Keloid
☆ U rezultatima Stiftung Warentest-a za 2022. iz Njemačke, zadovoljstvo potrošača ModelDerm-om bilo je samo nešto niže nego s plaćenim telemedicinskim konsultacijama.
Postoperativni keloid na zglobu koji je liječen intralezijskom injekcijom triamcinolona. Područje udubljenja eritema na lijevoj strani je tretirano područje.
Linearni keloidi. Kada se pojave na gornjoj prednjoj strani torza, često se pojavljuju u linearnom obliku.
Zadnji aurikularni keloid
Keloidi na tabanima mogu biti neugodni za hodanje. Intralezijske injekcije steroida se obično izvode nekoliko puta.
Keloidi se obično primećuju na nadlakticama.
Tipična manifestacija keloida u grudima.
References
Keloidi nastaju zbog neobičnog zacjeljivanja nakon ozljede ili upale kože. Genetski faktori i faktori okoline doprinose njihovom razvoju, s većom stopom kod tamnoputih osoba afričkog, azijskog i hispanskog porijekla. Keloidi se javljaju kada fibroblasti postanu preaktivni, proizvodeći prekomjerno kolagen i faktore rasta. To dovodi do stvaranja velikih, abnormalnih kolagenskih snopova poznatih kao keloidni kolagen, zajedno s povećanjem fibroblasta. Klinički, keloidi se pojavljuju kao čvrsti, gumeni čvorovi u područjima koja su prethodno bila ozlijeđena. Za razliku od normalnih ožiljaka, keloidi se protežu izvan prvobitnog mjesta traume. Pacijenti mogu osjetiti bol, svrab ili peckanje. Dostupni su različiti tretmani, uključujući injekcije steroida, krioterapiju, operaciju, radioterapiju i lasersku terapiju.
Keloids result from abnormal wound healing in response to skin trauma or inflammation. Keloid development rests on genetic and environmental factors. Higher incidences are seen in darker skinned individuals of African, Asian, and Hispanic descent. Overactive fibroblasts producing high amounts of collagen and growth factors are implicated in the pathogenesis of keloids. As a result, classic histologic findings demonstrate large, abnormal, hyalinized bundles of collagen referred to as keloidal collagen and numerous fibroblasts. Keloids present clinically as firm, rubbery nodules in an area of prior injury to the skin. In contrast to normal or hypertrophic scars, keloidal tissue extends beyond the initial site of trauma. Patients may complain of pain, itching, or burning. Multiple treatment modalities exist although none are uniformly successful. The most common treatments include intralesional or topical steroids, cryotherapy, surgical excision, radiotherapy, and laser therapy.
Keloids result from abnormal wound healing in response to skin trauma or inflammation. Keloid development rests on genetic and environmental factors. Higher incidences are seen in darker skinned individuals of African, Asian, and Hispanic descent. Overactive fibroblasts producing high amounts of collagen and growth factors are implicated in the pathogenesis of keloids. As a result, classic histologic findings demonstrate large, abnormal, hyalinized bundles of collagen referred to as keloidal collagen and numerous fibroblasts. Keloids present clinically as firm, rubbery nodules in an area of prior injury to the skin. In contrast to normal or hypertrophic scars, keloidal tissue extends beyond the initial site of trauma. Patients may complain of pain, itching, or burning. Multiple treatment modalities exist although none are uniformly successful. The most common treatments include intralesional or topical steroids, cryotherapy, surgical excision, radiotherapy, and laser therapy.
Trenutna istraživanja sugeriraju da je silikonski gel ili folija zajedno s injekcijama kortikosteroida preferirani početni tretman za keloide. Dodatni tretmani kao što su intralesionalni 5-fluorouracil (5-FU) , bleomicin ili verapamil takođe se mogu razmotriti, iako njihova efikasnost varira. Laserska terapija, kada se kombinira s injekcijama kortikosteroida ili lokalnim steroidima pod okluzijom, može poboljšati prodiranje lijekova. Za neposlušne keloide, hirurško uklanjanje praćeno trenutnom terapijom zračenjem pokazalo se efikasnim. Konačno, dokazano je da upotreba silikonske folije i presoterapije smanjuju vjerovatnoću ponovnog pojave keloida.
Current literature supports silicone gel or sheeting with corticosteroid injections as first-line therapy for keloids. Adjuvant intralesional 5-fluorouracil (5-FU), bleomycin, or verapamil can be considered, although mixed results have been reported with each. Laser therapy can be used in combination with intralesional corticosteroids or topical steroids with occlusion to improve drug penetration. Excision of keloids with immediate post-excision radiation therapy is an effective option for recalcitrant lesions. Finally, silicone sheeting and pressure therapy have evidence for reducing keloid recurrence.
Current literature supports silicone gel or sheeting with corticosteroid injections as first-line therapy for keloids. Adjuvant intralesional 5-fluorouracil (5-FU), bleomycin, or verapamil can be considered, although mixed results have been reported with each. Laser therapy can be used in combination with intralesional corticosteroids or topical steroids with occlusion to improve drug penetration. Excision of keloids with immediate post-excision radiation therapy is an effective option for recalcitrant lesions. Finally, silicone sheeting and pressure therapy have evidence for reducing keloid recurrence.
Trenutno ne postoji jedinstveni tretman koji garantuje konstantno nisku stopu recidiva za keloide. Međutim, rastuće opcije, poput korištenja lasera uz steroide ili kombiniranja 5-fluorouracila sa steroidima, pokazuju se obećavajućim. Buduća istraživanja bi se mogla fokusirati na to koliko dobro novi tretmani, kao što su autologno presađivanje masti ili terapije bazirane na matičnim stanicama, djeluju u upravljanju keloidima.
There continues to be no gold standard of treatment that provides a consistently low recurrence rate; however the increasing number of available treatments and synergistic combinations of these treatments (i.e., laser-based devices in combination with intralesional steroids, or 5-fluorouracil in combination with steroid therapy) is showing favorable results. Future studies could target the efficacy of novel treatment modalities (i.e., autologous fat grafting or stem cell-based therapies) for keloid management.
There continues to be no gold standard of treatment that provides a consistently low recurrence rate; however the increasing number of available treatments and synergistic combinations of these treatments (i.e., laser-based devices in combination with intralesional steroids, or 5-fluorouracil in combination with steroid therapy) is showing favorable results. Future studies could target the efficacy of novel treatment modalities (i.e., autologous fat grafting or stem cell-based therapies) for keloid management.
Ožiljci su čest dio procesa zacjeljivanja nakon ozljeda kože. Idealno bi bilo da ožiljci budu ravni, tanki i da odgovaraju boji kože. Mnogi faktori mogu dovesti do lošeg zacjeljivanja rana, kao što su infekcija, smanjen protok krvi, ishemija i trauma. Ožiljci koji su debeli, tamniji od okolne kože ili se pretjerano smanjuju mogu uzrokovati značajne probleme i s fizičkom funkcijom i emocionalnim zdravljem.
Scars are a natural and normal part of healing following an injury to the integumentary system. Ideally, scars should be flat, narrow, and color-matched. Several factors can contribute to poor wound healing. These include but are not limited to infection, poor blood flow, ischemia, and trauma. Proliferative, hyperpigmented, or contracted scars can cause serious problems with both function and emotional well-being.
Scars are a natural and normal part of healing following an injury to the integumentary system. Ideally, scars should be flat, narrow, and color-matched. Several factors can contribute to poor wound healing. These include but are not limited to infection, poor blood flow, ischemia, and trauma. Proliferative, hyperpigmented, or contracted scars can cause serious problems with both function and emotional well-being.
Keloidni ožiljci se češće viđaju kod ljudi afričkog, azijskog ili latinoameričkog porijekla. Ljudi u dobi između 10 i 30 godina imaju veću sklonost razvoju keloida od starijih.
Iako se obično javljaju na mjestu ozljede, keloid mogu nastati i spontano. Mogu se pojaviti na mjestu pirsinga, pa čak i od nečega jednostavnog kao što je bubuljica ili ogrebotina. Mogu se javiti kao rezultat teških ožiljaka od akni ili vodenih kozica, infekcije na mjestu rane, ponovljene traume nekog područja, prekomjerne napetosti kože tokom zatvaranja rane ili stranog tijela u rani.
Keloidni ožiljci se mogu razviti nakon operacije. Češći su na nekim mjestima, kao što su centralni grudni koš (od sternotomije), leđa i ramena (obično su posljedica akni) i ušne školjke (od pirsinga uha). Mogu se pojaviti i na pirsingu na tijelu. Najčešće mrlje su ušne resice, ruke, karlični region i preko ključne kosti.
Dostupni tretmani su terapija tlakom, oblaganje silikonskim gelom, triamcinolon acetonid unutar lezije, kriohirurgija, zračenje, laserska terapija, interferon, 5-FU i hirurška ekscizija.
○ Tretman
Hipertrofični ožiljci se mogu poboljšati sa 5 do 10 intralezijskih injekcija steroida u intervalu od 1 mjeseca.
#Triamcinolone intralesional injection
Lasersko liječenje može se isprobati za eritem povezan s ožiljcima, ali injekcije triamcinilona također mogu poboljšati eritem izravnavanjem ožiljka.
#Dye laser (e.g. V-beam)