Keloid
☆ Germaniyaning 2022 yilgi Stiftung Warentest natijalariga ko'ra, iste'molchilarning ModelDermdan qoniqish darajasi pullik teletibbiyot maslahatlariga qaraganda bir oz pastroq bo'lgan.
Triamsinolon intralezyonal in'ektsiya bilan davolangan bilakdagi operatsiyadan keyingi keloid. Chap tarafdagi cho'kib ketgan eritema maydoni davolangan joydir.
Chiziqli keloidlar. Ular torsonning yuqori old qismida paydo bo'lganda, ular ko'pincha chiziqli shaklda paydo bo'ladi.
Posterior aurikulyar keloid
Oyoq tagidagi keloidlar yurish uchun noqulay bo'lishi mumkin. Intralezyonal steroid in'ektsiyalari odatda bir necha marta amalga oshiriladi.
Keloidlar odatda yuqori qo'llarda kuzatiladi.
Ko'krak keloidlarining tipik ko'rinishi.
References
Keloidlar terining shikastlanishi yoki yallig'lanishidan keyin g'ayrioddiy shifo tufayli hosil bo'ladi. Irsiy va atrof-muhit omillari ularning rivojlanishiga hissa qo'shadi, afrikalik, osiyolik va ispaniyalik qora tanli odamlarda yuqori ko'rsatkichlar. Keloidlar fibroblastlar haddan tashqari faollashganda, ortiqcha kollagen va o'sish omillarini ishlab chiqarganda paydo bo'ladi. Bu fibroblastlarning ko'payishi bilan birga keloid kollagen deb nomlanuvchi katta, g'ayritabiiy kollagen to'plamlarining shakllanishiga olib keladi. Klinik jihatdan keloidlar ilgari shikastlangan joylarda qattiq, rezina nodullar ko'rinishida namoyon bo'ladi. Oddiy chandiqlardan farqli o'laroq, keloidlar asl shikastlanish joyidan tashqariga chiqadi. Bemorlarda og'riq, qichishish yoki yonish hissi paydo bo'lishi mumkin. Ukol in'ektsiyalari, kriyoterapiya, jarrohlik, radioterapiya va lazer terapiyasi kabi turli xil davolash usullari mavjud.
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.
Hozirgi tadqiqotlar shuni ko'rsatadiki, silikon jel yoki choyshab kortikosteroid in'ektsiyalari bilan birga keloidlarni davolash uchun afzal qilingan dastlabki davolash hisoblanadi. Intralezyonal 5-ftorouratsil (5-FU) , bleomitsin yoki verapamil kabi qo'shimcha davolash usullari ham ko'rib chiqilishi mumkin, ammo ularning samaradorligi farq qiladi. Lazer terapiyasi kortikosteroid in'ektsiyalari yoki okklyuziya ostida topikal steroidlar bilan birgalikda dorilarning kirib borishini kuchaytirishi mumkin. Rekalsitran keloidlar uchun jarrohlik yo'li bilan olib tashlash, so'ngra darhol radiatsiya terapiyasi samarali ekanligini ko'rsatdi. Nihoyat, silikon qoplama va bosim terapiyasidan foydalanish keloidning takrorlanish ehtimolini kamaytirishi isbotlangan.
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.
Hozirgi vaqtda keloidlar uchun doimiy past takrorlanish darajasini kafolatlaydigan yagona o'lchamli davolash usuli yo'q. Biroq, steroidlar bilan bir qatorda lazerlarni qo'llash yoki 5-ftorurasilni steroidlar bilan birlashtirish kabi o'sib borayotgan variantlar istiqbolli. Kelajakdagi tadqiqotlar keloidlarni boshqarishda yangi davolash usullari, masalan, yog 'payvandlash yoki ildiz hujayralariga asoslangan terapiya qanchalik yaxshi ishlashiga e'tibor qaratishi mumkin.
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.
Skarlar teri jarohatlaridan keyin shifo jarayonining keng tarqalgan qismidir. Ideal holda, chandiqlar tekis, ingichka bo'lishi va terining rangiga mos kelishi kerak. Ko'pgina omillar yaraning yomon davolanishiga olib kelishi mumkin, masalan, infektsiya, qon oqimining pasayishi, ishemiya va travma. Qalin, atrofdagi teriga qaraganda quyuqroq yoki haddan tashqari qisqaradigan chandiqlar ham jismoniy, ham hissiy salomatlik bilan bog'liq jiddiy muammolarni keltirib chiqarishi mumkin.
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 chandiqlari ko'proq afrikalik, osiyolik yoki ispaniyalik odamlarda uchraydi. 10 yoshdan 30 yoshgacha bo'lgan odamlarda keloid rivojlanishiga keksalarga qaraganda ko'proq moyil bo'ladi.
Ular odatda shikastlanish joyida paydo bo'lishiga qaramay, keloid o'z-o'zidan paydo bo'lishi mumkin. Ular pirsing joyida va hatto pimple yoki tirnalish kabi oddiy narsalardan ham paydo bo'lishi mumkin. Ular akne yoki suvchechakning kuchli chandiqlari, yara joyida infektsiya, takroriy jarohatlar, yarani yopish paytida terining haddan tashqari kuchlanishi yoki yaradagi begona jism natijasida paydo bo'lishi mumkin.
Jarrohlikdan keyin keloid izlari paydo bo'lishi mumkin. Ular ba'zi joylarda ko'proq uchraydi, masalan, markaziy ko'krak (sternotomiyadan), orqa va elkada (odatda akne natijasida paydo bo'ladi) va quloq bo'laklarida (quloq teshilishidan). Ular tana pirsinglarida ham paydo bo'lishi mumkin. Eng ko'p uchraydigan dog'lar quloq bo'shlig'i, qo'llar, tos mintaqasi va yoqa suyagi ustidadir.
Mavjud muolajalar bosimli terapiya, silikon jel qoplamasi, intra-lezyon triamsinolon asetonid, kriojarrohlik, radiatsiya, lazer terapiyasi, Interferon, 5-FU va jarrohlik eksizyondir.
○ Davolash
Gipertrofik chandiqlar 1 oylik interval bilan 5-10 intralezyonal steroid in'ektsiyalari bilan yaxshilanishi mumkin.
#Triamcinolone intralesional injection
Skarlanish bilan bog'liq eritema uchun lazer bilan davolashni sinab ko'rish mumkin, ammo triamsinilon in'ektsiyalari ham chandiqni tekislash orqali eritemani yaxshilashi mumkin.
#Dye laser (e.g. V-beam)