Keloid
☆ Yng nghanlyniadau Stiftung Warentest 2022 o’r Almaen, roedd boddhad defnyddwyr â ModelDerm ond ychydig yn is nag ymgynghoriadau telefeddygaeth taledig.
Celoid ar ôl llawdriniaeth ar yr arddwrn a gafodd ei drin â chwistrelliad mewnanafiadol triamcinolone. Yr ardal erythema suddedig ar yr ochr chwith yw'r ardal sydd wedi'i thrin.
Keloids Llinol. Pan fyddant yn digwydd ar flaen uchaf y torso, maent yn aml yn ymddangos mewn siâp llinellol.
Posterior auricular Keloid
Gall keloidau ar wadnau'r traed fod yn anghyfforddus i gerdded ymlaen. Mae pigiadau steroid mewnanadlol yn cael eu perfformio sawl gwaith fel arfer.
Gwelir keloidau yn gyffredin ar y breichiau uchaf.
Amlygiad nodweddiadol o keloidau'r frest.
References
Mae keloidau yn ffurfio oherwydd iachâd anarferol ar ôl anaf i'r croen neu lid. Mae ffactorau genetig ac amgylcheddol yn cyfrannu at eu datblygiad, gyda chyfraddau uwch mewn unigolion â chroen tywyllach o dras Affricanaidd, Asiaidd a Sbaenaidd. Mae keloidau yn digwydd pan fydd ffibroblastau'n gorfywiog, gan gynhyrchu colagen gormodol a ffactorau twf. Mae hyn yn arwain at ffurfio bwndeli colagen mawr, annormal a elwir yn golagen keloidal, ynghyd â chynnydd mewn ffibroblastau. Yn glinigol, mae keloidau yn ymddangos fel nodwlau rwber cadarn mewn ardaloedd a anafwyd yn flaenorol. Yn wahanol i greithiau arferol, mae keloidau yn ymestyn y tu hwnt i'r safle trawma gwreiddiol. Gall cleifion brofi poen, cosi neu losgi. Mae triniaethau amrywiol ar gael, gan gynnwys pigiadau steroid, cryotherapi, llawdriniaeth, radiotherapi, a therapi laser.
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.
Mae'r ymchwil presennol yn awgrymu mai gel silicon neu gynfasau ynghyd â phigiadau corticosteroid yw'r driniaeth gychwynnol a ffefrir ar gyfer keloidau. Gellir hefyd ystyried triniaethau ychwanegol fel 5-fluorouracil intralesional (5-FU) , bleomycin, neu verapamil, er bod eu heffeithiolrwydd yn amrywio. Gall therapi laser, o'i gyfuno â phigiadau corticosteroid neu steroidau argroenol dan gyfyngiad, wella treiddiad cyffuriau. Ar gyfer keloidau ysbeidiol, dangoswyd bod tynnu llawfeddygol ac yna therapi ymbelydredd ar unwaith yn effeithiol. Yn olaf, profwyd bod defnyddio gorchuddion silicon a therapi pwysau yn lleihau'r tebygolrwydd y bydd keloid yn digwydd eto.
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.
Ar hyn o bryd, nid oes un driniaeth sy'n addas i bawb sy'n gwarantu cyfradd ailadrodd gyson isel ar gyfer keloidau. Fodd bynnag, mae'r opsiynau cynyddol, fel defnyddio laserau ochr yn ochr â steroidau neu gyfuno 5-fluorouracil â steroidau, yn profi'n addawol. Gallai ymchwil yn y dyfodol ganolbwyntio ar ba mor dda y mae triniaethau newydd, fel impio braster awtologaidd neu therapïau bôn-gelloedd, yn gweithio ar gyfer rheoli keloidau.
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.
Mae creithiau yn rhan gyffredin o'r broses wella ar ôl anafiadau i'r croen. Yn ddelfrydol, dylai creithiau fod yn wastad, yn denau, ac yn cyfateb i liw'r croen. Gall llawer o ffactorau arwain at wella clwyfau gwael, megis haint, llai o lif gwaed, isgemia, a thrawma. Gall creithiau sy'n drwchus, yn dywyllach na'r croen o'u cwmpas, neu'n crebachu'n ormodol achosi problemau sylweddol gyda gweithrediad corfforol ac iechyd emosiynol.
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.
Gwelir creithiau keloid yn amlach mewn pobl o dras Affricanaidd, Asiaidd neu Sbaenaidd. Mae gan bobl rhwng 10 a 30 oed dueddiad uwch i ddatblygu keloid na'r henoed.
Er eu bod fel arfer yn digwydd ar safle anaf, gall keloid godi'n ddigymell hefyd. Gallant ddigwydd ar safle tyllu a hyd yn oed o rywbeth mor syml â pimple neu grafiad. Gallant ddigwydd o ganlyniad i acne difrifol neu greithiau brech yr ieir, haint ar safle clwyf, trawma mynych i ardal, tensiwn croen gormodol yn ystod cau clwyf neu gorff estron mewn clwyf.
Gall creithiau keloid ddatblygu ar ôl llawdriniaeth. Maent yn fwy cyffredin mewn rhai safleoedd, megis y frest ganolog (o sternotomi), y cefn a'r ysgwyddau (sy'n deillio o acne fel arfer), a llabedau'r glust (o dyllu'r glust). Gallant hefyd ddigwydd ar dyllu'r corff. Y mannau mwyaf cyffredin yw llabedau clust, breichiau, rhanbarth y pelfis, a thros asgwrn y goler.
Y triniaethau sydd ar gael yw therapi pwysau, gorchuddion gel silicon, asetonid triamcinolone mewn-anafol, cryolawdriniaeth, ymbelydredd, therapi laser, Interferon, 5-FU a thorri llawfeddygol.
○ triniaeth
Gall creithiau hypertroffig wella gyda 5 i 10 pigiad steroid mewnanafiadol bob 1 mis.
#Triamcinolone intralesional injection
Gellir rhoi cynnig ar driniaeth laser ar gyfer erythema sy'n gysylltiedig â chreithiau, ond gall pigiadau triamcinilone hefyd wella'r erythema trwy fflatio'r graith.
#Dye laser (e.g. V-beam)