloid (K) in 10 patients of the first group. Skin biopsies obtained at peroperative and postoperative 3rd month were subjected to histopathologic examination in this group. In the second group, 10 patients with full thickness soft tissue loss secondary to burns, trauma or excisional reasons were also treated with HA application. Vancouver scar scale were used to determine the scar quality in both groups. Mean age was 25. 2 ± 10.2 and mean follow-up duration was 6.3±3.6 months in group 1. Preoperative and postoperative VSS scores in group 1 were 10.7±1.16 and 6.2±0.91, respectively. This difference was statistically significant (p<0,005). No HS or K development was seen in any patient in group 2 during the following period. Collagenisation scores of preoperative skin biopsies were significantly higher than postoperative scores (p<0,0001).Vascularisation scores of preoperative skin biopsies were significantly lower than postoperative scores (p<0,00001). The use of HA skin substitute in adults for treatment of HS or K provided the desired clinical healing in the 6 months' follow-up periods. At the same time, HA application as an alternative to other treatment modalities led to a durable skin coverage in full thickness tissue loss in adult patients.

A modern method of treatment: The role of silver dressings in promoting healing and preventing pathological scarring in patients with burn wounds

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Munteanu, A; Florescu, IP; Nitescu, C

2016-01-01

Burn wounds are a global public health problem, which affects all countries, no matter the development stage and occurs in all age groups, from toddlers to elderly. In spite of burns being the cause of numerous household and work accidents, there are still no clear stated unanimous rules for their treatment. Every day new products appear on the market, each of them trying to prove more effective. Since ancient times, silver has been known for its antimicrobial properties, so it has been used for a long time in the treatment of burns and other types of wounds. One of the relatively modern methods of treatment is applying silver sheets on the scald lesions. In this paper, which was part of a larger study (research for a PhD thesis), concerning prevention and treatment of the post-burn pathological scars, the cases of some patients with burns, who were treated by using the above mentioned method were presented and analyzed. The results obtained by applying silver sheets were then commented and interpreted, pointing out the advantages and disadvantages compared to silver sulfadiazine creams and ointments, which have already been used at a large scale. The prevention and treatment of post-burn pathological (hypertrophic and keloid) scars is a field in which still little is known and in which there are also no clearly set therapy plans. We hope that through this research and the following ones we will manage to establish some major guidelines concerning the prevention of pathological scars, which are not only disabling, but also a major aesthetic issue for any patient, in order to obtain better outcomes. PMID:27974941

The downregulation of microRNA let-7a contributes to the excessive expression of type I collagen in systemic and localized scleroderma.

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Makino, Katsunari; Jinnin, Masatoshi; Hirano, Ayaka; Yamane, Keitaro; Eto, Mitsuhiko; Kusano, Takamitsu; Honda, Noritoshi; Kajihara, Ikko; Makino, Takamitsu; Sakai, Keisuke; Masuguchi, Shinichi; Fukushima, Satoshi; Ihn, Hironobu

2013-04-15

Systemic and localized scleroderma (SSc and LSc) is characterized by excessive deposition of collagen and tissue fibrosis in the skin. Although they have fundamental common characteristics including autoimmunity, little is known about the exact mechanism that mediates the excessive collagen expression in these disorders. In the current study, we tried to evaluate the possibility that microRNAs (miRNAs) play some roles in the pathogenesis of fibrosis seen in these diseases. miRNA expression patterns were evaluated by miRNA array analysis, real-time PCR, and in situ hybridization. The function of miRNAs in dermal fibroblasts was assessed using miRNA inhibitors, precursors, or protectors. In the mouse model of bleomycin-induced dermal sclerosis, the overexpression of miRNAs was performed by i.p. miRNA injection. We demonstrated let-7a expression was downregulated in SSc and LSc skin both in vivo and in vitro, compared with normal or keloid skin. The inhibition or overexpression of let-7a in human or mouse skin fibroblasts affected the protein expression of type I collagen or luciferase activity of collagen 3'-untranslated region. Also, we found let-7a was detectable and quantitative in the serum and investigated serum let-7a levels in patients with SSc or LSc. let-7a concentration was significantly decreased in these patients, especially in LSc patients. Moreover, we revealed that the intermittent overexpression of let-7a in the skin by i.p. miRNA injection improved the skin fibrosis induced by bleomycin in mice. Investigation of more detailed mechanisms of miRNA-mediated regulation of collagen expression may lead to new therapeutic approaches against SSc and LSc.

Radiotherapy of benign diseases in Berlin (West)

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Saller, A.

1979-01-01

1. In Berlin (West), X-ray therapy was applied during the year 1973 in 18 hospitals and by 33 practicing physicians. The 3rd quarter of the year 1973 was taken as basis for the frequency of therapeutic X-ray application. From a total of 15912 patients, 9432 were X-rayed on account of malignant diseases, 6480 because of benigne diseases. This number definitely surpasses the number of cases treated in Munich by X-ray therapy. In Berlin, this might be connected to the age structure. 2. Utilizing the quotations and calculations put down in the report about the effect of atomic radiation by the Scientific Committee of the United Nations, and the values quoted for gonadal doses in the literature, a total-GSD-value of 0.82 +- 0.2 mrem/a was calculated for hospitals and practicing physicians in Berlin. In spite of higher frequencies, this value is approximately of the same order of magnitude as the values calculated for Munich for the year 1971 by I. and H.P. Schmelz. 3. The total-GSD-value for the population of the Federal Republic of Germany resulting from artificial radiation exposure during 1976 is reported to be approximately 60 mrem. Thus, the GSD-value for the X-ray therapy of benign diseases lies approximately at 1.3% and should be of minor significance for radiation-hygienic reflections. 4. Of primary concern is still the radiation exposure to individual patients. Because of possible secondary effects, X-ray therapy for keloids and hemangiomas in infancy and youth are of particular significance. For this reason, its proportion to GSD is also in Berlin relatively large. (orig.) [de

Ultraviolet A1 phototherapy: One center's experience

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Sasi Kiran Attili

2017-01-01

Full Text Available Background: Ultraviolet A1(UVA1 phototherapy is increasingly being used in the treatment of morphea, atopic dermatitis, lupus and some other recalcitrant dermatoses. We present a retrospective review of our experience with this modality. Aim: To evaluate the treatment response rates for various dermatoses and adverse effects of UVA1 phototherapy. Methods: We reviewed phototherapy notes along with electronic and/or paper case records for all patients treated with UVA1 phototherapy from October 1996 to December 2008. Results: A total of 269 patients (outcomes available for 247 had 361 treatment courses (treatment data available for 317 courses over this period. We found phototherapy to be beneficial in 28 (53% of 53 patients with atopic dermatitis and 19 (51% of 37 patients with morphea. A beneficial outcome was recorded in all six (100% cases of urticaria and six (85.7% of seven patients treated for a polymorphic light eruption. Benefit was also recorded in systemic lupus erythematosus (8 (44.4% of 18, lichen sclerosus (6 (42.9% of 14, mastocytosis (2 (33.3% of 6, necrobiosis lipoidica (4 (30.8% of 13, granuloma annulare (2 (25% of 8, scleroderma (2 (22.2% of 9 and keloids (1 (7.7% of 13. Overall, treatment was well tolerated with no patients having to stop treatment due to adverse effects. Limitations: This is a retrospective study with no control group. Subjective/recall bias is quite possible as a number of patients were followed up over the phone. Conclusions: Our data suggest that ultraviolet A1 can be considered for the treatment of selected dermatoses. However, long-term malignancy risk is as yet unknown.

Effect of Topical Estrogen in the Mangement of Traumatic Facial Wounds

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Seyed Amirhosein Ghazizadeh Hashemi

2016-01-01

Full Text Available Introduction: Acute skin wound healing is a complicated process comprising various phases. Recent animal studies have shown that steroid sex hormones such as estrogen maybe helpful in the regulation of several pathophysiologic stages that are involved in wound healing. In this study we examined the effects of topical estrogen in the treatment of traumatic facial wounds.   Materials and Methods: Patients referred to Luqman Hospital, Tehran with traumatic wounds were enrolled in this case-control study into two groups of equal size. From the second week of the study, topical estrogen (0.625 mg conjugated topical estrogen ointment was administered in the case group, while the control group received a Eucerin dressing only. The two groups were then compared in terms of wound healing rate on Day 7,14, and 30.   Results: Thirty patients with mean age of 16.02+36.23 years were compared in the control and estrogen-treated groups. After treatment, no scars or keloids were observed in either group. The wound area in the estrogen group was lower than that in the control group on Day 14 and 30, but the difference was not significant (P>0.05. Healing rates in the control group on Day  14 (7.1+42.3 vs.50.3+4.9 mm2 and Day 30 (1.9+93.5 vs. + 97.3+0.6 mm2 (were lower than those in the estrogen group, but the differences were not significant (P>0.05. Findings show that the required time for wound healing in the estrogen-treated group was lower than that in the control group, but the difference was not significant (P>0.05.   Conclusion:  Based on this study, topical estrogen has no effect on the rate of wound healing or the rate of wound area .

Effect of Topical Estrogen in the Mangement of Traumatic Facial Wounds

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Ghazizadeh Hashemi, Seyed Amirhosein; Barati, Behrooz; Mohammadi, Hosein; Saeidi, Masumeh; Bahreini, Abbas; Kiani, Mohammad Ali

2016-01-01

Introduction: Acute skin wound healing is a complicated process comprising various phases. Recent animal studies have shown that steroid sex hormones such as estrogen maybe helpful in the regulation of several pathophysiologic stages that are involved in wound healing. In this study we examined the effects of topical estrogen in the treatment of traumatic facial wounds. Materials and Methods: Patients referred to Luqman Hospital, Tehran with traumatic wounds were enrolled in this case-control study into two groups of equal size. From the second week of the study, topical estrogen (0.625 mg conjugated topical estrogen ointment) was administered in the case group, while the control group received a Eucerin dressing only. The two groups were then compared in terms of wound healing rate on Day 7,14, and 30. Results: Thirty patients with mean age of 16.02+36.23 years were compared in the control and estrogen-treated groups. After treatment, no scars or keloids were observed in either group. The wound area in the estrogen group was lower than that in the control group on Day 14 and 30, but the difference was not significant (P>0.05). Healing rates in the control group on Day 14 (7.1+42.3 vs.50.3+4.9 mm2) and Day 30 (1.9+93.5 vs. + 97.3+0.6 mm2) (were lower than those in the estrogen group, but the differences were not significant (P>0.05). Findings show that the required time for wound healing in the estrogen-treated group was lower than that in the control group, but the difference was not significant (P>0.05). Conclusion: Based on this study, topical estrogen has no effect on the rate of wound healing or the rate of wound area. PMID:26878003

Forearm lengthening by distraction osteogenesis: A report on 5 limbs in 3 cases.

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Tonogai, Ichiro; Takahashi, Mitsuhiko; Tsutsui, Takahiko; Goto, Tomohiro; Hamada, Daisuke; Suzue, Naoto; Matsuura, Tetsuya; Yasui, Natsuo; Sairyo, Koichi

2015-01-01

Radioulnar length discrepancy causes pain and decreases function of the wrist, forearm, and elbow. Limb lengthening, which has been used in the treatment of various deformities of the forearm, is necessary to restore balance between the ulna and radius. We treated 5 limbs in 3 patients (2 boys, 1 girl; mean age 9.3 years old) with radioulnar length discrepancy by distraction osteogenesis of either the ulna or radius using external fixators. We dissected the interosseous membrane between the ulna and radius in 3 limbs in 2 cases and did not do so in 2 limbs of 1 case. These cases include 2 cases with hereditary multiple exostoses, and 1 case with multiple epiphyseal dysplasia. The results were investigated and evaluated in this study, using appropriate clinical and radiographic parameters, noting the state of the interosseous membrane, which has an important role in forearm stability. The mean fixation period was 113 days. The mean distraction distance was 22.8 mm. The mean follow-up period was 637.7 days. The mean ulnar shortening and radial articular angle respectively improved from 7.4 mm and 30.2° preoperatively to -0.1 mm and 34.8° postoperatively. Balance between the ulna and radius was restored, and the results showed significant improvements in range of motion of the joints. However, 2 unintended radial head subluxations occurred in 2 limbs without dissection of the interosseous membrane. In addition, a keloid remained in 1 limb due to pin site infection. Forearm lengthening by distraction osteogenesis was useful in our cases. It is important to recognize the function of the interosseous membrane when lengthening is performed by osteotomy of the proximal ulna by gradual distraction with an external fixator.

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Thais Jerez Jaime

2013-02-01

Full Text Available Cutaneous endometriosis is a rare manifestation of endometriosis, representing 0.5% to 1% of all endometriosis cases. It can be divided into primary and secondary, when appearing spontaneously or after a surgical procedure, when it is mostly found on surgical scar tissue. Some etiologies were proposed, but none of them could entirely explain the appearance of the tumor. Differential diagnosis includes melanoma, metastatic nodule, keloid and pyogenic granuloma. Dermoscopic features are not yet well established, but there are some characteristics that suggest the diagnosis. Treatment is surgical in larger sized lesions. Malignization can occur. The screening for endometriosis is mandatory by means of gynecologic, imaging and marked-tumor evaluation. We report a case of primary umbilical endometriosis and discuss its dermoscopic aspects.A endometriose cutânea é forma rara de endometriose, representando de 0,5% a 1% de todos os casos da doença. Pode ser dividida em forma primária, de surgimento espontâneo, ou secundária, após procedimentos cirúrgicos aonde geralmente encontra-se sobre a cicatriz cirúrgica. Diversas etiologias foram propostas, porém, nenhuma capaz de explicar inteiramente seu aparecimento. Diagnósticos diferenciais incluem melanoma, nódulos metastáticos, quelóide e granuloma piogênico. A dermatoscopia da lesão ainda não foi bem estabelecida, mas existem alguns achados que podem sugerir o diagnóstico. O tratamento é cirúrgico nos casos de lesões maiores e o screening para endometriose é mandatório através de avaliação ginecológica, de imagem e marcador tumoral. Relatamos um caso de endometriose cutânea primária e discutimos seus aspectos dermatoscópicos.

Trends and complications of ear piercing among selected Nigerian population

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Olajide Toye Gabriel

2017-01-01

Full Text Available Background: The reported health and socioeconomic consequences of ear piercing, especially in modern day society, underscore the need to further research into this subject. In this study, we determine the trends and complications of ear piercing among selected Nigerian population. Aim and Objectives: The aim and objective of this study was to draw attention to the trends and complications of ear piercing with a view to prevent its associated complications. Methodology: It is a descriptive cross-sectional study carried out between February and May 2015 among selected Nigerian population from two of its six geo-political zones. A self-administered semi-structured questionnaire which had been pretested was used to collect data from 458 respondents who consented using multistage sampling technique. Results: Of 480 respondents enumerated, 458 completed the questionnaires and gave their biodata. The male:female ratio was 1:6.2. Their ages ranged from 18 to 75 years with a mean of 35.56 ± 10.16. About 35.4% of the respondents were within the age group of 31–40 years. Majority of the respondents, i.e.,79.3% practiced ear piercing on their children. Most of them (86.8% preferred single piercing. Ear piercing was performed within the 1st week of birth in 37.2% of the respondents. Large percentage (93.2% of the respondents will not encourage ear piercing in male children. Nearly 20.5% of the respondents observed complications. Conclusion: Ear piercing remained a common practice in Nigeria, with respondents preferring it on females. Majority of the piercings are done in childhood and by untrained personnel. Keloid formation was the notable complication observed by the respondents. There is a need to increase awareness about the hazards of ear piercings and to enact laws that regulate ear piercings particularly in children which is hereby stretched.

The Safety and Efficacy of the 1540nm Non-Ablative Fractional XD Probe of Star Lux 500 Device in the Treatment of Striae Alba: Before-After Study.

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Malekzad, Farhad; Shakoei, Safoura; Ayatollahi, Azin; Hejazi, Somayeh

2014-01-01

Striae distensae (SD) are a frequent skin condition for which treatment remains a challenge. The 1540-nm non-ablative fractional laser (Star Lux 500) has been shown to improve atrophic scars by increasing the amount of dermal collagen. To assess the safety and efficacy of the Star Lux 500 laser in the treatment of mature hypopigmented striae in Persian people (Striae Alba). Ten women aged 26-50 years with SD and Fitzpatrick skin types III-V were enrolled in the study. The exclusion criteria were a history of keloids, photosensitivity and collagen, elastin disorders as well as history of other striae treatment within one year. The lesions were treated with non-ablative fractional laser 1540nm, and a total of four treatments were given at 4-week intervals. Clinical standard photographs were taken before each treatment. Also, patients were followed up at 3 months after the last treatment. Clinical improvement was assessed by comparing baseline and post-treatment photographs by two independent blinded physicians using grading scale. Treatment efficacy analysis was performed via the comparison between the images taken before and after each treatment session. There was a clinically appreciable improvement in striae ranging from 1 to 24%. A significant improvement in striae between the 16-week treatment and the 4-week treatment was identified (P<0.0001). Three months after the final treatment, patients showed noticeable improvement in the striae, compared with baseline (P<0.048). Mild post inflammatory hyperpigmentation was observed in one patient after the 8-week treatment and mild to moderate acne occurred in another patient after 4 weeks of treatment. Therapy with Star lux 500 laser had clinically and statistically striae improvement with no adverse events. This may be a safe and an effective treatment modality for Striae Alba lesions.

Surgical outcome in patients taking concomitant or recent intake of oral isotretinoin: A multicentric Study-ISO-AIMS study

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Omprakash Heggadahalli Mahadevappa

2016-01-01

Full Text Available Background: The current standard recommendation is to avoid surgical interventions in patients taking oral isotretinoin. However, this recommendation has been questioned in several recent publications. Aim: To document the safety of cosmetic and surgical interventions, among patients receiving or recently received oral isotretinoin. Materials and Methods: Association of Cutaneous Surgeons, India, in May 2012, initiated this study, at 11 centers in different parts of India. The data of 183 cases were collected monthly, from June 2012 to May 2013. Of these 61 patients had stopped oral isotretinoin before surgery and 122 were concomitantly taking oral isotretinoin during the study period. In these 183 patients, a total of 504 interventions were performed. These included[1] 246 sessions of chemical peels such as glycolic acid, salicylic acid, trichloroacetic acid, and combination peels;[2] 158 sessions of lasers such as ablative fractional laser resurfacing with erbium-doped yttrium aluminum garnet and CO2, conventional full face CO2laser resurfacing, laser-assisted hair reduction with long-pulsed neodymium-doped yttrium aluminum garnet, diode laser, and LASIK surgery;[3] 27 sessions of cold steel surgeries such as microneedling, skin biopsy, subcision, punch elevation of scars, excision of skin lesion, and wisdom tooth extraction;[4] 1 session of electrosurgery. Results: No significant side effects were noted in most patients. 2 cases of keloid were documented which amounted to 0.4% of side effects in 504 interventions, with a significant P value of 0.000. Reversible transient side effects were erythema in 10 interventions and hyperpigmentation in 15. Conclusion: The study showed that performing dermatosurgical and laser procedures in patients receiving or recently received isotretinoin is safe, and the current guidelines of avoiding dermatosurgical and laser interventions in such patients taking isotretinoin need to be revised.

Cushing's syndrome after intralesional triamcinolone acetonide: a systematic review of the literature and multinational survey.

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Fredman, Rafi; Tenenhaus, Mayer

2013-06-01

Intralesional triamcinolone acetonide (TAC) is a well-established treatment for keloids and hypertrophic scars. The present text provides a systematic review of all previously reported cases of Cushing's syndrome resulting from intralesional TAC in an effort to discover whether an association exists between dosage or frequency of injection and the subsequent development of Cushing's syndrome. Data collected from a multinational survey of plastic surgeons is presented and discussed to understand current trends in the use of TAC. Recommendations for early recognition of Cushing's syndrome, TAC dosages in children, and follow up guidelines are presented. A systematic review of the literature from 1950 to 2012 was performed to evaluate outcomes following intralesional TAC used for the treatment of scars. A confidential survey was sent to 4125 plastic surgeons, 102 responses from 9 countries were received. A total of 18 cases of Cushing's syndrome after intralesional TAC have been reported in the English world literature. Survey data reveals that at least 30% (25/84) of plastic surgeons exceed the recommended dosage of TAC and 47% (46/97) are not aware of Cushing's syndrome as a possible complication of intralesional TAC. Cushing's syndrome resulting from intralesional TAC has been reported multiple times in the literature. Published literature suggests that TAC administered within the most recent recommendations does not appear to place adult patients at increased risk for developing Cushing's syndrome. Children appear to be most at risk for developing Cushing's syndrome and yet insufficient recommendations currently exist with regard to their safe dosage. Intralesional dosage should not exceed 30 mg per month in children while noting that at least one reported case of Cushing's syndrome resulted from a smaller dose. Diligent follow up and patient education is advised for any patient treated with TAC so that complications can be recognized and addressed promptly

Expanding the applications of Cadaveric skin - the properties and uses of an acellular dermal matrix

International Nuclear Information System (INIS)

Greenleaf, G.; Livesey, S.

1999-01-01

The ability to transplant organs and tissues has been one of the most significant advances of modern medicine. The availability of cadaveric allograft skin has greatly facilitated the practice of aggressive, early excision of massive burn injuries. Due to its ultimate rejection however, the role of allograft skin has historically been limited to that of a temporary wound dressing. Development of an acellular dermal allograft has greatly expanded the applications for donated human skin. AlloDerm(r) preserved dermal graft (LifeCell, The Woodlands, TX) is prepared via ionic separation of allograft skin followed by detergent removal of antigenic cells. Acellular dermal grafts are then cryoprotected and freeze-dried. The process maintains the structural integrity of the extracellular matrix and preserves the biochemical composition of the basement membrane. The resultant immunologically inert allograft can be used in a variety of applications. In burn injuries, lack of an adequate dermal component at either the donor or wound site may result in complications including contraction, delayed healing, hypertrophic scarring and keloid formation. Utilizing allogenic dermis eliminates the need for autologous dermis at the wound site and minimizes donor site trauma by allowing procurement of ultra-thin (0.006 ) autografts. Expanding the scope of traditional uses for allograft skin, acellular dermal grafts have been successfully utilized in a variety of procedures including duraplasty, orbital reconstruction, and hemia repar. In periodontal surgery, allograft tissue eliminates the need for painful palatal autografts and has been used to increase attached gingiva and reduce gingival recession. Resorption of autologous grafts or extrusion of synthetic material often hampers repair or reconstruction of soft tissue deficits. Transplantation of acellular allograft dermis provides a biochemically and structurally intact matrix, which persists and is ultimately repopulated with

ASSESSMENT OF MICRONEEDLING THERAPY IN THE MANAGEMENT OF ATROPHIC FACIAL ACNE SCARS

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Ajay

2015-12-01

Full Text Available STUDY BACKGROUND Post acne scars are always a challenge to treat, especially the ones which are deep seated. There are many treatment options like laser resurfacing, dermabrasion, microdermabrasion and non-ablative laser resurfacing but with considerable morbidity and interference with the daily activities of the patient in the post-treatment period. Microneedling or dermaroller therapy is one of the new treatment options in the management of acne scars with satisfactory improvement and no significant side effect. The aim of the present study is to perform an objective evaluation the efficacy of microneedling in the treatment of atrophic acne scars. MATERIALS AND METHODS Thirty patients of skin type III-V having atrophic facial acne scars presenting to our dermatology OPD. were received multiple sittings of microneedling (dermaroller treatment with an interval of 6 weeks between each session. Goodman & Baron’s acne scar grading system was used for assessment of their scars and was evaluated clinically by serial photography at the start as well as at two months after the conclusion of the treatment. Patients on anticoagulant therapy, of keloidal tendency, with bleeding disorders, vitiligo patients, pregnant and lactating mothers and patients with active acne lesions were excluded from the study. The duration of this study was for ten months-from January 2014 to October 2014. RESULTS Any change in the grading of scars after the end of treatment and follow-up period was noted down. The efficacy and improvement of dermaroller treatment was assessed by Goodman and Baron’s Global Acne Scarring System. Out of 30 patients, 26(80.64% patients achieved a reduction in the severity of their scarring by one or two grades. Quantitative assessment showed that 13.3% of patients had minimal, 16.6% had good and 70% showed very good improvement. Adverse effects were limited to transient pain, erythema and edema. CONCLUSION Microneedling therapy seems to be

Complications of laparoscopic cholecystectomy: an analysis of 400 consecutive cases

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Afzal, M.; Butt, M.Q.

2014-01-01

To analyze the complications of first 400 laparoscopic cholecystectomies (LC) for patients with symptomatic gall stone disease at a tertiary care hospital. Study Design: Quasi-experimental study. Place and Duration of Study: PNS Shifa Karachi and CMH Lahore, Pakistan from Nov 2009 to Jan 2013. Patients and Methods: A prospective analysis of complications occurring in first 400 consecutive laparoscopic cholecystectomies by a single consultant/unit at a tertiary care hospital was made. Out of total 421 patients presenting with symptomatic gall stone disease in a single unit, 21 cases that underwent open cholecystectomy were excluded from the study. Laparoscopic cholecystectomies were performed using three port and four port technique and data including age, sex, diagnosis, number of trocar placements, conversion to open surgery and its reasons, operative time, post-operative hospital stay and complications was collected on personal computer and analyzed using Statistical package for social sciences (SPSS) version 13. Results: Total 400 patients were included in study with median age of 44 years. Female to male ratio was 5.3: 1. Depending upon the preoperative diagnosis and laparoscopic findings, patients had diagnosis of Chronic cholecystitis / biliary colic 68.25%, acute cholecystitis 23.75%, empyema gall bladder 7.25%, gallstone pancreatitis 0.5% and mucocele gallbladder 0.25%. Median operating time was 30min. Median hospital stay was 1 days (range 1 -20 days). Conversion rate was 1.25%. Postoperative complications included bleeding 0.5%, biliaryperitonitis due to cystic duct leak 0.25%, biloma 0.25%, sub hepaticabscess 0.25%, subcutaneous fat necrosis right flank at drain site 0.25%, umbilical trocarsite infection 2%, keloid at umbilical port site 0.25% and incisional hernia at umbilicus 0.25%. There was one hospital death due to myocardial infarction on 2nd post-operative day. Conclusion: Laparoscopic Cholecystectomy is associated with some serious complications

Versatality of supraclavicular flap in neck, face, and upper chest region coverage

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Almas, D.; Masood, T.; Dar, M.F.; Noman, B.

2015-01-01

The objective is to analyze the utility of the island supraclavicular flap in a region where skin graft cannot be used and free flap is not feasible. We assessed complications and functional outcomes. Study Design: Prospective descriptive study. Place and Duration of Study: The study was done at plastic and reconstructive surgery department CMH Rawalpindi during the period of 03 year from October 2011 to October 2014. Material and Patients: An island supraclavicular artery flap was used to reconstruct oncologic, and post burn neck contractures release defects. 30 patients were included in the study. Doppler probe was used to help with localization of vascular pedicle. All the patients with scarring in both shoulder regions, history of radiation to neck and undergoing radical neck dissection were excluded. Results: A total of 30 patients were included 20 (66.6%) male and 10 (33.3%) were female. Oncologicre section was followed by immediate reconstruction with island supraclavicular artery flap. Post burn contractures were released and covered by a pedicled supraclavicular artery flap. The recipient sites were neck, face, oral and upper chest region. The average harvest time was 1 and half hour. Donor site was closed primarily in 22 (73.3%) while 8 (26.6%) require skin grafting. Post burn contractures needed scar management with intralesional steroid, pressure garments and scar revision with Z-plasty in 4(13.3%) cases. 1 (3.3%) flap failed completely and the defect was covered with a skin graft. We had 01 (3.3%) mortality due to respiratory obstruction, despite adequate flap perfusion for 24 hours. Minor complications included, partial flap loss, seroma, and haematoma formation. In addition hypertrophied scar, spreading scar and keloid formation occurred at the donor site 18 (60%). Conclusion: Island supraclavicular artery flap with an easy learning curve is a reliable flap. It has a good colour and texture match with minimal donor site morbidity. It is an excellent

Body piercing: complications and prevention of health risks.

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Holbrook, Jaimee; Minocha, Julia; Laumann, Anne

2012-02-01

Body and earlobe piercing are common practices in the USA today. Minor complications including infection and bleeding occur frequently and, although rare, major complications have been reported. Healthcare professionals should be cognizant of the medical consequences of body piercing. Complications vary depending on the body-piercing site, materials used, experience of the practitioner, hygiene regimens, and aftercare by the recipient. Localized infections are common. Systemic infections such as viral hepatitis and toxic shock syndrome and distant infections such as endocarditis and brain abscesses have been reported. Other general complications include allergic contact dermatitis (e.g. from nickel or latex), bleeding, scarring and keloid formation, nerve damage, and interference with medical procedures such as intubation and blood/organ donation. Site-specific complications have been reported. Oral piercings may lead to difficulty speaking and eating, excessive salivation, and dental problems. Oral and nasal piercings may be aspirated or become embedded, requiring surgical removal. Piercing tracts in the ear, nipple, and navel are prone to tearing. Galactorrhea may be caused by stimulation from a nipple piercing. Genital piercings may lead to infertility secondary to infection, and obstruction of the urethra secondary to scar formation. In men, priapism and fistula formation may occur. Women who are pregnant or breastfeeding and have a piercing or are considering obtaining one need to be aware of the rare complications that may affect them or their child. Though not a 'complication' per se, many studies have reported body piercing as a marker for high-risk behavior, psychopathologic symptoms, and anti-social personality traits. When it comes to piercing complications, prevention is the key. Body piercers should take a complete medical and social history to identify conditions that may predispose an individual to complications, and candidates should choose a

Use of onion extract, heparin, allantoin gel in prevention of scarring in chinese patients having laser removal of tattoos: a prospective randomized controlled trial.

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Ho, Wai Sun; Ying, Shun Yuen; Chan, Pik Chu; Chan, Henry H

2006-07-01

With rapid advancement in cutaneous laser therapy, Q-switched lasers have become the standard treatment for tattoo removal. The longer wavelength Q-switched Nd:YAG laser is used when removing tattoos in darker skin patients to avoid scarring and permanent pigment changes. Nevertheless, the local experience revealed that nearly 25% of the Chinese patients developed scarring. Meanwhile, multiple clinical studies have shown that Contractubex gel (Merz Pharma, Frankfurt, Germany) was effective in the treatment and prevention of hypertrophic scars and keloids. To evaluate the efficacy of Contractubex gel in the prevention of scarring after laser removal of tattoos in Chinese patients. A total of 120 Chinese patients with 144 professional blue-black tattoos were recruited into the study. They were randomly assigned into the Contractubex group or the control group. All patients were treated with a QS 1,064-nm Nd:YAG laser using a 3-mm spot size, a 10-Hz repeat rate, a pulse duration of 6 nanoseconds, and fluences that ranged from 3.6 to 4.8 J/cm2 (mean fluence, 4.2 J/cm2). The treated areas were assessed 3 months after the last treatments for clinical clearance and complications. Fifty-two patients with 61 tattoos in the Contractubex group were able to achieve a mean clearing rate of 82.3+/-11.6%. There were 7 tattoos in 7 patients that developed scarring, 4 patients had permanent hypopigmentation, and 3 patients had transient hyperpigmentation. In contrast, 55 patients with 68 tattoos in the control group had a mean clearing rate of 80.4+/-11.3%. Among them, 16 tattoos in 14 patients developed scarring, 4 patients had permanent hypopigmentation, and 5 patients had transient hyperpigmentation. Although there was no significant difference in age, sex, fluence, treatment session, and clinical clearance between the two groups, the Contractubex group had a statistically significantly lower rate of scarring than the control group (ptattoos.

Radiation for not-so-benign coronary artery disease

International Nuclear Information System (INIS)

Massullo, Vincent

1996-01-01

The role of radiation therapy in the treatment of malignant disease has long been accepted. More limited application of radiation in the treatment of benign conditions has been proven but generally not pursued. On the centennial anniversary of radiation therapy, a promising, but as yet unproved, application of radiation for treatment of benign vascular disease has become an exciting field of research, speculation, and controversy. This panel presentation will discuss the rationales and dilemmas of applying radiation in the prevention of arterial restenosis after therapeutic intervention. Coronary artery bypass grafting and more recently coronary angioplasty have become accepted, effective therapies to reverse significant coronary stenosis, and thereby benefit the majority of patients with coronary artery disease. However, a large proportion of patients will suffer restenosis in spite of optimal conventional therapy. The search for a means to prevent such restenosis has been partially successful by therapies, and even engineering intravascular devices. In spite of these efforts, a significant number of patients will fail today's conventional therapy and suffer arterial restenosis. Fibroblast myointimal proliferation is felt to be a major element in this restenosis process. Clinical experience shows that radiation inhibits other similar benign fibroblast proliferative processes such as keloid scar formation and heterotopic ossification. Radiation is now being considered as a means to inhibit myointimal fibroblast proliferation and hopefully prevent attendant arterial restenosis as well. This has catalyzed various animal model investigations that have shown significant arteries. Promising results in the animal model and in very early human institutional trials. These trials are designed to determine if radiation is truly effective and can be safely delivered to prevent restenosis in diseased human arteries. This panel discussion will provide a firm basic science and

Can thermal lasers promote skin wound healing?

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Capon, Alexandre; Mordon, Serge

2003-01-01

Lasers are now widely used for treating numerous cutaneous lesions, for scar revision (hypertrophic and keloid scars), for tissue welding, and for skin resurfacing and remodeling (wrinkle removal). In these procedures lasers are used to generate heat. The modulation of the effect (volatilization, coagulation, hyperthermia) of the laser is obtained by using different wavelengths and laser parameters. The heat source obtained by conversion of light into heat can be very superficial, yet intense, if the laser light is well absorbed (far-infrared:CO(2) or Erbium:Yttrium Aluminum Garnet [Er:YAG] lasers), or it can be much deeper and less intense if the laser light is less absorbed by the skin (visible or near-infrared). Lasers transfer energy, in the form of heat, to surrounding tissues and, regardless of the laser used, a 45-50 degrees C temperature gradient will be obtained in the surrounding skin. If a wound healing process exists, it is a result of live cells reacting to this low temperature increase. The generated supraphysiologic level of heat is able to induce a heat shock response (HSR), which can be defined as the temporary changes in cellular metabolism. These changes are rapid and transient, and are characterized by the production of a small family of proteins termed the heat shock proteins (HSP). Recent experimental studies have clearly demonstrated that HSP 70, which is over-expressed following laser irradiation, could play a role with a coordinated expression of other growth factors such as transforming growth factor (TGF)-beta. TGF-beta is known to be a key element in the inflammatory response and the fibrogenic process. In this process, the fibroblasts are the key cells since they produce collagen and extracellular matrix. In conclusion, the analysis of the literature, and the fundamental considerations concerning the healing process when using thermal lasers, are in favor of a modification of the growth factors synthesis after laser irradiation, induced

[Early hypertrophic scar after surgery on the nasal region: value of long-acting corticosteroid injections].

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Amici, J-M

2014-01-01

"Pincushioning" is a complication of post-surgical scarring following use of transposition flaps particularly when surgery is performed on the nasal region. The transposition flap technique is very useful for the repair of certain defects of the tip of the nose, the medial canthus or of the ala nasi. The aim of this study is to define the clinical characteristics of this scarring dystrophy, which we propose to call "early hypertrophy scarring", to clarify the nature thereof and to assess the efficacy of intralesional injection of corticosteroids at the first signs of hypertrophy. A prospective, open, non-comparative, single-centre study examined the clinical and histological characteristics of early hypertrophy scarring and the effectiveness of therapy with one or two injections of corticosteroids performed on the 15th day post-operatively and optionally repeated at D45 depending on the outcome. From January 2011 to January 2013, 12 consecutive patients with early hypertrophy scarring were included (ten men and two women - mean age: 64 years). All had undergone surgery for basal cell carcinoma under local anaesthesia with one-stage repair by means of a rhombic flap or a bilobed flap located in the nasal area. Scars were injected strictly intra-lesionally with triamcinolone acetate (40 mg/1 mL) until whitening occurred. A single injection was performed in three cases of rhombic flap while a second injection was given at D45 in the remaining nine cases. Complete regression of the early hypertrophy scarring was obtained in ten of the 12 patients by D90. Incomplete regression was observed but with a marked improvement in the other two patients. Early hypertrophy scarring is distinguished by its clinical characteristics of hypertrophic or keloid scars. Biopsy performed in two cases showed the fibrous but non-fatty nature of early hypertrophy scarring. Biomechanical factors particular to the nasal region and the transposition flap technique could account for the early

[PERSONALIZED APPROACH TO PATIENT WITH CHRONIC WOUND IN FAMILY MEDICINE].

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Sinožić, T; Katić, M; Kovačević, J

2016-01-01

It can be said that the occurrence and development of wounds, healing, delayed healing, and the notion of chronic wound are some of the basic characteristics of all living beings. When it comes to people, there are a number of processes that take place during wound healing, and even under ideal circumstances, they create a functionally less valuable skin tissue, along with structural and functional changes. Fibrosis in the form of hypertrophic scars and keloids, contractures and adhesions are examples of excessive healing. Microcirculation is significantly different from healthy skin circulation with consequential formation of local hypoxia and stagnation in lymph flow with edema. Poor functionality of the scar tissue, particularly in the areas exposed to stronger forces, can cause forming of wounds. Such wounds are hard to heal despite the inexistence of other possible reasons for delayed healing, precisely because of their poor functionality and placement. The presence of wound requiring long-term treatment affects all areas of patient life and leads to decline in the quality of life. Exemplified by case presentation of a patient with post-traumatic wound in the scar area, in our office we showed a model of care based on the principle of overall personalized care with the biopsychosocial approach. Diagnostic and therapeutic procedures included wound assessment, biofilm and lymphedema detection, assessment of the patient’s psychosocial status, risk factors for wound healing, vascular ultrasound diagnostics, carboxytherapy as specialized adjuvant therapy, use of modern wound dressings, and compression therapy. Supportive psychotherapy was conducted in positive communication environment during treatment. In this way, in an atmosphere of cooperation with the patient, it was possible not only to influence the process of wound healing as the primary objective, but also to improve the quality of the patient’s life, as well as to influence our professional

The Gift Box Open Achilles Tendon Repair Method: A Retrospective Clinical Series.

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Labib, Sameh A; Hoffler, C Edward; Shah, Jay N; Rolf, Robert H; Tingan, Alexis

2016-01-01

Previous biomechanical studies have shown that the gift box technique for open Achilles tendon repair is twice as strong as a Krackow repair. The technique incorporates a paramedian skin incision with a midline paratenon incision, and a modification of the Krackow stitch is used to reinforce the repair. The wound is closed in layers such that the paratenon repair is offset from paramedian skin incision, further protecting the repair. The present study retrospectively reviews the clinical results for a series of patients who underwent the gift box technique for treatment of acute Achilles tendon ruptures from March 2002 to April 2007. The patients completed the Foot Function Index and the American Orthopaedic Foot and Ankle Society ankle-hindfoot scale. The tendon width and calf circumference were measured bilaterally and compared using paired t tests with a 5% α level. A total of 44 subjects, mean age 37.5 ± 8.6 years, underwent surgery approximately 10.8 ± 6.5 days after injury. The response rate was 35 (79.54%) patients for the questionnaire and 20 (45.45%) for the examination. The mean follow-up period was 35.7 ± 20.1 months. The complications included one stitch abscess, persistent pain, and keloid formation. One (2.86%) respondent reported significant weakness. Five (14.29%) respondents indicated persistent peri-incisional numbness. The range of motion was full or adequate. The mean American Orthopaedic Foot and Ankle Society ankle-hindfoot scale score was 93.2 ± 6.8) and the mean Foot Function Index score was 7.0 ± 10.5. The calf girth and tendon width differences were statistically significantly between the limbs. The patients reported no repeat ruptures, sural nerve injuries, dehiscence, or infections. We present the outcomes data from patients who had undergone this alternative technique for Achilles tendon repair. The technique is reproducible, with good patient satisfaction and return to activity. The results compared well with the historical

Dermatosis neglecta: simulación, una realidad. A propósito de un caso Dermatosis neglecta: simulation, a reality. A propos of a case

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JA Pineda-Pineda

Full Text Available La dermatosis neglecta es una patología poco conocida, causada por la falta de higiene, generalmente secundaria al temor de agravar algún problema subyacente de piel como el acné, cicatrices postquirúrgicas, zonas que han recibido radioterapia, cicatrices queloides entre otras, presentando placas cubiertas con costras gruesas, con escamas oleosas e hiperpigmentación, que desaparecen al lavado o limpieza enérgica con alcohol o acetona, quedando la piel sana. Presentamos el caso de un paciente de 20 años de edad, proveniente de la consulta dermatológica de la Liga contra el Cáncer de San Pedro Sula, Honduras, quien se presenta en primera instancia por un cuadro de acné para el que se lo medica con peróxido de benzoilo y protector solar. Acude dos meses después con elementos costrosos gruesos adherentes y oleosos acompañados de eritema e hiperpigmentación, los que desaparecen con la limpieza profunda con alcohol, quedando la piel totalmente limpia. Al interrogatorio refiere que no se había lavado la cara para no empeorar su cuadro de acné. Se hace entonces el diagnóstico de dermatosis neglecta.The neglecta dermatosis is an almost unknown pathology. It is caused of lack of hygienic measures, generally subsequent to the pain to increase an existent trouble on the skin (ex: acne, postsurgical scars, radiotherapy, scars, keloids, etc presenting plates covered with thick crusts, with oily flakes and hyper keratosis pigmentation, which disappears with energetic washing or cleaning with alcohol or acetone, leaving a healthy skin. We present the case of a 20 years old patient who visited the dermatological department of the La Liga Contra el Cancer in San Pedro Sula, Honduras. The first time that he visited the doctor´s office was for acne and he was prescribed with benzoyl peroxide and sunscreen. Two months later the patient came with his skin hyper pigmented and covered with thick oily crusts which disappeared with energetic cleansing

Radiation therapy for benign diseases: patterns of care study in Germany

International Nuclear Information System (INIS)

Seegenschmiedt, M. Heinrich; Katalinic, Alexander; Makoski, Hans-Bruno; Haase, Wulf; Gademann, Guenther; Hassenstein, Eckhard

2000-01-01

Background: Radiotherapy of benign diseases is controversial and rarely applied in Anglo-American countries, whereas in other parts of the world it is commonly practiced for several benign disorders. Similar to a European survey, a pattern of care study was conducted in Germany. Method: Using a mailed questionnaire, radiation equipment, treatment indication, number of patients, and treatment concepts were assessed in 1994, 1995, and 1996 in 134 of 152 German institutions (88%): 22 in East and 112 in West Germany; 30 in university hospitals and 104 in community hospitals. Average numbers of each institution and of all institutions were analyzed for frequencies and ratios between regions and among institutions. Radiation treatment concepts were analyzed. Results: A mean of 2 (range 1-7) megavoltage and 1.4 (range 0-4) orthovoltage units were available per institution; 32 institutions (24%) had no orthovoltage equipment. A mean of 20,082 patients were treated annually: 456 (2%) for inflammatory diseases (221 hidradenitis, 78 local infection, 23 parotitis; 134 not specified) 12,600 (63%) for degenerative diseases (2711 peritendinitis humeroscapularis, 1555 epicondylitis humeri; 1382 plantar/dorsal heel spur; 2434 degenerative osteoarthritis; 4518 not specified); 927 (5%) for hyperproliferative diseases (146 Dupuytren's contracture, 382 keloids; 155 Peyronie's disease; 244 not specified); 1210 (6%) for functional disorders (853 Graves' orbitopathy; 357 not specified); and 4889 (24%) for other disorders (e.g., 3680 heterotopic ossification prophylaxis). In univariate analysis, there were geographic (West vs. East Germany) differences in using radiation therapy (RT) for inflammatory and degenerative disorders, and institutional differences (university versus community hospitals) in using RT for hyperproliferative and functional disorders (p < 0.05). The prescribed dose concepts were mostly in the low dose range, <10 Gy but varied widely and inconsistently within

Standard guidelines of care: CO2 laser for removal of benign skin lesions and resurfacing.

Science.gov (United States)

Krupashankar, D S

2008-01-01

Resurfacing is a treatment to remove acne and chicken pox scars, and changes in the skin due to ageing. MACHINES: Both ablative and nonablative lasers are available for use. CO 2 laser is the gold standard in ablative lasers. Detailed knowledge of the machines is essential. INDICATIONS FOR CO 2 LASER: Therapeutic indications: Actinic and seborrheic keratosis, warts, moles, skin tags, epidermal and dermal nevi, vitiligo blister and punch grafting, rhinophyma, sebaceous hyperplasia, xanthelasma, syringomas, actinic cheilitis angiofibroma, scar treatment, keloid, skin cancer, neurofibroma and diffuse actinic keratoses. CO 2 laser is not recommended for the removal of tattoos. AESTHETIC INDICATIONS: Resurfacing for acne, chicken pox and surgical scars, periorbital and perioral wrinkles, photo ageing changes, facial resurfacing. PHYSICIANS' QUALIFICATIONS: Any qualified dermatologist (DVD or MD) may practice CO 2 laser. The dermatologist should possess postgraduate qualification in dermatology and should have had specific hands-on training in lasers either during postgraduation or later at a facility which routinely performs laser procedures under a competent dermatologist/plastic surgeon, who has experience and training in using lasers. For the use of CO 2 lasers for benign growths, a full day workshop is adequate. As parameters may vary in different machines, specific training with the available machine at either the manufacturer's facility or at another centre using the machine is recommended. CO 2 lasers can be used in the dermatologist's minor procedure room for the above indications. However, when used for full-face resurfacing, the hospital operation theatre or day care facility with immediate access to emergency medical care is essential. Smoke evacuator is mandatory. Detailed counseling with respect to the treatment, desired effects, possible postoperative complications, should be discussed with the patient. The patient should be provided brochures to study and

Standard guidelines of care: CO 2 laser for removal of benign skin lesions and resurfacing

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Krupashankar D

2008-03-01

Full Text Available Resurfacing is a treatment to remove acne and chicken pox scars, and changes in the skin due to ageing. Machines : Both ablative and nonablative lasers are available for use. CO 2 laser is the gold standard in ablative lasers. Detailed knowledge of the machines is essential. Indications for CO 2 laser: Therapeutic indications: Actinic and seborrheic keratosis, warts, moles, skin tags, epidermal and dermal nevi, vitiligo blister and punch grafting, rhinophyma, sebaceous hyperplasia, xanthelasma, syringomas, actinic cheilitis angiofibroma, scar treatment, keloid, skin cancer, neurofibroma and diffuse actinic keratoses. CO 2 laser is not recommended for the removal of tattoos. Aesthetic indications: Resurfacing for acne, chicken pox and surgical scars, periorbital and perioral wrinkles, photo ageing changes, facial resurfacing. Physicians′ qualifications: Any qualified dermatologist (DVD or MD may practice CO 2 laser. The dermatologist should possess postgraduate qualification in dermatology and should have had specific hands-on training in lasers either during postgraduation or later at a facility which routinely performs laser procedures under a competent dermatologist/plastic surgeon, who has experience and training in using lasers. For the use of CO 2 lasers for benign growths, a full day workshop is adequate. As parameters may vary in different machines, specific training with the available machine at either the manufacturer′s facility or at another centre using the machine is recommended. Facility: CO 2 lasers can be used in the dermatologist′s minor procedure room for the above indications. However, when used for full-face resurfacing, the hospital operation theatre or day care facility with immediate access to emergency medical care is essential. Smoke evacuator is mandatory. Preoperative counseling and Informed consent Detailed counseling with respect to the treatment, desired effects, possible postoperative complications, should be

POSSIBILITIES OF DIAGNOSIS OF RADIATION INJURIES AND REHABILITATION OF PATIENTS AFTER COMBINED TREATMENT OF MALIGNANT TUMORS OF THE BREAST

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A. V. Kondakov

2016-01-01

Full Text Available Purpose. To develop and introduce into practice health facility individual programs of rehabilitation treatment and rehabilitation after combined treatment of breast cancer with the use of thermal imaging diagnostic method.Materials and methods. The study included 259 women who had undergone combined treatment of breast cancer. The main contingent of the test (82.4% were middle-aged women from 33 to 59 years old. For an objective diagnosis of the state of post-radiation fibrosis and scarring using modern methods of instrumental diagnostics: Sonoelastography, infrared thermography and thermal imaging diagnostics. In individual cases, to assess the developmental stages of lymphedema using lymphoscintigraphy and MRI.Results. The proposed method of of research of the thermal state of postoperative functional area allows to identify disease and organic components in the form of scars and radiation fibrosis. This method allows to visualize the state of the heat balance on the surface of the skin and evaluate the impact of means of rehabilitation of the thermal regime of post-operative area. Critical thermal asymmetry increase by 2–3 degrees on Celsius indicates negative impact on homeostasis means of rehabilitation of post-operative area.Conclusions. Thermal imaging diagnostics of scares, radiation damage and postmastectomy syndrome is a highly informative method of objective evaluation of the effectiveness of the rehabilitation process and can be recommended for use in specialized medical rehabilitation offices. For this, it developed adhesive-correcting method of prevention and treatment of late radiation damage, fibrosis, and keloids through innovative adhesive ekzoform. Develop a model structure and staffing with specialized rehabilitation rooms for women after combined treatment of breast cancer. Traditional means of rehabilitation (silicone-biological prosthetics have a number of significant shortcomings in the

Common pediatric and adolescent skin conditions.

Science.gov (United States)

Sanfilippo, Angela M; Barrio, Victoria; Kulp-Shorten, Carol; Callen, Jeffrey P

2003-10-01

Skin lesions are encountered in all areas of medicine, and it is therefore important for physicians to understand the fundamentals of explaining and diagnosing common skin conditions. This article begins with a discussion of description and documentation of skin lesions based on color, size, morphology, and distribution. Pigmentation disorders such as vitiligo are depicted. Cutaneous growths that are found in the pediatric and adolescent population include acrochordons, dermatofibromas, keloids, milia, neurofibromas, and pyogenic granulomas. Treatment of these growths usually involves observation or curettage with electrodessication.Psoriasis, atopic dermatitis, poison ivy, and eczema are comprised of scaling patches and plaques; poison ivy and atopic dermatitis may also present with bullous and vesicular changes. Therapy typically consists of topical emollients and corticosteroids; phototherapy is reserved for refractory cases. Acne vulgaris is the most common skin disease of the pediatric and adolescent population. This condition can be psychologically debilitating and, therefore, proper treatment is of paramount importance. Therapeutic options include topical as well as oral antibiotics and retinoids. Extreme caution must be used when prescribing retinoids to post-pubescent females, as these agents are teratogenic. Vascular anomalies are most commonly exemplified as port wine stains and hemangiomas. Port wine stains may be treated with pulsed dye laser or may be observed if they are not of concern to the patient or physician. Hemangiomas typically spontaneously regress by age ten; however, there has been recent concern that certain cases may need to be treated. Dermal rashes may be localized or generalized. Treatment of generalized drug eruptions involves elimination of the inciting agent, topical antipruritics, and systemic corticosteroids for severe reactions. Infectious etiologic agents of skin disease include bacteria, fungi, and viruses. Many sexually

Standard guidelines of care for acne surgery

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Khunger Niti

2008-03-01

Full Text Available Acne surgery is the use of various surgical procedures for the treatment of postacne scarring and also, as adjuvant treatment for active acne. Surgery is indicated both in active acne and post-acne scars. Physicians′ qualifications: Any Dermatologist can perform most acne surgery techniques as these are usually taught during postgraduation. However, certain techniques such as dermabrasion, laser resurfacing, scar revisions need specific "hands-on" training in appropriate training centers. Facility: Most acne surgery procedures can be performed in a physician′s minor procedure room. However, full-face dermabrasion and laser resurfacing need an operation theatre in a hospital setting. Active acne: Surgical treatment is only an adjunct to medical therapy, which remains the mainstay of treatment. Comedone extraction is a process of applying simple mechanical pressure with a comedone extractor, to extract the contents of the blocked pilosebaceous follicle. Superficial chemical peel is a process of applying a chemical agent to the skin, so as to cause controlled destruction of the epidermis leading to exfoliation. Glycolic acid, salicylic acid and trichloroacetic acid are commonly used peeling agents for the treatment of active acne and superficial acne scars. Cryotherapy: Cryoslush and cryopeel are used for the treatment of nodulocystic acne. Intralesional corticosteroids are indicated for the treatment of nodules, cysts and keloidal acne scars. Nonablative lasers and light therapy using Blue light, non ablative radiofrequency, Nd:YAG laser, IPL (Intense Pulsed Light, PDT (Photodynamic Therapy, pulse dye laser and light and heat energy machines have been used in recent years for the treatment of active inflammatory acne and superficial acne scars. Proper counseling is very important in the treatment of acne scars. Treatment depends on the type of acne scars; a patient may need more than one type of treatment. Subcision is a treatment to break the

The Asian dermatologic patient: review of common pigmentary disorders and cutaneous diseases.

Science.gov (United States)

Ho, Stephanie G Y; Chan, Henry H L

2009-01-01

acne scarring. Acne, which is common in Asians, can be treated with topical and oral antibacterials, hormonal treatments, and isotretinoin. Infra-red diode lasers used with a low-fluence, multiple-pass approach have also been shown to be effective with few complications. Fractional skin resurfacing is very useful for improving the appearance of acne scarring. Hypertrophic and keloid scarring, another common condition seen in Asians, can be treated with the combined used of intralesional triamcinolone and fluorouracil, followed by pulsed-dye laser. Esthetic enhancement procedures such as botulinum toxin type A and fillers are becoming increasingly popular. These are effective for rhytide improvement and facial or body contouring. We highlight the differences between Asian skin and other skin types and review conditions common in skin of color together with treatment strategies.

DEGRO guidelines for the radiotherapy of non-malignant disorders. Part III: Hyperproliferative disorders

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Seegenschmiedt, M.H. [Center for Radiotherapy, Hamburg (Germany); Micke, Oliver [Franziskus Hospital Bielefeld, Department of Radiotherapy and Radiation Oncology, Bielefeld (Germany); Niewald, Marcus [University of Saarland, Department of Radiotherapy and Radiation Oncology, Homburg/Saar (Germany); Muecke, Ralph [Lippe Hospital Lemgo, Department of Radiotherapy, Lemgo (Germany); Marien Hospital Herne, Ruhr University Bochum, Department of Radiotherapy and Radiation Oncology, Herne (Germany); Eich, Hans Theodor; Kriz, Jan [University of Muenster, Department of Radiotherapy and Radiation Oncology, Muenster (Germany); Heyd, Reinhard [Municipal Hospital Aschaffenburg, Radiotherapy Practice, Aschaffenburg (Germany); Collaboration: The German Cooperative Group on Radiotherapy of Benign Diseases (GCG-BD)

2015-07-15

Radiation therapy (RT) is an established and effective treatment modality in the management of a large variety of hyperproliferative disorders and benign neoplasms. Objective of this article is to summarize the updated DEGRO consensus S2e guideline recommendations. This report comprises an overview of the relevant aspects of the updated guidelines with regard to treatment decision, dose prescription, and RT technique for a selected group of disorders including Morbus Dupuytren (MD)/Morbus Ledderhose (ML), keloids, Peyronie's disease (induratio penis plastica, IPP), desmoid tumors, pigmented villonodular synovitis (PVNS), symptomatic vertebral hemangiomas (sVH), and Gorham-Stout syndrome (GSS). On the basis of results in the literature, we attempted to classify the level of evidence (LoE) and the grade of recommendation (GR) according to the Oxford criteria. There is comprehensive evidence in the literature that RT is a reasonable and effective treatment modality for the treatment of all the above-mentioned disorders. The LoE varies from 2c to 4, and GR varies from A to C. The use of RT can be recommended for the interdisciplinary management of most of the reported disorders. It can be used in the primary treatment approach and as an effective adjunct to other treatment modalities or in some indications as a valuable alternative treatment option. We hope that the updated DEGRO S2e consensus guideline recommendations are a helpful tool for radiation oncologists in the clinical decision-making process. (orig.) [German] Die Radiotherapie (RT) ist eine etablierte und effektive Therapieoption fuer zahlreiche hyperproliferative Erkrankungen und gutartige Neubildungen. Gegenstand dieses Artikels ist die Zusammenfassung der aktualisierten DEGRO-S2e-Konsensus-Leitlinienempfehlungen.. Die Arbeit enthaelt eine Uebersicht ueber die relevanten Aspekte der aktualisierten Leitlinien bezueglich der Indikationsstellung, der Dosisverschreibung und den Bestrahlungstechniken fuer

Standard guidelines of care for chemical peels

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Khunger Niti

2008-03-01

Full Text Available Chemical peeling is the application of a chemical agent to the skin, which causes controlled destruction of a part of or the entire epidermis, with or without the dermis, leading to exfoliation and removal of superficial lesions, followed by regeneration of new epidermal and dermal tissues. Indications for chemical peeling include pigmentary disorders, superficial acne scars, ageing skin changes, and benign epidermal growths. Contraindications include patients with active bacterial, viral or fungal infection, tendency to keloid formation, facial dermatitis, taking photosensitizing medications and unrealistic expectations. Physicians′ qualifications : The physician performing chemical peeling should have completed postgraduate training in dermatology. The training for chemical peeling may be acquired during post graduation or later at a center that provides education and training in cutaneous surgery or in focused workshops providing such training. The physician should have adequate knowledge of the different peeling agents used, the process of wound healing, the technique as well as the identification and management of complications. Facility : Chemical peeling can be performed safely in any clinic/outpatient day care dermatosurgical facility. Preoperative counseling and Informed consent : A detailed consent form listing details about the procedure and possible complications should be signed by the patient. The consent form should specifically state the limitations of the procedure and should clearly mention if more procedures are needed for proper results. The patient should be provided with adequate opportunity to seek information through brochures, presentations, and personal discussions. The need for postoperative medical therapy should be emphasized. Superficial peels are considered safe in Indian patients. Medium depth peels should be performed with great caution, especially in dark skinned patients. Deep peels are not recommended for

Basic components of connective tissues and extracellular matrix: elastin, fibrillin, fibulins, fibrinogen, fibronectin, laminin, tenascins and thrombospondins.

Science.gov (United States)

Halper, Jaroslava; Kjaer, Michael

2014-01-01

-elastic extracellular matrixes, and interact closely with tropoelastin and integrins. Not only do microfibrils provide structural integrity of specific organ systems, but they also provide a scaffold for elastogenesis in elastic tissues. Fibrillin is important for the assembly of elastin into elastic fibers. Mutations in the fibrillin-1 gene are closely associated with Marfan syndrome. Fibulins are tightly connected with basement membranes, elastic fibers and other components of extracellular matrix and participate in formation of elastic fibers. Tenascins are ECM polymorphic glycoproteins found in many connective tissues in the body. Their expression is regulated by mechanical stress both during development and in adulthood. Tenascins mediate both inflammatory and fibrotic processes to enable effective tissue repair and play roles in pathogenesis of Ehlers-Danlos, heart disease, and regeneration and recovery of musculo-tendinous tissue. One of the roles of thrombospondin 1 is activation of TGFβ. Increased expression of thrombospondin and TGFβ activity was observed in fibrotic skin disorders such as keloids and scleroderma. Cartilage oligomeric matrix protein (COMP) or thrombospondin-5 is primarily present in the cartilage. High levels of COMP are present in fibrotic scars and systemic sclerosis of the skin, and in tendon, especially with physical activity, loading and post-injury. It plays a role in vascular wall remodeling and has been found in atherosclerotic plaques as well.

Dupuytren’s contracture of hand and its medical and social review

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V. O. Vishnevskiy

2014-02-01

prognostic factors include: the formation of keloid scars, persistent development of contractures and arthritis of the joints of fingers. For the expert diagnosis, the most important are functional disorders such as the capture and retention of items. Other types of disorders are less important. The restriction of mobility little joints with vicious position of fingers of the hand limit the ability to work and ability to self-service. The case of the bilateral affected leads to disability group III. At carrying out of medical and social examination and its conclusion, it is necessary to take into account the age, concomitant pathology, compensatory abilities of the patient, as well as the dynamics of recovery function of the hand after correction. Conclusions: Dupuytren’s contracture is the complex orthopedic pathology that can be interpreted as dysplasia of connective tissue. It makes 11,8% of all diseases of hand and affects mainly men of the middle age. In clinical practice is most often applied four-degree’s classification considering severity of deformation and function disorders of hand, which needs clarification of criteria for medical and social examination. The optimal method of Dupuytren’s contracture treatment is operative – the total aponeuroectomia, however the quantity of unsatisfactory outcomes reaches 13 % of cases, and cases on physical inability up to 3 %. According to our clinical observation of the 68 patients (up to 3 years after surgery the recurrence rate amounted to 31,7%, and physical inability level is 5,9% of cases. In our opinion, aponeuroectomia should be regarded as complex microsurgical operation, by using rational approaches and obligatory plastic substitution of the defects of the skin. The basic criteria of the clinical and labor prognosis and medical and social examination are characters of morphological changes and a degree of the basic functions disorders of hand. They reduce work capacity, quality of life, and at bilateral

Alogenosis iatrogénica: Una nueva enfermedad A new desease: Iatrogenic allogenosis

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F. Coiffman

2008-03-01

ático. Las resecciones quirúrgicas solo deben hacerse en zonas muy limitadas, pues producen depresiones cutáneas y cicatrices retráctiles. Las masas muy grandes no se deben resecar debido a las deformaciones consecuentes. Se debe proteger la piel con sustancias emolientes. El aspecto más importante de este estudio es lo que no debe hacerse: los corticoides locales o generales no sirven y aumentan la atrofia de la piel; las punciones y la liposucción no ayudan, pues las masas son sólidas y fibróticas; los masajes, el ultrasonido y el láser no ayudan y a veces empeoran la situación. En todos los países se deben realizar campañas oficiales de prevención contra estas sustancias.The need to replenish wrinkles and depressions has enticed the creation of multiple solid or semi-solid injectable substances. The disastrous results of some of these have led me to create the term "Iatrogenic Allogenosis": "Allogenosis", because it is produced by allogenic (foreign substances. "Iatrogenic", because we, the physicians or persons injecting these substances, have caused this disease. Over one million persons in Latin-America have become victims of these substances. Our objective is to learn how to treat these cases. We have studied 358 cases in a 10-year time span. We have grouped them and tried to reach conclusions. Mostly used substances are: liquid silicon, paraffin, liquid petrolatum, Vaseline, mineral oil, animal fat, etc. We have not included in this study some substances that have been fairly accepted by surgeons: autogenous fat, bovine collagen, hydroxyapatite, acrylic, hyaluronic acid, etc. Reactions are local and general. The latency period varies from 6 hours to 25 years. Local reactions are: pain, erhytema, edema, pigmentations, swelling, fibrosis, keloids, infection, fistulas, necrosis, gravity displacement, etc. The general ones are: fever, arthralgia, general discomfort, we have no find relations with autoimmune diseases (dermatomyositis, scleroderma, etc

Glycerin-Based Hydrogel for Infection Control.

Science.gov (United States)

Stout, Edward I; McKessor, Angie

2012-02-01

concentration will be cytotoxic to all cells that have been tested if they are exposed long enough. These properties of glycerin have been recognized by the European Skin Bank, where they use 85% glycerin solutions to store cadaver skin at ∼42F, and can be used for potential wound coverings. The cadaver skin that has been prepared by this method has been available since 1994. 6 The concern for safety resulted in a three-day international synmposium 7 with emphasis on glycerin-preserved cadaver skin providing healthy environment for the preserved skin to be successfully accepted without rejection, having no complications of infection and providing excellent healing outcomes and minimal scaring. Additional research by Dr. David P. Mackie of the Red Cross Hospital, The Netherlands, reported that using 85% glycerin solutions had slow bactericidal effects and also showed virocidal activity on several types of viruses. 8 Dr. Hoekstra has observed that within 2 hours after application of Elasto-Gel™, the inflammatory reaction is reduced. 9 Vandeputte, Belgium, showed that wounds covered with Elasto-Gel™ had fewer myofibroblasts than those covered with hydrocolloid. 10 It has been proposed that myofibroblasts in high concentrations contribute to the formation of hypertrophic and keloid scars. As noted earlier, there is less scar formation when glycerin-based gel sheets are used. The data sited here have shown that glycerin and glycerin-based products are effective antimicrobial agents with less side effects. Many verbal reports along with personal communications have indicated that applying glycerin-based gel sheets to stalled wounds, some 15-20-year-old chronic wounds, resulted in healing in 1-20 weeks (data/case studies on file). Elasto-Gel™ has been approved for all types of wounds, that is, pressure ulcers, acute and chronic wounds, diabetic wounds, traumatic wounds, dermatology wounds, cancer tumors, and first- and second-degree burns, to name a few. Because of the

Tissue adhesives for simple traumatic lacerations.

Science.gov (United States)

Beam, Joel W

2008-01-01

Farion K, Osmond MH, Hartling L, et al. Tissue adhesives for traumatic lacerations in children and adults. Cochrane Database Syst Rev. 2001(4);CD003326. What is the clinical evidence base for tissue adhesives in the management of simple traumatic lacerations? Studies were identified by searches of the following databases: Cochrane Wounds Group Specialized Trials Register (September 2003), Cochrane Central Register of Controlled Trials (CENTRAL) (CDROM 2003, issue 3), MEDLINE (1966 to September 2003, week 1), EMBASE (1988 to 2003, week 36), Web of Science Science Citation Index (1975 to September 13, 2003) and various clinical trials registers (September 2003). Investigators and product manufacturers were contacted to identify additional eligible studies. The search terms included wounds and injuries, laceration, face injury, nose injury, tissue adhesives, and acrylates. Each study fulfilled the following criteria: (1) The study was a randomized controlled trial that compared tissue adhesives with standard wound closure (SWC) (sutures, staples, adhesive strips) or tissue adhesive with tissue adhesive. (2) The wounds were acute, linear lacerations less than 12 hours old, resulting from blunt or sharp trauma. (3) The wound length, width, and depth allowed for approximation of the edges with minimal tension after deep sutures were placed, if required. Studies were included with no language or publication status restriction, with participants of any age recruited in an emergency department, outpatient clinic, walk-in clinic, or other primary care setting. Studies were excluded if the wounds were stellate lacerations, puncture wounds, mammalian bites, infected, heavily contaminated or devitalized, crossing joints or mucocutaneous junctions, in hair-bearing areas, or in patients with keloid formation or chronic illness. The characteristics of the study and participants, interventions, outcome measures, and findings were extracted by one author and verified by a second

Rompiendo paradigmas: reducción mamaria vía axilar Quebra de paradigma: redução mamária axilar Breaking paradygms: axillary reduction mammoplasty

Directory of Open Access Journals (Sweden)

Y. Felicio

2012-12-01

ísicos e de fisioterapia, no período de 30 dias cederam. Em média, no período acima de 6 meses a maioria das pacientes demonstraram nítida satisfação. Há quatro décadas toda comunidade mundial de cirurgiões plásticos utiliza técnicas de redução mamária que resultam com uma, duas ou três cicatrizes na mama. Se faz necessário romper paradigmas, pois, desde 1924 há registro de cirurgias de redução mamária pela via axilar. Na atualidade, muitas pacientes evitam submeter-se a cirurgia de redução mamária devido a grande extensão das cicatrizes. Se faz necessário divulgar a via axilar que possibilita apenas uma única cicatriz que permanece escondida nas pregas axilares.We present a study on axillary breast reduction surgery conducted between March 1993 and March 2012 to test the effectiveness of a method that besides reducing the breast it´s cheaper than conventional ones, requires shorter operative time, and avoids wasting time on complex mathematical calculations to determine the amount of tissue to resect. Resection of glandular and fatty breast tissue is done maintaining the central portion of the breast and nipple-areola complex (CAP and, according to each case, favors the areolar retraction depending on the amount of tissue resected and the presence of elastic fibers in the breast without any surgery on the areola. We study a total of 500 breasts operated on axillary breast reduction, aged between 16 and 58 years. Surgeries were 66 % for breast hypertrophy, ptosis 15 %, 10% asymmetry, mastopexy associated with silicone implants 8% and 1% for tumor resection associated with breast reduction. The amount of breast tissue resected ranged from 50 to 1,500 g., with the highest percentage of cases, 35%, in the group between 200-300 gr. resected. The complication rate was 3.4%, low compared to the one presented in conventional techniques (personal statistics. In 500 breasts operated we found 17 complications: 6 keloids and hypertrophic scars after seromas