Keloid - 瘢痕疙瘩
手腕上的术后疤痕疙瘩，采用曲安西龙病灶内注射治疗。左侧凹陷的红斑区域是治疗区域。
线性瘢痕疙瘩。当它们出现在躯干的上前部时，它们通常呈线性形状。
耳后瘢痕疙瘩
脚底的疤痕疙瘩行走起来会很不舒服。病灶内类固醇注射通常需要进行多次。
疤痕疙瘩常见于上臂。
胸部瘢痕疙瘩的典型表现。
References
疤痕疙瘩是由于皮肤受伤或炎症后异常愈合而形成的。遗传和环境因素对其发育有影响，在非洲、亚洲和西班牙裔的深色皮肤个体中，这一比例较高。当成纤维细胞过度活跃，产生过多的胶原蛋白和生长因子时，就会出现疤痕疙瘩。这导致形成大的、异常的胶原蛋白束（称为瘢痕疙瘩胶原蛋白），以及成纤维细胞的增加。临床上，疤痕疙瘩在先前受伤的区域表现为坚硬的橡胶状结节。与正常疤痕不同，疤痕疙瘩会延伸到原来的创伤部位之外。患者可能会感到疼痛、瘙痒或烧灼感。有多种治疗方法可供选择，包括类固醇注射、冷冻疗法、手术、放射疗法和激光疗法。
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.
目前的研究表明，硅胶或硅胶片联合皮质类固醇注射是治疗疤痕疙瘩的首选初始治疗方法。也可以考虑病灶内注射 5-氟尿嘧啶 (5-FU) 、博莱霉素或维拉帕米等其他治疗方法，尽管它们的效果各不相同。激光治疗与皮质类固醇注射或闭塞下局部类固醇结合使用，可以增强药物的渗透。对于顽固性疤痕疙瘩，手术切除并立即进行放射治疗已被证明是有效的。最后，使用硅胶片和压力疗法已被证明可以降低疤痕疙瘩复发的可能性。
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.
目前，还没有一种万能的治疗方法可以保证疤痕疙瘩的复发率始终保持较低水平。然而，越来越多的选择，例如将激光与类固醇一起使用或将 5-氟尿嘧啶与类固醇结合使用，被证明是有希望的。未来的研究可能集中于新疗法（例如自体脂肪移植或基于干细胞的疗法）在治疗疤痕疙瘩方面的效果。
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.
疤痕是皮肤受伤后愈合过程中的常见部分。理想情况下，疤痕应该平坦、薄且与肤色相匹配。许多因素都会导致伤口愈合不良，例如感染、血流减少、缺血和创伤。较厚、比周围皮肤颜色更深或过度收缩的疤痕可能会导致身体功能和情绪健康出现严重问题。
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.
疤痕疙瘩在非洲、亚洲或西班牙裔人群中更常见。 10岁至30岁之间的人比老年人更容易出现疤痕疙瘩。
虽然 瘢痕疙瘩 (keloid) 通常发生在受伤部位，但也可以自发出现。它们可能发生在穿孔部位，甚至可能发生在像粉刺或抓伤这样简单的地方。它们的发生可能是由于严重的痤疮或水痘疤痕、伤口部位感染、某个区域反复外伤、伤口闭合过程中皮肤过度紧张或伤口中有异物造成的。
手术后可能会出现瘢痕疙瘩。它们在某些部位更常见，例如中央胸部（来自胸骨切开术）、背部和肩膀（通常由痤疮引起）和耳垂（来自耳洞）。它们也可能出现在身体穿孔上。最常见的斑点是耳垂、手臂、骨盆区域和锁骨上方。
可用的治疗方法包括压力疗法、硅胶片、病灶内曲安奈德、冷冻手术、放射疗法、激光疗法、干扰素、5-FU 和手术切除。
○ 治疗
间隔 1 个月进行 5 至 10 次病灶内类固醇注射可改善肥厚性疤痕。
#Triamcinolone intralesional injection
可以尝试激光治疗与疤痕相关的红斑，但注射曲安西龙也可以通过压平疤痕来改善红斑。
#Dye laser (e.g. V-beam)