Keloid - 瘢痕疙瘩
手腕上的術後疤痕疙瘩，以曲安西龍病灶內注射治療。左側凹陷的紅斑區域是治療區域。
線性瘢痕疙瘩。當它們出現在軀幹的上前部時，它們通常呈現線性形狀。
耳後瘢瘤
腳底的疤痕疙瘩行走起來會很不舒服。
疤痕疙瘩常見於上臂。
胸部瘢瘤的典型表現。
References
疤痕疙瘩是由於皮膚受傷或發炎後異常癒合而形成的。遺傳和環境因素對其發育有影響，在非洲、亞洲和西班牙裔的深色皮膚個體中，比例較高。當纖維母細胞過度活躍，產生過多的膠原蛋白和生長因子時，就會出現疤痕疙瘩。這導致形成大的、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加。臨床上，疤痕疙瘩在先前受傷的區域表現為堅硬的橡膠狀結節。與正常疤痕不同，疤痕疙瘩會延伸到原來的創傷部位之外。患者可能會感到疼痛、搔癢或灼熱感。有多種治療方法可供選擇，包括類固醇注射、冷凍療法、手術、放射療法和雷射療法。
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，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。也可以考慮病灶內注射 5-氟尿嘧啶 (5-FU) 、博萊黴素或維拉帕米等其他治療方法，儘管它們的效果各不相同。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，手術切除並立即進行放射治療已被證明是有效的。最後，使用矽膠片和壓力療法已被證明可以降低疤痕疙瘩復發的可能性。
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，還沒有萬能的治療方法可以保證疤痕疙瘩的復發率始終保持在較低水準。然而，越來越多的選擇，例如將雷射與類固醇一起使用或將 5-氟尿嘧啶與類固醇結合使用，被證明是有希望的。未來的研究可能集中在新療法（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.
疤痕是皮膚受傷後癒合過程中常見的部位。理想情況下，疤痕應該是平坦、薄且與膚色相匹配。許多因素都會導致傷口癒合不良，例如感染、血流減少、缺血和創傷。較厚、比周圍皮膚顏色更深或過度收縮的疤痕可能會導致身體功能和情緒健康出現嚴重問題。
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、亞洲或西班牙裔人群中更常見。 10歲至30歲之間的人比老年人更容易出現疤痕疙瘩。
雖然 瘢痕疙瘩 (keloid) 通常發生在受傷部位，但也可以自發性出現。它們可能發生在穿孔部位，甚至可能發生在像粉刺或抓傷這樣簡單的地方。它們的發生可能是由於嚴重的痤瘡或水痘疤痕、傷口部位感染、某個區域反覆外傷、傷口閉合過程中皮膚過度緊張或傷口中有異物造成的。
手術後可能會出現瘢瘤。它們在某些部位更常見，例如中央胸部（來自胸骨切開術）、背部和肩膀（通常由痤瘡引起）和耳垂（來自耳洞）。它們也可能出現在身體穿孔上。最常見的斑點是耳垂、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、病灶內曲安奈德、冷凍手術、放射療法、雷射療法、幹擾素、5-FU 和手術切除。
○ 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
可以嘗試雷射治療與疤痕相關的紅斑，但注射曲安西龍也可以透過壓平疤痕來改善紅斑。
#Dye laser (e.g. V-beam)