Keloid
☆ V rezultatih raziskave Stiftung Warentest iz Nemčije leta 2022 je bilo zadovoljstvo potrošnikov z ModelDermom le nekoliko nižje kot s plačanimi telemedicinskimi svetovanji.
Pooperativni keloid na zapestju, ki je bil zdravljen z intralezijsko injekcijo triamcinolona. Poglobljeno območje eritema na levi strani je tretirano območje.
Linearni keloidi. Ko se pojavijo na zgornjem sprednjem delu trupa, se pogosto pojavijo v linearni obliki.
Posteriorni aurikularni keloid
Keloidi na podplatih so lahko neprijetni pri hoji. Intralezijske injekcije steroidov se običajno izvajajo večkrat.
Keloidi so običajno opaženi na nadlakteh.
Tipična manifestacija keloidov na prsih.
References
Keloidi nastanejo zaradi nenavadnega celjenja po poškodbi ali vnetju kože. Genetski in okoljski dejavniki prispevajo k njihovemu razvoju, z večjo stopnjo pri temneje poltih posameznikih afriškega, azijskega in latinoameriškega porekla. Keloidi nastanejo, ko postanejo fibroblasti prekomerno aktivni, kar povzroči prekomerno proizvodnjo kolagena in rastnih faktorjev. To vodi do nastanka velikih, nenormalnih kolagenskih snopov, znanih kot keloidni kolagen, skupaj s povečanjem fibroblastov. Klinično se keloidi kažejo kot čvrsti, gumijasti vozli na območjih, ki so bila prej poškodovana. Za razliko od običajnih brazgotin se keloidi razširijo preko mesta prvotne poškodbe. Bolniki lahko občutijo bolečino, srbenje ali pekoč občutek. Na voljo so različna zdravljenja, vključno z injekcijami steroidov, krioterapijo, operacijo, radioterapijo in lasersko terapijo.
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.
Sedanje raziskave kažejo, da je silikonski gel ali obloga skupaj z injekcijami kortikosteroidov najprimernejše začetno zdravljenje keloidov. V poštev pridejo tudi dodatna zdravljenja, kot je intralezijski 5-fluorouracil (5-FU) , bleomicin ali verapamil, čeprav je njihova učinkovitost različna. Laserska terapija v kombinaciji z injekcijami kortikosteroidov ali lokalnimi steroidi pod okluzijo lahko poveča penetracijo zdravil. Pri neposlušnih keloidih se je izkazalo, da je kirurška odstranitev, ki ji sledi takojšnja radioterapija, učinkovita. Končno je bilo dokazano, da uporaba silikonske prevleke in tlačne terapije zmanjša verjetnost ponovitve 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 ni enotnega zdravljenja, ki bi zagotavljalo dosledno nizko stopnjo ponovitve keloidov. Vendar se vse večje možnosti, kot je uporaba laserjev poleg steroidov ali kombiniranje 5-fluorouracila s steroidi, izkažejo za obetavne. Prihodnje raziskave bi se lahko osredotočile na to, kako dobro so novi načini zdravljenja, kot je avtologno presaditev maščob ali terapije na osnovi izvornih celic, učinkoviti pri obvladovanju keloidov.
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.
Brazgotine so običajen del procesa celjenja po poškodbah kože. V idealnem primeru bi morale biti brazgotine ravne, tanke in se ujemati z barvo kože. Mnogi dejavniki lahko povzročijo slabo celjenje ran, kot so okužba, zmanjšan pretok krvi, ishemija in travma. Brazgotine, ki so debele, temnejše od okoliške kože ali se pretirano skrčijo, lahko povzročijo znatne težave tako s fizično funkcijo kot s čustvenim zdravjem.
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.
Keloidne brazgotine se pogosteje pojavljajo pri ljudeh afriškega, azijskega ali latinoameriškega porekla. Ljudje, stari od 10 do 30 let, imajo večjo nagnjenost k razvoju keloidov kot starejši.
Čeprav se običajno pojavijo na mestu poškodbe, lahko keloid nastanejo tudi spontano. Lahko se pojavijo na mestu piercinga in celo zaradi nečesa tako preprostega, kot je mozolj ali praska. Pojavijo se lahko kot posledica hudih brazgotin po aknah ali noricah, okužbe na mestu rane, ponavljajoče se poškodbe območja, prekomerne napetosti kože med zapiranjem rane ali tujka v rani.
Keloidne brazgotine se lahko razvijejo po operaciji. Pogostejši so na nekaterih mestih, kot so osrednji del prsnega koša (zaradi sternotomije), hrbet in ramena (običajno so posledica aken) in ušesne mečice (zaradi prebadanja ušes). Lahko se pojavijo tudi na telesnih piercingih. Najpogostejše pike so ušesne mečice, roke, medenični predel in nad ključnico.
Zdravljenja, ki so na voljo, so tlačna terapija, obloga s silikonskim gelom, triamcinolon acetonid znotraj lezije, kriokirurgija, obsevanje, laserska terapija, interferon, 5-FU in kirurška ekscizija.
○ zdravljenje
Hipertrofične brazgotine se lahko izboljšajo s 5 do 10 intralezionalnimi injekcijami steroidov v 1-mesečnem intervalu.
#Triamcinolone intralesional injection
Lasersko zdravljenje se lahko poskusi za eritem, povezan z brazgotinjenjem, vendar lahko injekcije triamcinilona tudi izboljšajo eritem tako, da sploščijo brazgotino.
#Dye laser (e.g. V-beam)