Keloid - 瘢痕疙瘩
手腕术后出现的疤痕疙瘩，采用曲安西龙(triamcinolone) 病灶内注射治疗。左侧凹陷的红斑区为治疗区域。
线性瘢痕疙瘩。它们出现在躯干上前部时，通常呈线性形状。
耳后瘢痕疙瘩
脚底的疤痕疙瘩在行走时会感到不适。病灶内类固醇注射通常需要多次进行。
疤痕疙瘩常见于上臂。
胸部瘢痕疙瘩的典型表现。
relevance score : -100.0%
References疤痕疙瘩是由于皮肤受伤或炎症后异常愈合而形成的。遗传和环境因素会影响其发生，在非洲、亚洲和西班牙裔深色皮肤人群中，其发病率较高。当成纤维细胞过度活跃、产生过量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），并伴随成纤维细胞增多。临床上，疤痕疙瘩在先前受伤的部位表现为坚硬的橡胶样结节。与普通瘢痕不同，疤痕疙瘩会向原创伤之外延伸。患者常感到疼痛、瘙痒或灼热感。治疗方法包括类固醇注射、冷冻疗法、手术、放射疗法和激光疗法等。
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方案。也可以考虑在病灶内注射5-氟尿嘧啶 (5-FU)、博莱霉素 (bleomycin) 或维拉帕米 (verapamil) 等其他药物，尽管它们的疗效各不相同。激光治疗配合皮质类固醇注射或局部类固醇封闭使用，可增强药物的渗透。对于顽固性疤痕疙瘩，手术切除后立即进行放射治疗已被证实有效。最后，使用硅胶片结合压力疗法可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在较低水平。然而，越来越多的选择，如激光联合类固醇使用，或5-氟尿嘧啶(5-Fluorouracil)联合类固醇使用，已显示出希望。未来的研究可能聚焦于新疗法（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现象。理想情况下，疤痕应平坦、薄且颜色与周围皮肤相匹配。多种因素可导致伤口愈合不良，如感染、血流减少、缺血和创伤。较厚、颜色比周围皮肤深或过度收缩的疤痕，可能严重影响身体功能和情绪健康。
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.
瘢痕疙瘩在非洲、亚洲或西班牙裔人群中更常见。10岁至30岁的人比老年人更容易出现瘢痕疙瘩。
虽然瘢痕疙瘩 (keloid) 通常发生在受伤部位，但也可以自发出现。它们可能出现在穿孔部位，甚至在像粉刺或抓伤这样的小创口中出现。其发生可能与严重的痤疮或水痘疤痕、伤口感染、局部反复外伤、伤口闭合时皮肤过度紧张或伤口中有异物等因素有关。
手术后也可能出现瘢痕疙瘩。它们在某些部位更常见，例如中央胸部（胸骨切开术后）、背部和肩部（常因痤疮）、以及耳垂（穿耳后）。它们也可能出现在身体穿孔处。最常见的部位是耳垂、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
激光治疗可用于改善与疤痕相关的红斑，注射曲安西龙也能通过压平疤痕来减轻红斑。
#Dye laser (e.g. V-beam)