Keloid
☆ I le 2022 Stiftung Warentest i'uga mai Siamani, o le fa'amalieina o tagata fa'atau i ModelDerm sa na'o sina maualalo ifo nai lo fa'atalanoaga telemedicine totogi.
O se keloid pe a uma le taotoga i luga o le tapulima na togafitia i tui triamcinolone intralesional. O le vaega erythema goto i le itu agavale o le vaega ua togafitia.
Linear Keloids. A tupu i luga o le pito i luga o le tino, e masani ona foliga mai i se laina laina.
Posterior auricular Keloid
Keloids i alofivae e mafai ona le lelei e savali i luga. Intralesional steroid injections e masani ona faia i le tele o taimi.
Keloids e masani ona matauina i luga o lima.
Fa'aaliga masani o keloid fatafata.
References
Keloids e tupu ona o le faʻamalologa e le masani ai pe a uma le paʻu manuʻa poʻo le mumū. O a'afiaga fa'atupu ma le si'osi'omaga e fesoasoani i lo latou atina'e, fa'atasi ai ma le maualuga o fua faatatau i tagata pa'uuliuli o tagata Aferika, Asia, ma Hispanic. Keloids e tupu pe a ova le fibroblasts, e maua ai le tele o collagen ma le tuputupu aʻe. O le mea lea e o'o atu ai i le fa'atupuina o fusi lapopo'a e le masani ai e ta'ua o le keloidal collagen, fa'atasi ai ma le fa'ateleina o fibroblasts. I le falema'i, o keloid e foliga mai o ni nodule mautu i vaega na manu'a muamua. E le pei o ma'ila masani, o keloids e o'o atu i tua atu o le nofoaga muamua o manu'a. E ono maua e tagata ma'i le tiga, mageso, po'o le mu. O lo'o maua togafitiga eseese, e aofia ai tui fa'ama'i, cryotherapy, taotoga, radiotherapy, ma le 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.
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.
O suʻesuʻega o loʻo i ai nei o loʻo fautua mai ai o le silicone gel poʻo le laupepa faʻatasi ai ma tui corticosteroid o le togafitiga muamua e sili ona lelei mo keloids. Togafitiga fa'aopoopo e pei ole intralesional 5-fluorouracil (5-FU) , bleomycin, po'o le verapamil e mafai fo'i ona iloiloina, e ui ina eseese lo latou aoga. Leisa togafitiga, pe a tuʻufaʻatasia ma tui corticosteroid poʻo vailaʻau faʻamaʻi i lalo ole occlusion, e mafai ona faʻaleleia ai le faʻaogaina o vailaʻau. Mo keloids toe fa'afoliga, o le tipi'esea o ta'otoga soso'o ma le fa'amama fa'avevela fa'afuase'i ua fa'aalia e aoga. Ma le mea mulimuli, o le faʻaaogaina o laupepa silikoni ma le faʻamalosia o togafitiga ua faʻamaonia e faʻaitiitia ai le ono mafai ona toe foʻi mai le 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 le taimi nei, e leai se togafitiga e tasi e fetaui ma mea uma e faʻamautinoa ai le maualalo o le toe foʻi mai o keloids. Ae ui i lea, o le faʻatupulaia o filifiliga, e pei o le faʻaogaina o lasers faʻatasi ma steroids poʻo le tuʻufaʻatasia o le 5-fluorouracil ma steroids, o loʻo faʻamaonia le manuia. O su'esu'ega i le lumana'i e mafai ona taula'i i le lelei o togafitiga fou, e pei o le su'iina o ga'o autologous po'o togafitiga fa'avae sela, e galue mo le puleaina o 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.
O ma'ila o se vaega masani o le fa'amalologa pe a uma manu'a pa'u. O le mea lelei, o ma'ila e tatau ona mafolafola, manifinifi, ma fetaui ma le lanu o le pa'u. E tele mea e mafai ona oʻo atu ai i le le lelei o le faʻamalolo o manuʻa, e pei o faʻamaʻi pipisi, faʻaitiitia le tafe toto, ischemia, ma manuʻa. O ma'ila e mafiafia, e sili atu le pogisa nai lo le pa'u o lo'o siomia ai, po'o le fa'afefe tele e mafai ona mafua ai ni fa'afitauli ogaoga i le tino ma le soifua maloloina o lagona.
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.
Keloid ma'ila e vaaia soo i tagata o Aferika, Asia, po o le Hispanic tupuaga. O tagata i le va o le 10 ma le 30 tausaga le matutua e sili atu le maualuga e atiaʻe se keloid nai lo tagata matutua.
E ui lava e masani ona tupu i le nofoaga o se manu'a, keloid e mafai foi ona tula'i fa'afuase'i. E mafai ona tupu i luga o le nofoaga o se tui ma e oʻo lava mai se mea faigofie e pei o se pimple poʻo se maosi. E mafai ona tupu ona o le tuga o le ma'ila po'o le ma'ila moa, fa'ama'i i se nofoaga o manu'a, fa'alavelave fa'afuase'i i se vaega, ma'a'a tele le pa'u a'o tapuni le manu'a po'o se tino mai fafo i se manu'a.
Keloid ma'ila e mafai ona tupu pe a uma le taotoga. E sili atu ona taatele i nisi nofoaga, e pei o le fatafata tutotonu (mai le sternotomy), tua ma tauau (e masani ona mafua mai i le paʻu), ma le taliga taliga (mai le tatui o taliga). E mafai fo'i ona tupu ile tui o le tino. O pito sili ona taatele o taliga, lima, pelvic region, ma luga o le ponaivi kola.
Togafitiga o lo'o maua o le fa'aosoina o le fa'amalositino, silicone gel ie, intra-lesional triamcinolone acetonide, cryosurgery, radiation, laser therapy, Interferon, 5-FU ma le taotoga fa'apitoa.
○ Togafitiga
E mafai ona fa'aleleia le ma'ila o le Hypertrophic ile 5 i le 10 tui fa'ama'i fa'ama'i ile 1 masina.
#Triamcinolone intralesional injection
E mafai ona fa'ata'ita'iina togafitiga fa'a leisa mo erythema e feso'ota'i ma ma'ila, peita'i e mafai fo'i e tui o le triamcinilone ona fa'aleleia atili le erythema e ala i le fa'amafola o le ma'ila.
#Dye laser (e.g. V-beam)