Keloid
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Postoperativni keloid na zapešću koji je liječen intralezionalnom injekcijom triamcinolona. Udubljeno područje eritema na lijevoj strani je tretirano područje.
Linearni keloidi. Kada se pojave na gornjem prednjem dijelu torza, često se pojavljuju u linearnom obliku.
Stražnji aurikularni keloid
Keloidi na tabanima mogu biti neugodni za hodanje. Intralezijske injekcije steroida obično se daju nekoliko puta.
Keloidi se obično nalaze na nadlakticama.
Tipična manifestacija keloida na prsima.
References
Keloidi nastaju zbog neobičnog zacjeljivanja nakon ozljede kože ili upale. Genetski čimbenici i čimbenici okoliša pridonose njihovom razvoju, s višim stopama kod tamnoputih osoba afričkog, azijskog i latinoameričkog podrijetla. Keloidi nastaju kada fibroblasti postanu preaktivni, proizvodeći prekomjernu količinu kolagena i faktora rasta. To dovodi do stvaranja velikih, abnormalnih kolagenskih snopova poznatih kao keloidni kolagen, zajedno s povećanjem fibroblasta. Klinički, keloidi se pojavljuju kao čvrsti, gumeni noduli na prethodno ozlijeđenim područjima. Za razliku od normalnih ožiljaka, keloidi se protežu izvan izvornog mjesta traume. Pacijenti mogu osjetiti bol, svrbež ili peckanje. Dostupni su različiti tretmani, uključujući injekcije steroida, krioterapiju, kirurgiju, 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 obloga zajedno s injekcijama kortikosteroida poželjan početni tretman za keloide. Mogu se razmotriti i dodatni tretmani poput intralezijskog 5-fluorouracila (5-FU) , bleomicina ili verapamila, iako njihova učinkovitost varira. Laserska terapija, u kombinaciji s injekcijama kortikosteroida ili lokalnim steroidima pod okluzijom, može poboljšati prodiranje lijekova. Za neposlušne keloide pokazalo se učinkovitim kirurško uklanjanje praćeno trenutnom terapijom zračenjem. Naposljetku, dokazano je da upotreba silikonske folije i presoterapije smanjuje vjerojatnost ponovnog pojavljivanja 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.
Trenutačno ne postoji jedinstveni tretman za sve koji jamči dosljedno nisku stopu recidiva keloida. Međutim, rastuće mogućnosti, poput korištenja lasera uz steroide ili kombiniranja 5-fluorouracila sa steroidima, pokazuju se obećavajućim. Buduća bi se istraživanja mogla usredotočiti na to koliko dobro novi tretmani, poput presađivanja autologne masti ili terapije temeljene na matičnim stanicama, djeluju na liječenje keloida.
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 uobičajeni dio procesa zacjeljivanja nakon ozljeda kože. U idealnom slučaju, ožiljci bi trebali biti ravni, tanki i odgovarati boji kože. Mnogi čimbenici mogu dovesti do lošeg zacjeljivanja rana, poput infekcije, smanjenog protoka krvi, ishemije i traume. Ožiljci koji su debeli, tamniji od okolne kože ili se pretjerano smanjuju mogu uzrokovati značajne probleme 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 češće se vide kod ljudi afričkog, azijskog ili latinoameričkog podrijetla. Osobe između 10 i 30 godina imaju veću sklonost razvoju keloida nego starije osobe.
Iako se obično javljaju na mjestu ozljede, keloid mogu nastati i spontano. Mogu se pojaviti na mjestu piercinga, pa čak i od nečega tako jednostavnog kao što je prištić ili ogrebotina. Mogu se pojaviti kao posljedica teških akni ili ožiljaka od vodenih kozica, infekcije na mjestu rane, opetovane traume na nekom području, pretjerane napetosti kože tijekom zatvaranja rane ili stranog tijela u rani.
Keloidni ožiljci mogu se razviti nakon operacije. Češći su na nekim mjestima, poput središnjeg prsnog koša (zbog sternotomije), leđa i ramena (obično nastaju zbog akni) i ušnih resica (zbog bušenja ušiju). Mogu se pojaviti i na piercingu. Najčešće mrlje su ušne školjke, ruke, zdjelica i preko ključne kosti.
Dostupni tretmani su presoterapija, obloga od silikonskog gela, triamcinolon acetonid unutar lezije, kriokirurgija, zračenje, laserska terapija, interferon, 5-FU i kirurška ekscizija.
○ liječenje
Hipertrofični ožiljci mogu se poboljšati s 5 do 10 intralezionalnih injekcija steroida u intervalu od 1 mjeseca.
#Triamcinolone intralesional injection
Lasersko liječenje može se pokušati za eritem povezan s ožiljcima, ali injekcije triamcinilona također mogu poboljšati eritem izravnavanjem ožiljka.
#Dye laser (e.g. V-beam)