Treatment of keloids using 5‐fluorouracil in combination with crystalline triamcinolone acetonide suspension: evaluating therapeutic effects by using non‐invasive objective measures

Background Intralesional 5‐fluorouracil (5‐FU) in combination with triamcinolone acetonide (TAC) has been recommended as a promising alternative for keloids not responding to silicone‐based products, cryotherapy or intralesional corticosteroids alone. Although numerous studies support the efficacy of this regime, there is a lack of objective data. Objectives In this study, we evaluate the therapeutic effect of four courses of intralesional 5‐FU in combination with TAC (3 : 1) utilizing 3D analysis (PRIMOS®pico), ultrasound and scar scales such as the Patient and Observer Scar Assessment Scales (POSAS) and the Dermatology Life Quality Index (DLQI). Methods Twenty‐five patients with keloids were treated using 5‐FU and TAC every 4 weeks. Objective assessments were performed and the scar scales administered at baseline, as well as during consecutive visits at 1‐ and 12‐month follow‐up (FU). Routine laboratory tests were performed at baseline and at 1‐month FU. Results 3D PRIMOS and ultrasound measurements revealed highly significant and stable reductions in height (baseline mean score: 4.0 ± 1.7 mm, 1‐month FU mean score: 1.5 ± 0.8 mm, 12‐month FU mean score: 1.8 ± 0.9 mm, P = <0.0001), volume (baseline mean score: 1,105 ± 911.5 mm3, 1‐month FU mean score: 416.1 ± 218.1 mm3, 12‐month FU mean sore: 431.2 ± 253.6 mm3, P = <0.0001, respectively) and penetration depth of keloids (relative reduction between baseline and 12‐month FU of 74.4%, P = <0.0001). The POSAS and DLQI scales confirmed significant objective and subjective improvements in scar appearance in all categories. The life quality associated with keloid appearance improved from a ‘moderate effect’ to a ‘small effect’ throughout the course of the study. Conclusions Results of this study confirm the efficacy and safety of the combination of 5‐FU and TAC in keloids. Treatments were well tolerated and demonstrated stable results at 12‐month FU

Evaluation der fraktionierten, nicht-ablativen 1565nm Lasertherapie von Selbstverletzungsnarben und Striae distensae albae anhand von objektiven Messmethoden

Das vorliegende Forschungsvorhaben untersucht erstmalig die Wirksamkeit eines fraktionierten, nicht-ablativen 1565nm Er:glass Lasers bei reifen Selbstverletzungsnarben. Für diesen Narbensubtyp existieren, neben der chirurgischen Exzision, nur wenige Behandlungsoptionen. Der Einsatz des Lasers stellt eine neue, minimal-invasive Therapiemöglichkeit für diese Indikation dar. Zur Evaluation des Therapieverlaufs wurden etablierte Messmethoden eingesetzt. Neben standardisierten Fragebögen, wie dem POSAS und dem DLQI, sowie einer digitalen und dreidimensionalen Fotodokumentation, lag ein besonderer Fokus in der objektiven Messmethodik (PRIMOS). Durch den Einsatz von PRIMOS konnten Veränderungen in der Narbenoberfläche objektiv evaluiert und durch absolute Zahlen in Mikrometern beziffert werden. In der Therapie von SD albae nimmt der Einsatz von Licht- und Lasersystemen bereits heute einen zentralen Stellenwert ein. Obwohl es unzählige Studien zu verschiedenen Lasern und Wellenlängen in der Therapie von SD albae gibt, führen diese nur selten objektive Daten zur Unterstützung Ihrer Ergebnisse auf. Meist werden nur fotodokumentierte Vorher-Nachher Vergleiche oder die Patientenzufriedenheit nach Lasertherapie zur Evaluation des Therapieerfolges verwendet. Das vorliegende Forschungsprojekt soll anhand der etablierten Messmethoden zur Beurteilung von Narbengeweben den Einsatz eines fraktionierten, nicht-ablativen 1565nm Er:glass Lasers in der Behandlung von reifen SD albae objektivieren. Die Ergebnisse dieser Arbeit wurden in internationalen Fachjournalen veröffentlicht

Evaluation der fraktionierten, nicht-ablativen 1565nm Lasertherapie von Selbstverletzungsnarben und Striae distensae albae anhand von objektiven Messmethoden

Das vorliegende Forschungsvorhaben untersucht erstmalig die Wirksamkeit eines fraktionierten, nicht-ablativen 1565nm Er:glass Lasers bei reifen Selbstverletzungsnarben. Für diesen Narbensubtyp existieren, neben der chirurgischen Exzision, nur wenige Behandlungsoptionen. Der Einsatz des Lasers stellt eine neue, minimal-invasive Therapiemöglichkeit für diese Indikation dar. Zur Evaluation des Therapieverlaufs wurden etablierte Messmethoden eingesetzt. Neben standardisierten Fragebögen, wie dem POSAS und dem DLQI, sowie einer digitalen und dreidimensionalen Fotodokumentation, lag ein besonderer Fokus in der objektiven Messmethodik (PRIMOS). Durch den Einsatz von PRIMOS konnten Veränderungen in der Narbenoberfläche objektiv evaluiert und durch absolute Zahlen in Mikrometern beziffert werden. In der Therapie von SD albae nimmt der Einsatz von Licht- und Lasersystemen bereits heute einen zentralen Stellenwert ein. Obwohl es unzählige Studien zu verschiedenen Lasern und Wellenlängen in der Therapie von SD albae gibt, führen diese nur selten objektive Daten zur Unterstützung Ihrer Ergebnisse auf. Meist werden nur fotodokumentierte Vorher-Nachher Vergleiche oder die Patientenzufriedenheit nach Lasertherapie zur Evaluation des Therapieerfolges verwendet. Das vorliegende Forschungsprojekt soll anhand der etablierten Messmethoden zur Beurteilung von Narbengeweben den Einsatz eines fraktionierten, nicht-ablativen 1565nm Er:glass Lasers in der Behandlung von reifen SD albae objektivieren. Die Ergebnisse dieser Arbeit wurden in internationalen Fachjournalen veröffentlicht

Psychological stress on the prognosis of postoperative fibroproliferative scars recurrence

Introduction: Chronicity, prolonged and painful treatments and high rates of recurrence make the pathogenesis of keloid and hypertrophic scars the constant target of research. Some hypotheses propose a relationship of immune, genetic, metabolic, vascular, endocrine, sebaceous and viral factors. The influence of the nervous system on the induction and exacerbation of skin diseases has already been well defined in dermatopathies, such as psoriasis, vitiligo, and atopic dermatitis. However, for fibroproliferative scars, there is still no evidence of the importance of psychological stress in the formation of these injuries. Objective: Our goal was to investigate psychological stress on the prognosis of the postoperative recurrence of fibroproliferative scars. Methods: Patients with fibroproliferative scars (n=25), candidates for surgical resection and postoperative radiotherapy, had their psychological stress evaluated on the day before the surgical procedure. The parameters evaluated were pain and itching (Visual Numerical Scale), quality of life (Questionnaire QualiFibro/Plastic Surgery-UNIFESP), perceived stress (Perceived Stress Scale), depression and anxiety (Hospital Depression and Anxiety Scale), salivary cortisol and minimum and maximum galvanic skin responses (GSR) at rest and under stress (i.e., while the questionnaires were being filled out). Patients were evaluated during the 3rd, 6th, 9th and 12th months of postoperative care. During each return visit, two experts classified the lesions as non-recurrent and recurrent. Results: The recurrence group presented the greatest values in GSR during a stressful situation. The chance of recurrence increased by 34% at each increase of 1000 arbitrary units in maximum GSR during stress. Conclusion: Psychological stress influenced the recurrence of fibroproliferative scars.Introdução: A cronicidade, os tratamentos prolongados e dolorosos e as altas taxas de recidiva fazem da patogênese do queloide e cicatrizes hipertróficas alvo de permanente investigação. Algumas teorias propuseram a relação de fatores imunológicos, metabólicos, vasculares, genéticos, endócrinos, sebáceos e até virais. A influência do sistema nervoso na indução e exacerbação das doenças cutâneas já está bem definida em dermopatias como psoríase, vitiligo, e dermatite atópica. Entretanto, para os distúrbios cicatriciais fibroproliferativos, apesar de alguns estudos mostrarem indícios, ainda não existe evidência sobre a importância do estresse psicológico na formação dessas lesões. Objetivo: investigar o estresse psicológico no prognóstico de recidiva pós-operatória de cicatrizes fibroproliferativas. Métodos: Pacientes com cicatrizes fibroproliferativas (n=25), candidatos à ressecção cirúrgica e radioterapia pós-operatória, passaram por avaliação do estresse psicológico na véspera do procedimento cirúrgico. Os parâmetros avaliados foram: dor e prurido (Escala Visual Numérica), qualidade de vida (Questionário QualiFibro), estresse percebido (Escala de Estresse Percebido), depressão e ansiedade (Escala Hospitalar de Depressão e Ansiedade), cortisol salivar e Resposta Galvânica da Pele (GSR) mínima e máxima, ao repouso e sob estresse (durante o preenchimento dos questionários). Os pacientes foram avaliados no 3º, 6º, 9º e 12º meses de pós-operatório. Em cada retorno, dois especialistas classificavam as lesões em não-recidivada e recidivada. Resultados: O grupo Recidiva apresentou maiores valores na GSR durante a situação de estresse. A chance de recidiva aumentou em 34% a cada aumento de 1000 unidades arbitrárias na GSR máxima em estresse. Conclusão: O estresse psicológico influenciou na recidiva de cicatrizes fibroproliferativas.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)TEDEBV UNIFESP: Teses e dissertaçõe

Providing Comprehensive Psychosocial Care for Adolescents with Keloids in Dermatology Practice

Keloids, characterized by excessive collagen deposition resulting in raised and often painful scars, profoundly affect the psychosocial well-being of adolescents, leading to anxiety, depression, and social withdrawal during a critical period of identity formation. Current literature highlights these challenges but lacks comprehensive management strategies within dermatological practice. This review identifies the need for integrated care models that combine clinical treatment with mental health support, including routine psychosocial screening, immediate counseling referrals, and adolescent-specific education programs on keloid management and emotional coping. Training dermatologists to recognize psychological distress and adopt compassionate communication is essential. Collaborative research should focus on evaluating these integrative care models and developing evidence-based guidelines. By pioneering these comprehensive strategies, dermatology practices can improve physical outcomes and significantly enhance the quality of life for adolescents with keloids, addressing both the physical and psychological scars. Future research should prioritize the longitudinal impact of these interventions on mental health and treatment adherence, establishing a new standard of care that fully supports adolescent keloid patients. By implementing these comprehensive strategies, dermatology practices can enhance physical outcomes and significantly improve the quality of life for adolescents with keloids, addressing both the physical and psychological impacts in the management of keloids in this vulnerable population

การศึกษาเปรียบเทียบประสิทธิผลของเจลซิลิโคนที่มีส่วนประกอบของสารสกัดหัวหอมและว่านหางจระเข้กับแผ่นเจลซิลิโคนในการป้องกันการเกิดรอยแผลเป็นนูนหลังผ่าตัด

MASTER OF SCIENCE (M.Sc.)วิทยาศาสตรมหาบัณฑิต (วท.ม.)Hypertrophic scars and keloids may cause post-surgery problems. Some studies showed that onion extract and aloe vera might be beneficial for postoperative scars. However, few of the randomized clinical trials were investigated. Aim of this study was to compare the efficacy of silicone gel containing onion extract and aloe vera (SGOA) to silicone gel sheets (SGS) to prevent postoperative hypertrophic scars and keloids. The prospective randomized assessor-blind controlled trial was conducted with 40 patients who had undergone surgery. The patients were divided into two groups. The first group was treated with SGOA, while the second group was treated with SGS. The patients were evaluated after one, two, and three months. The objective assessment was to determine the incidences of scarring, erythema, and melanin values using Mexameter, and pliability through Cutometer. The subjective assessment consisted of the patient and observer scar assessment scale (POSAS), and patient satisfaction.  After the twelve-week follow up, there was no statistically significant differences in the scarring incidence rate of both groups (p=0.465). None of these patients developed keloids. There were no statistical differences in the POSAS score, erythema, melanin value, and pliability between both groups. In addition, pain and itchiness significantly decreased in both groups. The patients were highly satisfied with both treatments. No adverse effects were reported in either group. SGOA is effective at preventing in prevent hypertrophic scars and keloids as SGS. Therefore, it can be one of the alternatives for preventing postoperative scars.รอยแผลเป็นนูนเป็นปัญหาที่พบได้บ่อยหลังการผ่าตัด มีการศึกษาประสิทธิผลของสารสกัดจากหัวหอมและว่านหางจระเข้ต่อรอยแผลหลังจากการผ่าตัดแต่ยังไม่มากนัก  งานวิจัยนี้จึงได้ศึกษาประสิทธิผลของการใช้เจลซิลิโคนที่มีส่วนประกอบหลักของสารสกัดจากหัวหอมและว่านหางจระเข้ เปรียบเทียบกับการใช้แผ่นเจลซิลิโคนในคนไข้หลังการผ่าตัดเพื่อป้องกันการเกิดรอยแผลเป็นนูน ซึ่งเป็นการทดลองแบบสุ่ม ที่มีการอำพรางผู้ประเมินเพียงฝ่ายเดียว ในอาสาสมัครจำนวน 40 คน โดยแบ่งคนไข้ออกเป็นสองกลุ่ม กลุ่มละ 20 คน กลุ่มหนึ่งจะได้รับการรักษาโดยใช้ซิลิโคนเจลที่มีส่วนประกอบหลักของสารสกัดจากหัวหอมและว่านหางจระเข้และอีกกลุ่มจะได้รับการรักษาด้วยแผ่นเจลซิลิโคน  นัดมาติดตามผลในเดือนที่ 1,2 และ 3  การประเมินประกอบด้วย อุบัติการณ์การเกิดรอยแผลเป็นนูน ระดับความแดงและความเข้มเม็ดสี จากเครื่อง Mexameter® ระดับความยืดหยุ่น จากเครื่อง Cutometer®  แบบสอบถาม Patient and observer scar assessment scale (POSAS) รวมถึง ความพึงพอใจของอาสาสมัคร ผลการศึกษาพบว่าอัตราการเกิดรอยแผลเป็นนูนชนิดธรรมดาทั้งสองกลุ่มไม่มีความแตกต่างกันอย่างมีนัยสำคัญทางสถิติ (p=0.465) ไม่พบการเกิดรอยแผลเป็นนูนชนิดคีรอยด์ทั้งสองกลุ่ม อีกทั้งไม่พบความแตกต่างอย่างมีนัยสำคัญทางสถิติของคะแนน POSAS ทั้งในส่วนที่แพทย์และอาสาสมัครประเมิน ค่าความแดง ความเข้มเม็ดสีและค่าความยืดหยุ่น นอกจากนี้อาการเจ็บและอาการคันพบว่าลดลงอย่างมีนัยสำคัญทางสถิติทั้งสองกลุ่ม อาสาสมัครพึงพอใจมากกับทั้งสองการรักษาและไม่พบผลข้างเคียงในทั้งสองกลุ่ม จึงได้ข้อสรุปว่าเจลซิลิโคนที่มีส่วนประกอบหลักของสารสกัดจากหัวหอมและว่านหางจระเข้ มีประสิทธิผลเทียบเท่ากับแผ่นเจลซิลิโคนในการป้องกันรอยแผลเป็นนูน จึงสามารถเป็นอีกหนึ่งทางเลือกสำหรับการปเองกันรอยแผลเป็นนูนหลังผ่าตัดได

Less is More in Keloid Disease : a Clinical Study

The overall aim of the present research project was to improve health care for keloid patients. We started by determining the burden of keloid disease and analyzing what factors add to the disease burden. After identifying which factors cause the greatest quality of life impairment, treatments can be aimed to improve these factors affecting quality of life most. Many keloid patients report pain as their main symptom, however, often no treatment is prescribed to relieve pain. To explore symptomatic therapy options we need to know more of the etiology and kind of pain in keloid patients. Our aim to reduce the use of brachytherapy in keloid patients stimulated us to investigate whether other treatments could be effectively used as well and whether radiation doses could be reduced. In this way we wanted to provide scientific evidence guiding clinicians in their choice of treatment, mainly based on patient reported outcome measures