Keloid - 瘢痕疙瘩
手腕上的術後疤痕疙瘩，使用 triamcinolone(曲安西龍) 於病灶內注射治療。左側凹陷的紅斑區域為治療區域。
線性瘢痕疙瘩。當它們出現在軀幹的上前部時，通常呈線性形狀。
耳後瘢瘤
腳底的疤痕疙瘩在行走時會感到不適。
疤痕疙瘩常見於上臂。
胸部瘢瘤的典型表現。
relevance score : -100.0%
References疤痕疙瘩是由於皮膚受傷或發炎後異常癒合而形成的。遺傳與環境因素會影響其發生，在非洲、亞洲及西班牙裔的深色皮膚族群中，其發生率較高。當纖維母細胞過度活躍，產生過多的膠原蛋白與生長因子時，就會形成疤痕疙瘩。這會導致大型、異常的膠原蛋白束（稱為瘢瘤膠原蛋白）以及成纖維細胞的增生。臨床上，疤痕疙瘩在先前受傷的部位呈現堅硬、橡膠狀的結節。與普通疤痕不同，疤痕疙瘩會向原創傷以外的區域延伸。患者可能會感到疼痛、搔癢或灼熱感。治療方式包括類固醇注射、冷凍療法、手術、放射療法及雷射療法等。
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.
目前的研究顯示，矽膠或矽膠片合併皮質類固醇注射是治療疤痕疙瘩的首選初始治療方法。也可以考慮在病灶內注射 5-氟尿嘧啶 (5-FU)、bleomycin(博萊黴素) 或 verapamil(維拉帕米) 等其他治療方式，儘管其效果各有差異。雷射治療與皮質類固醇注射或閉塞下局部類固醇結合使用，可增強藥物的滲透。對於頑固性疤痕疙瘩，手術切除後立即進行放射治療已證實有效。最後，使用矽膠片搭配壓力療法亦可降低疤痕疙瘩復發的機率。
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，仍未有萬能的治療方法能保證疤痕疙瘩的復發率持續維持在較低水平。然而，越來越多的選擇，如雷射結合類固醇或 5-氟尿嘧啶結合類固醇，已顯示出希望。未來的研究可能會聚焦於新療法（例如自體脂肪移植或基於幹細胞的療法）在治療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.
疤痕是皮膚受傷後在癒合過程中常見的結果。理想情況下，疤痕應該平坦、薄且與膚色相匹配。許多因素會導致傷口癒合不良，例如感染、血流減少、缺血和創傷。較厚、顏色較深或過度收縮的疤痕，可能嚴重影響身體功能與情緒健康。
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、亞洲或西班牙裔人群中較常見，10 歲至 30 歲之間的人比老年人更容易出現。
雖然瘢痕疙瘩 (Keloid) 通常發生在受傷部位，但也可自發性出現，可能出現在穿孔部位，甚至在粉刺或抓傷等較小的創口。其形成原因可能包括嚴重的痤瘡或水痘疤痕、傷口感染、局部反覆外傷、傷口閉合時皮膚過度緊張，或傷口中有異物。
手術後也可能出現瘢痕疙瘩，常見於中央胸部（如胸骨切開術後）、背部和肩膀（多因痤瘡）、以及耳垂（穿耳後）。最常見的部位還包括手臂、骨盆區域和鎖骨上方。
可用的治療方法包括壓力療法、矽膠片、病灶內 Triamcinolone、冷凍手術、放射療法、雷射療法、干擾素、5‑FU 以及手術切除。
○ 治療
間隔 1 個月進行 5 至 10 次病灶內類固醇注射，可改善肥厚性疤痕。
#Triamcinolone intralesional injection
可嘗試雷射治療以減輕疤痕相關的紅斑，亦可使用 Triamcinolone 注射來壓平疤痕，改善紅斑。
#Dye laser (e.g. V-beam)