Keloid
☆ I te 2022 Stiftung Warentest hua mai i Tiamana, he iti noa iho te pai o nga kaihoko ki a ModelDerm i nga korero mo te waea rongoa utu.
He keloid i muri i te mahi i runga i te ringaringa i rongoatia ki te werohanga triamcinolone intralesional. Ko te waahi erythema kua totohu ki te taha maui ko te waahi rongoa.
Linear Keloids. Ka puta ki te taha o runga o te rama, ka puta he ahua rarangi.
Keloid auricular o muri
Ko nga keloids i runga i nga kapu o nga waewae ka kore e pai ki te haere i runga. Ko te nuinga o nga wa ka mahia nga werohanga steroid i roto i nga wa maha.
Ka kitea nga keloids i runga i nga ringa o runga.
Te whakaaturanga angamaheni o nga keloid o te uma.
References
Ka puta nga keloid na te rongoa rereke i muri i te whara kiri, i te mumura ranei. Ko nga ahuatanga o te ira me te taiao e whai waahi ana ki to raatau whanaketanga, me te nui ake o nga reiti i roto i nga taangata kiri pouri o nga uri o Awherika, Ahia, Hispanic. Ka puta nga keloids ka kaha te kaha o te fibroblasts, ka whakaputa i te nui o te collagen me te tipu. Ko tenei ka arai ki te hanganga o nga paihere collagen nui, rerekee e mohiotia ana ko te keloidal collagen, me te piki haere o nga fibroblasts. I roto i te haumanu, ka puta nga keloids he nodule rapa i nga waahi i whara i mua. Kaore i rite ki nga nawe noa, ka toro atu nga keloids ki tua atu i te waahi o te mamae. Ka mamae pea nga turoro, te mamae, te wera ranei. He maha nga momo maimoatanga e waatea ana, tae atu ki te werohanga steroid, cryotherapy, pokanga, radiotherapy, me te rongoa 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.
Ko nga rangahau o naianei e kii ana ko te kaera silicone he papanga ranei me nga werohanga corticosteroid te maimoatanga tuatahi mo nga keloids. Ko etahi atu maimoatanga penei i te 5-fluorouracil (5-FU) , te bleomycin, te verapamil ranei ka taea te whakaaro, ahakoa he rereke te whai huatanga. Ko te whakamaarama taiaho, ka honoa ki nga werohanga corticosteroid, ki nga steroids o runga ranei i raro i te aukati, ka kaha ake te kuhu o nga raau taero. Mo nga keloids whakakeke, kua kitea te whai hua te tango pokanga whai muri i te whakamaarama iraruke. I te mutunga, ko te whakamahi i te papanga silicone me te whakamaarama pehanga kua whakamatauhia ki te whakaheke i te tupono o te hokinga mai o te keloid.
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.
I tenei wa, karekau he maimoatanga kotahi te rahi e pai ana ki te katoa e whakapumau ana i te iti o te hokinga mai o nga keloids. Heoi, ko nga whiringa e tipu haere ana, penei i te whakamahi lasers i te taha o te steroids, te whakakotahi ranei i te 5-fluorouracil me te steroids, kei te whai hua. Ko nga rangahau a meake nei ka aro atu ki te pai o nga maimoatanga hou, penei i te taapiri ngako autologous me nga rongoa-aa-a-waa-a-papa, te mahi mo te whakahaere keloids.
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.
Ko nga whiu he waahanga noa o te mahi whakaora i muri i nga whara kiri. Ko te mea pai, kia papatahi, kia angiangi nga whiu, kia rite ki te tae kiri. He maha nga take ka paheke te whakaora i nga patunga, penei i te mate, te heke o te rere toto, te ischemia, me te whara. Ko nga marumaru he matotoru, he pouri ake i te kiri a tawhio noa, he tino mimiti ranei ka puta he raru nui ki te mahi tinana me te hauora aronganui.
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.
He maha nga wa ka kitea nga whiu keloid ki nga tangata o Awherika, Ahia, Hispanic ranei. Ko nga taangata kei waenga i te 10 me te 30 tau he nui ake te mate ki te whakawhanake i te keloid atu i nga kaumātua.
Ahakoa i te nuinga o te wa ka puta ki te waahi o te whara, keloid ka ara ake ano. Ka puta mai i te waahi o te werohanga me te mea mai i tetahi mea ngawari penei i te pimple me te rakuraku ranei. Ka puta mai na te nui o te hakihaki, te maru heihei ranei, te mate ki te waahi patunga, te mamae tonu ki tetahi waahi, te taumahatanga o te kiri i te wa e kati ana te patunga, he tinana ke ranei i roto i te patunga.
Ka taea te whakawhanake i nga whiu keloid i muri i te pokanga. He nui ake i etahi waahi, penei i te pouaka pokapū (mai i te sternotomy), te tuara me nga pakihiwi (te nuinga ka puta mai i te hakihaki), me nga riu taringa (mai i te werohanga taringa). Ka puta ano i runga i nga werohanga tinana. Ko te nuinga o nga waahi ko nga taringa, nga ringa, te rohe pelvic, me runga ake i te koiwi.
Ko nga maimoatanga e waatea ana ko te whakamaarama pehanga, te riipene reera silicone, triamcinolone acetonide intra-lesional, cryosurgery, radiation, laser therapy, Interferon, 5-FU me te tangohanga pokanga.
○ Maimoatanga
Ka taea te whakapai ake nga nawe hypertrophic ki te 5 ki te 10 werohanga pūtaiaki intralesional 1 marama.
#Triamcinolone intralesional injection
Ka whakamatauhia te maimoatanga taiaho mo te erythema e pa ana ki te nawe, engari ka taea ano e nga werohanga triamcinilone te whakapai ake i te erythema ma te whakapati i te nawe.
#Dye laser (e.g. V-beam)