Keloid - Keloidea
☆ Alemaniako Stiftung Warentest-en 2022ko emaitzetan, ModelDerm-ekin kontsumitzaileen gogobetetasuna apur bat txikiagoa izan zen ordaindutako telemedikuntzako kontsultekin baino.
Ebakuntza osteko keloide bat eskumuturrean, triamcinolona lesio barneko injekzioarekin tratatu zena. Ezkerreko aldean hondoratutako eritema gunea tratatutako gunea da.
Keloide linealak. Enborraren goiko aurrealdean gertatzen direnean, askotan forma linealean agertzen dira.
Atzeko keloide aurikularra
Oinen zoletan keloideak deserosoak izan daitezke oinez ibiltzeko. Esteroide barneko injekzioak normalean hainbat aldiz egiten dira.
Keloideak besoetan behatu ohi dira.
Bularreko keloideen adierazpen tipikoa.
References
Keloideak larruazaleko lesioen edo hanturaren ondoren ezohiko sendatzearen ondorioz sortzen dira. Faktore genetikoek eta ingurumen-faktoreek haien garapenean laguntzen dute, afrikar, asiar eta jatorri hispanoko azal iluneko gizabanakoetan tasa handiagoak izanik. Keloideak fibroblastoak gehiegizko aktiboak bihurtzen direnean gertatzen dira, gehiegizko kolagenoa eta hazkuntza-faktoreak sortuz. Horrek kolageno keloidal izenez ezagutzen diren kolageno-sorta handi eta anormalak sortzen ditu, fibroblastoen gehikuntzarekin batera. Klinikoki, keloideak nodulu sendo eta gomatsu gisa agertzen dira aurretik zauritutako eremuetan. Orbain normalak ez bezala, keloideak jatorrizko trauma gunetik haratago zabaltzen dira. Pazienteek mina, azkura edo erredura izan ditzakete. Hainbat tratamendu daude eskuragarri, besteak beste, esteroideen injekzioak, krioterapia, kirurgia, erradioterapia eta laser terapia.
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.
Gaur egungo ikerketek iradokitzen dute silikonazko gel edo xafla kortikoideen injekzioekin batera keloideen hasierako tratamendu hobetsia dela. 5-fluorourazilo barneko (5-FU) , bleomizina edo verapamil bezalako tratamendu osagarriak ere kontuan hartu daitezke, nahiz eta haien eraginkortasuna aldatu egiten den. Laser terapia, kortikoideen injekzioak edo oklusiopean dauden esteroide topikoekin konbinatuta, drogak sartzea hobetu dezake. Keloide errekalzitranteentzat, kentze kirurgikoa eta berehalako erradioterapiaren ondoren eraginkorra izan da. Azkenik, silikonazko xafla eta presio terapia erabiliz keloideak errepikatzeko probabilitatea murrizten duela frogatu da.
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.
Gaur egun, ez dago keloideen errepikapen-tasa baxua bermatzen duen neurri bakarreko tratamendurik. Hala ere, hazten ari diren aukerak, esteroideekin batera laserrak erabiltzea edo 5-fluorouracil esteroideekin konbinatzea bezalakoak, itxaropentsuak dira. Etorkizuneko ikerketek keloideak kudeatzeko tratamendu berriek, hala nola gantz-injerto autologoek edo zelula ametan oinarritutako terapiak, nola funtzionatzen duten azter dezakete.
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.
Orbainak larruazaleko lesioen ondoren sendatzeko prozesuko zati arruntak dira. Egokiena, orbainak lauak, meheak eta azalaren kolorearekin bat etorri behar dira. Faktore askok zaurien sendatze txarra ekar dezakete, hala nola infekzioak, odol-fluxua murriztea, iskemia eta traumatismoak. Lodiak, inguruko azala baino ilunagoak edo gehiegi uzkurtzen diren orbainek arazo garrantzitsuak sor ditzakete bai funtzio fisikoan, bai osasun emozionalarekin.
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.
Keloide orbainak maizago ikusten dira jatorri afrikar, asiar edo hispanoko pertsonengan. 10 eta 30 urte bitarteko pertsonek adinekoek baino joera handiagoa dute keloide bat garatzeko.
Normalean lesio baten gunean gertatzen diren arren, keloidea (keloid) berez ere sor daitezke. Piercing-en gunean gerta daitezke eta baita garau bat edo marradura bezain sinple batetik ere. Akne larriaren edo varixaren orbainaren ondorioz, zauri batean infekzioak, eremu batean behin eta berriz traumatismoak, zauria ixtean larruazaleko gehiegizko tentsioa edo zauri batean gorputz arrotz baten ondorioz gerta daitezke.
Ebakuntzaren ondoren orbain keloideak sor daitezke. Ohikoagoak dira gune batzuetan, hala nola, erdiko bularrean (esternotomia baten bidez), bizkarrean eta sorbaldak (normalean aknearen ondoriozkoak) eta belarriko lobuluetan (belarrietako zulaketen ondorioz). Gorputzeko piercingetan ere gerta daitezke. Orban ohikoenak belarri-lobulak, besoak, pelbiseko eskualdea eta lepoko hezurren gainean dira.
Eskuragarri dauden tratamenduak presio terapia, silikonazko gel xafla, triamzinolona azetonidoa, kriokirurgia, erradiazioa, laser terapia, interferoia, 5-FU eta eszisio kirurgikoa dira.
○ Tratamendua
Orbain hipertrofikoek 5 eta 10 esteroide barneko injekzioak hobetu daitezke hilabeteko tartean.
#Triamcinolone intralesional injection
Laser tratamendua orbainarekin lotutako eritemarako probatu daiteke, baina triamcinilona injekzioek eritema hobetu dezakete orbaina berdinduz.
#Dye laser (e.g. V-beam)