1
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Huang Y, Ren S, Yang Q. Efficacy and Safety of Excision Combination Therapies for Earlobe Keloids: A Systematic Review and Meta-analysis. Aesthetic Plast Surg 2024:10.1007/s00266-024-04092-0. [PMID: 38789810 DOI: 10.1007/s00266-024-04092-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 04/15/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND Different combinations of excision and adjuvant therapies have been applied to improve outcomes for earlobe keloids, though evidence in this field is still lacking. OBJECTIVES This study sought to systematically investigate efficacy and safety of these treatments. METHODS We conducted a systematic search on PubMed, Embase, Web of Science, and Cochrane Library to find all relevant studies. Meta-analysis of recurrence rates (RRs) and adverse event rates with 95% confidence intervals, and individual participants data (IPD) were calculated for each intervention when possible. Otherwise, narrative syntheses were performed. RESULTS A total of 85 articles, covering 23 treatments for earlobe keloids, were included, indicating a preference for multiple combination therapy. The estimated RRs for 6 interventions (i.e., excision monotherapy, combinations of excision with imiquimod, pressure therapy, radiotherapy, steroids, and steroids with pressure therapy) appeared to be comparable. Electron radiotherapy was found to have potential advantages over X-ray treatment, contributing to the observed heterogeneity. Further meta-analysis using IPD revealed that both combination therapies of excision plus steroid therapy (p=0.003) and excision plus radiotherapy (p=0.003) yielded better recurrence-free survival compared to excision alone. The median recurrence-free interval for combination therapy was 10 months. Adverse event rates were similar among different intervention groups. CONCLUSIONS This study suggests that combining excision with radiotherapy or perioperative steroid therapy has the potential to improve prognosis of earlobe keloids without increasing the risk of adverse events. Overall evaluation of patients' conditions and further studies with sufficient follow-up are warranted for clinical practice. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Ying Huang
- Department of Comprehensive Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Badachu Road 33, Beijing, People's Republic of China
| | - Shuofang Ren
- Department of Cardiac Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Qinghua Yang
- Department of Comprehensive Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Badachu Road 33, Beijing, People's Republic of China.
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2
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Chen T, Wang Z, Gong X, Zhang J, Zhang N, Yang J, Zhu Y, Zhou Y. Preparation of Compound Salvia miltiorrhiza- Blumea balsamifera Nanoemulsion Gel and Its Effect on Hypertrophic Scars in the Rabbit Ear Model. Mol Pharm 2024; 21:2298-2314. [PMID: 38527915 DOI: 10.1021/acs.molpharmaceut.3c01091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
Hypertrophic scars (HS) still remain an urgent challenge in the medical community. Traditional Chinese medicine (TCM) has unique advantages in the treatment of HS. However, due to the natural barrier of the skin, it is difficult for the natural active components of TCM to more effectively penetrate the skin and exert therapeutic effects. Therefore, the development of an efficient drug delivery system to facilitate enhanced transdermal absorption of TCM becomes imperative for its clinical application. In this study, we designed a compound Salvia miltiorrhiza-Blumea balsamifera nanoemulsion gel (CSB-NEG) and investigated its therapeutic effects on rabbit HS models. The prescription of CSB-NEG was optimized by single-factor, pseudoternary phase diagram, and central composite design experiments. The results showed that the average particle size and PDI of the optimized CSB-NE were 46.0 ± 0.2 nm and 0.222 ± 0.004, respectively, and the encapsulation efficiency of total phenolic acid was 93.37 ± 2.56%. CSB-NEG demonstrated excellent stability and skin permeation in vitro and displayed a significantly enhanced ability to inhibit scar formation compared to the CSB physical mixture in vivo. After 3 weeks of CSB-NEG treatment, the scar appeared to be flat, pink, and flexible. Furthermore, this treatment also resulted in a decrease in the levels of the collagen I/III ratio and TGF-β1 and Smad2 proteins while simultaneously promoting the growth and remodeling of microvessels. These findings suggest that CSB-NEG has the potential to effectively address the barrier properties of the skin and provide therapeutic benefits for HS, offering a new perspective for the prevention and treatment of HS.
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Affiliation(s)
- Teng Chen
- College of Pharmaceutical Sciences, Guizhou University of Traditional Chinese Medicine, Guiyang 550025, China
- Nano-drug Technology Research Center of Guizhou University of Traditional Chinese Medicine, Guiyang 550025, China
| | - Zuhua Wang
- College of Pharmaceutical Sciences, Guizhou University of Traditional Chinese Medicine, Guiyang 550025, China
- Nano-drug Technology Research Center of Guizhou University of Traditional Chinese Medicine, Guiyang 550025, China
| | - Xingchu Gong
- Pharmaceutical Informatics Institute, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou 310058, China
| | - Jiaojiao Zhang
- College of Food and Health, Zhejiang A&F University, Hangzhou 311300, China
| | - Ning Zhang
- School of Acupuncture-Moxibustion and Tuina, Guizhou University of Traditional Chinese Medicine, Guiyang 550025, China
| | - Jing Yang
- College of Pharmaceutical Sciences, Guizhou University of Traditional Chinese Medicine, Guiyang 550025, China
| | - Yue Zhu
- College of Pharmaceutical Sciences, Guizhou University of Traditional Chinese Medicine, Guiyang 550025, China
- Nano-drug Technology Research Center of Guizhou University of Traditional Chinese Medicine, Guiyang 550025, China
| | - Ying Zhou
- College of Pharmaceutical Sciences, Guizhou University of Traditional Chinese Medicine, Guiyang 550025, China
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3
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Kuhar HN, Nesemeier R, Kim LR. Prevention and Management of Complications in Nasal Reconstruction. Facial Plast Surg Clin North Am 2024; 32:303-313. [PMID: 38575288 DOI: 10.1016/j.fsc.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
Nasal reconstruction is a challenging practice with the potential for complications. Surgeons can prevent complications through preoperative optimization of patient factors, refinement of intraoperative surgical techniques, and postoperative surgical and nonsurgical wound care. Preoperatively, optimization of modifiable and recognition of nonmodifiable risk factors is paramount. Intraoperatively, meticulous flap design and surgical technique promote healing. In the postoperative setting, attentive wound care, adjuvant therapies, and close follow-up for consideration of additional procedures enhance outcomes. By anticipating potential complications across perioperative settings, surgeons can prevent common complications in nasal reconstruction and more effectively manage those complications that arise.
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Affiliation(s)
- Hannah N Kuhar
- Department of Otolaryngology-Head and Neck Surgery, Ohio State University Wexner Medical Center, Ohio State Eye and Ear Institute, 915 Olentangy River Road, Suite 4000, Columbus, OH 43212, USA
| | - Ryan Nesemeier
- Department of Otolaryngology-Head and Neck Surgery, Ohio State University Wexner Medical Center, Ohio State Eye and Ear Institute, 915 Olentangy River Road, Suite 4000, Columbus, OH 43212, USA
| | - Leslie R Kim
- Department of Otolaryngology-Head and Neck Surgery, Ohio State University Wexner Medical Center, Ohio State Eye and Ear Institute, 915 Olentangy River Road, Suite 4000, Columbus, OH 43212, USA.
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4
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Murakami T, Shigeki S. Pharmacotherapy for Keloids and Hypertrophic Scars. Int J Mol Sci 2024; 25:4674. [PMID: 38731893 PMCID: PMC11083137 DOI: 10.3390/ijms25094674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 04/19/2024] [Accepted: 04/23/2024] [Indexed: 05/13/2024] Open
Abstract
Keloids (KD) and hypertrophic scars (HTS), which are quite raised and pigmented and have increased vascularization and cellularity, are formed due to the impaired healing process of cutaneous injuries in some individuals having family history and genetic factors. These scars decrease the quality of life (QOL) of patients greatly, due to the pain, itching, contracture, cosmetic problems, and so on, depending on the location of the scars. Treatment/prevention that will satisfy patients' QOL is still under development. In this article, we review pharmacotherapy for treating KD and HTS, including the prevention of postsurgical recurrence (especially KD). Pharmacotherapy involves monotherapy using a single drug and combination pharmacotherapy using multiple drugs, where drugs are administered orally, topically and/or through intralesional injection. In addition, pharmacotherapy for KD/HTS is sometimes combined with surgical excision and/or with physical therapy such as cryotherapy, laser therapy, radiotherapy including brachytherapy, and silicone gel/sheeting. The results regarding the clinical effectiveness of each mono-pharmacotherapy for KD/HTS are not always consistent but rather scattered among researchers. Multimodal combination pharmacotherapy that targets multiple sites simultaneously is more effective than mono-pharmacotherapy. The literature was searched using PubMed, Google Scholar, and Online search engines.
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Affiliation(s)
- Teruo Murakami
- Laboratory of Biopharmaceutics and Pharmacokinetics, Faculty of Pharmaceutical Sciences, Hiroshima International University, Higashi-Hiroshima 731-2631, Japan;
| | - Sadayuki Shigeki
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Higashi-Hiroshima 731-2631, Japan
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5
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Sangha MS, Deroide F, Meys R. Wound healing, scarring and management. Clin Exp Dermatol 2024; 49:325-336. [PMID: 38001053 DOI: 10.1093/ced/llad410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 11/03/2023] [Accepted: 11/16/2023] [Indexed: 11/26/2023]
Abstract
Understanding wound healing is imperative for the dermatological physician to optimize surgical outcomes. Poor healing may result in negative functional, cosmetic and psychological sequelae. This review briefly outlines the physiology of wound healing, with a view to improving the management of wounds and scars, and minimizing the long-term scarring complications.
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Affiliation(s)
| | - Florence Deroide
- Department of Dermatology, Royal Free London NHS Foundation Trust, London, UK
| | - Rhonda Meys
- Department of Dermatology, Royal Free London NHS Foundation Trust, London, UK
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Boo YC. Insights into How Plant-Derived Extracts and Compounds Can Help in the Prevention and Treatment of Keloid Disease: Established and Emerging Therapeutic Targets. Int J Mol Sci 2024; 25:1235. [PMID: 38279232 PMCID: PMC10816582 DOI: 10.3390/ijms25021235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 01/16/2024] [Accepted: 01/18/2024] [Indexed: 01/28/2024] Open
Abstract
Keloid is a disease in which fibroblasts abnormally proliferate and synthesize excessive amounts of extracellular matrix, including collagen and fibronectin, during the healing process of skin wounds, causing larger scars that exceed the boundaries of the original wound. Currently, surgical excision, cryotherapy, radiation, laser treatment, photodynamic therapy, pressure therapy, silicone gel sheeting, and pharmacotherapy are used alone or in combinations to treat this disease, but the outcomes are usually unsatisfactory. The purpose of this review is to examine whether natural products can help treat keloid disease. I introduce well-established therapeutic targets for this disease and various other emerging therapeutic targets that have been proposed based on the phenotypic difference between keloid-derived fibroblasts (KFs) and normal epidermal fibroblasts (NFs). We then present recent studies on the biological effects of various plant-derived extracts and compounds on KFs and NFs. Associated ex vivo, in vivo, and clinical studies are also presented. Finally, we discuss the mechanisms of action of the plant-derived extracts and compounds, the pros and cons, and the future tasks for natural product-based therapy for keloid disease, as compared with existing other therapies. Extracts of Astragalus membranaceus, Salvia miltiorrhiza, Aneilema keisak, Galla Chinensis, Lycium chinense, Physalis angulate, Allium sepa, and Camellia sinensis appear to modulate cell proliferation, migration, and/or extracellular matrix (ECM) production in KFs, supporting their therapeutic potential. Various phenolic compounds, terpenoids, alkaloids, and other plant-derived compounds could modulate different cell signaling pathways associated with the pathogenesis of keloids. For now, many studies are limited to in vitro experiments; additional research and development are needed to proceed to clinical trials. Many emerging therapeutic targets could accelerate the discovery of plant-derived substances for the prevention and treatment of keloid disease. I hope that this review will bridge past, present, and future research on this subject and provide insight into new therapeutic targets and pharmaceuticals, aiming for effective keloid treatment.
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Affiliation(s)
- Yong Chool Boo
- Department of Molecular Medicine, School of Medicine, Kyungpook National University, 680 Gukchaebosang-ro, Jung-gu, Daegu 41944, Republic of Korea;
- BK21 Plus KNU Biomedical Convergence Program, Department of Biomedical Science, The Graduate School, Kyungpook National University, 680 Gukchaebosang-ro, Jung-gu, Daegu 41944, Republic of Korea
- Cell and Matrix Research Institute, Kyungpook National University, 680 Gukchaebosang-ro, Jung-gu, Daegu 41944, Republic of Korea
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7
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Huang R, Chen S, Song X, Zheng H. Inhalation of Carboxymethyl Chitosan Alleviates Posttraumatic Tracheal Fibrosis. Ann Otol Rhinol Laryngol 2024; 133:50-57. [PMID: 37394747 DOI: 10.1177/00034894231181749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
OBJECTIVES The present study was performed to determine whether the inhalation of carboxymethyl (CM)-chitosan can alleviate tracheal fibrosis in a rabbit model. METHODS We designed a rabbit model of tracheal stenosis involving electrocoagulation with a spherical electrode. Twenty New Zealand white rabbits were randomly divided into experimental and control groups (10 animals each). Tracheal damage was successfully established by electrocoagulation in all animals. The experimental group was given CM-chitosan (inhalation for 28 days), while the control group inhaled saline. The effects of CM-chitosan inhalation on tracheal fibrosis were analyzed. Laryngoscopy was performed to evaluate and grade tracheal granulation, while tracheal fibrosis was evaluated by histological examination. The effects of CM-chitosan inhalation on the tracheal mucosa were examined by scanning electron microscopy (SEM), and hydroxyproline content in tracheal scar tissue was determined by enzyme-linked immunosorbent assay (ELISA). RESULTS Laryngoscopy showed that the tracheal cross-sectional area was smaller in the experimental than control group. The amounts of loose connective tissue and damaged cartilage, as well as the severity of collagen and fibrosis, decreased following inhalation of CM-chitosan. According to the ELISA, the experimental group had low levels of hydroxyproline in the tracheal scar tissue. CONCLUSION The findings presented here showed that inhalation of CM-chitosan mitigated posttraumatic tracheal fibrosis in a rabbit model, thus suggesting a potential new treatment for tracheal stenosis.
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Affiliation(s)
- Rushi Huang
- Department of Otorhinolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Shicai Chen
- Department of Otorhinolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Xianmin Song
- Department of Otorhinolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Hongliang Zheng
- Department of Otorhinolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, China
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8
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Yang HA, Jheng WL, Yu J, Huang JY, Cheng KY, Lee JJ. Comparative Efficacy of Drug Interventions for Keloids: A Network Meta-analysis. Ann Plast Surg 2024; 92:S52-S59. [PMID: 38285997 DOI: 10.1097/sap.0000000000003759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Abstract
BACKGROUND Keloids are common benign skin lesions originating from a disorganized fibroproliferative collagen response; these lesions often lead to both physical and psychological problems. The optimal treatment for keloids is yet to be standardized. Intralesional injection, which is simple and nontraumatic, is one of the most commonly used treatment modalities for these lesions. In this study, we compared 5 different drugs (intralesional injections) for the treatment of keloids in terms of efficacy. METHODS We systemically searched relevant studies on PubMed, EMBASE, and Cochrane Library. Randomized clinical trials on the safety and efficacy of triamcinolone acetonide (TAC), 5-fluorouracil (5-FU), botulinum toxin A (BTA), verapamil, and bleomycin were included in this study. RESULTS This network meta-analysis included a total of 1114 patients from 20 randomized controlled trials. Botulinum toxin A alone and TAC plus 5-FU exhibited significantly better efficacy than did 5-FU, TAC, and verapamil. No significant difference in efficacy between BTA alone and TAC combined with 5-FU was observed. No significant differences were noted in the adverse event rate between BTA, TAC plus 5-FU, 5-FU, and TAC. Furthermore, we performed surface under the cumulative ranking curve analyses to predict the rank of each intervention (by efficacy and adverse event rate). The predicted ranking by efficacy was as follows: TAC plus 5-FU, BTA, bleomycin, TAC, 5-FU, and verapamil; the predicted ranking by adverse events was as follows: TAC, 5-FU, TAC plus 5-FU, and BTA. Funnel plot analysis revealed no publication bias. CONCLUSIONS Botulinum toxin A and TAC plus 5-FU appear to have outstanding therapeutic efficacy for keloids. The rate of adverse events was similar among BTA, TAC, 5-FU, and TAC plus 5-FU. Nonetheless, additional reviews of rigorous, large-scale randomized controlled trials are warranted for further validation of our findings.
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Affiliation(s)
| | | | | | | | - Kai-Yuan Cheng
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung City, Taiwan
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9
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Zhao H, Zhang J, He R, Bao L. Comprehensive Treatment of a Rare Case of Complete Primary Pachydermoperiostosis with Large Facial Keloid Scars: A Case Report and Literature Review. Case Rep Dermatol 2024; 16:63-69. [PMID: 38440721 PMCID: PMC10911786 DOI: 10.1159/000536550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 01/23/2024] [Indexed: 03/06/2024] Open
Abstract
Introduction Pachydermoperiostosis (PDP), or primary hypertrophic osteoarthropathy, is a rare autosomal dominant disease with primary clinical features of pachydermia (thickening of skin) and periostosis (new bone formation). Keloid scar formation is also rather obscure, and some scientists have claimed that keloid scars contain an excessive amount of fibroblasts compared with normal skin as well as a dense mass of irregularly deposited connective tissues. Case Presentation A 25-year-old man exhibited extensive skin folding on his face, a gyrus-like scalp, depressed nasolabial folds, and keloids. Symptoms began at 18 years of age, progressing insidiously. Additionally, he experienced clubbing of fingers and toes, joint pain, muscle soreness, and hyperhidrosis. Radiographic examinations revealed thickened bone and cystic regions. Diagnosed with complete primary PDP and facial keloid scars, he underwent skin dermabrasion, biopsies, and a comprehensive treatment involving, botulinum toxin injections, 5-fluorouracil, and a carbon dioxide lattice laser. Conclusion PDP presents challenges due to its unclear etiology but stabilizes over time in most cases. Comprehensive treatment strategies, including dermabrasion and a combination of intralesional therapies, are effective in managing keloids in PDP patients. This case contributes to the understanding of managing rare diseases and underscores the importance of personalized approaches to improve therapeutic outcomes in patients with complete primary PDP and concurrent keloids.
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Affiliation(s)
- Haibo Zhao
- Department of Dermatology, Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
- Candidate Branch of National Clinical Research Center for Skin Diseases, Shenzhen, China
| | - Jianglin Zhang
- Department of Dermatology, Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
- Candidate Branch of National Clinical Research Center for Skin Diseases, Shenzhen, China
| | - Renliang He
- Department of Dermatology, Dermatology Hospital of Southern Medical University, Guangzhou, China
| | - Linlin Bao
- Department of Dermatology, Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
- Candidate Branch of National Clinical Research Center for Skin Diseases, Shenzhen, China
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10
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Faour S, Farahat M, Aijaz A, Jeschke MG. Fibrosis in burns: an overview of mechanisms and therapies. Am J Physiol Cell Physiol 2023; 325:C1545-C1557. [PMID: 37811732 PMCID: PMC10881229 DOI: 10.1152/ajpcell.00254.2023] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 10/04/2023] [Accepted: 10/04/2023] [Indexed: 10/10/2023]
Abstract
Scar development remains a common occurrence and a major healthcare challenge affecting the lives of millions of patients annually. Severe injuries to the skin, such as burns can lead to pathological wound healing patterns, often characterized by dermal fibrosis or excessive scarring, and chronic inflammation. The two most common forms of fibrotic diseases following burn trauma are hypertrophic scars (HSCs) and keloids, which severely impact the patient's quality of life. Although the cellular and molecular mechanisms are similar, HSC and keloids have several distinct differences. In this review, we discuss the different forms of fibrosis that occur postburn injury, emphasizing how the extent of burn influences scar development. Moreover, we highlight how a systemic response induced by a burn injury drives wound fibrosis, including both the role of the inflammatory response, as well as the fate of fibroblast during skin healing. Finally, we list potential therapeutics aimed at alleviating pathological scar formation. An understanding of the mechanisms of postburn fibrosis will allow us to effectively move studies from bench to bedside.
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Affiliation(s)
- Sara Faour
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- TaARI, Hamilton, Ontario, Canada
| | - Mahmoud Farahat
- TaARI, Hamilton, Ontario, Canada
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Ayesha Aijaz
- TaARI, Hamilton, Ontario, Canada
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Marc G Jeschke
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- TaARI, Hamilton, Ontario, Canada
- Hamilton General Hospital, Hamilton Health Sciences, Hamilton, Ontario, Canada
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
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11
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Rimmer SN, Chandy RJ, Khan D, Feldman SR. Recurrence rates in the treatment of keloids and hypertrophic scars with intralesional triamcinolone combined with other intralesional agents. Arch Dermatol Res 2023; 315:2757-2767. [PMID: 37432467 DOI: 10.1007/s00403-023-02662-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/10/2023] [Accepted: 06/25/2023] [Indexed: 07/12/2023]
Abstract
Hypertrophic scars (HTS) and keloids are pathologic scars that are products of a wound healing pathway error attributed to genetic and inflammatory causes (Leventhal et al., Arch Facial Plast Surg 8(6):362-368. https://doi.org/10.1001/archfaci.8.6.362 , 2006). Methods of pathologic scar treatment include intralesional agents, cryotherapy, surgical excision, pressure dressings, topical agents, laser resurfacing, radiotherapy, and other investigational therapies (Leventhal et al. 2006). The recurrence of pathologic scar is high across all treatment modalities, including the use of intralesional agents (Trisliana Perdanasari et al., Arch Plast Surg 41(6):620-629. https://doi.org/10.5999/aps.2014.41.6.620 , 2014). In the treatment of pathologic scar, combination approaches using intralesional agents, such as triamcinolone (TAC), 5-fluorouracil (5FU), verapamil (VER), bleomycin (BLM), and botulinum toxin (BTX), are superior therapies when compared to monotherapy (Yosipovitch et al., J Dermatol Treat 12(2):87-90. https://doi.org/10.1080/095466301317085363 , 2001; Yang et al., Front Med 8:691628. https://doi.org/10.3389/fmed.2021.691628 , 2021; Sun et al., Aesthetic Plast Surg 45(2):791-805. https://doi.org/10.1007/s00266-019-01570-8 , 2021). This review assesses recurrence and the reporting of recurrence in pathologic scar after treatment with intralesional triamcinolone (TAC) in combination with another intralesional agent. A literature review was conducted using research journals from PubMed using the following search terms: [(keloid) AND (triamcinolone) AND (combination) AND (intralesional)], as well as [(keloid) AND (triamcinolone) AND (combination)]. Articles were reviewed and included if the article analyzed or compared intralesional agents for pathologic scar treatment within the last 10 years. The average follow-up period of included articles (n = 14) that utilized combination intralesional therapy (TAC-X) was approximately 11 months (range 1-24 months). Consistent recurrence rate reporting across studies was lacking. The combination agent with the highest recurrence rate was TAC-5FU (23.3%). The range of reported recurrence rates was 7.5-23.3%. Six studies using various intralesional combination regimens reported 0% recurrence over the follow-up period (TAC-5FU, TAC-BTX, TAC-BLM, TAC-CRY). Three studies did not report recurrence rates. While the efficacy of combination therapy is typically assessed via scar scales, the assessment of recurrence across studies of combination therapy is inconsistent and inadequate, with truncated follow-up periods. While scar recurrence can take place during 1-year post-treatment, long-term follow-up (18-24 months) is needed to characterize recurrence in the treatment of pathologic scar using various intralesional agents. Long-term follow-up periods allow patients to receive accurate prognostic information regarding recurrence after combination intralesional therapy. There are limitations to this review in that comparisons were made across studies with varying outcome variables, including scar size, injection concentration and interval, and follow-up period. Standardized follow-up periods and recurrence rate reporting are integral to furthering the understanding of these therapies and enhancing patient care.
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Affiliation(s)
- Sarah N Rimmer
- Department of Dermatology, Center for Dermatology Research, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
| | - Rithi J Chandy
- Department of Dermatology, Center for Dermatology Research, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Danyaal Khan
- Department of Dermatology, Center for Dermatology Research, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Steven R Feldman
- Department of Dermatology, Center for Dermatology Research, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Dermatology, University of Southern Denmark, Odense, Denmark
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12
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Bogari A, Cakmak O. Deep Neck Contouring: Indications and Techniques. Facial Plast Surg 2023. [PMID: 37903633 DOI: 10.1055/a-2201-5989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2023] Open
Abstract
A deep comprehension of key anatomical issues, along with the targeted application of suitable therapies, is vital for attaining exceptional neck contours. Traditional surgical approaches often focus solely on modifying subcutaneous fat and, occasionally, the platysma muscle, neglecting subplatysmal structures. This narrow focus may yield less-than-ideal results and potentially exacerbate existing issues, leading to additional contour abnormalities that prove challenging to correct. In fact, in most cases, there are additional factors deep to the platysma-such as subplatysmal fat, the anterior bellies of the digastric muscles, perihyoid fascia, and the submandibular glands-that contribute to obtuse neck contours. For these patients, accessing the neck through a submental incision allows for precise management of these deep neck structures as required. Unfamiliarity with deep anatomical structures can deter surgeons from performing subplatysmal procedures due to unwarranted concerns about increased complication risks. However, both published clinical series and our clinical experience indicate favorable long-term outcomes with natural, refined, harmonious neck contours and a minimal rate of complications. This article serves as a comprehensive guide, describing indications, strategies, and providing a step-by-step description of the senior author's techniques for mastering deep neck contouring.
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Affiliation(s)
- Ahmad Bogari
- Fellow of International Federation of Facial Plastic Surgery Societies (IFFPSS), FACEISTANBUL, Istanbul, Turkey
| | - Ozcan Cakmak
- European and International Board Certified Facial Plastic Surgeon, FACEISTANBUL, Istanbul, Turkey
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13
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Biazus Soares G, Mahmoud O, Yosipovitch G. Pruritus in keloid scars: mechanisms and treatments. Ital J Dermatol Venerol 2023; 158:401-407. [PMID: 37916400 DOI: 10.23736/s2784-8671.23.07554-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
Keloids occur after cutaneous injury and can cause distress due to physical appearance and associated symptoms such as pain and pruritus. Keloid-associated pruritus is a common manifestation and has negative impacts on quality of life. The mechanism underlying this type of pruritus is multifactorial and thought to involve small nerve fiber damage, neurogenic inflammation, and a Th2-predominant inflammatory response. Various agents have been shown to reduce keloid pruritus, including intralesional corticosteroids, botulinum toxin A, 5-fluorouracil, and bleomycin. Other treatment modalities such as cryotherapy and hyperbaric oxygen therapy are also effective. Future treatments targeting the mechanisms involved in keloid-associated itch could provide improvements in pruritus and quality of life in these patients, but further studies on the efficacy of these agents are needed.
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Affiliation(s)
- Georgia Biazus Soares
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miami Itch Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Omar Mahmoud
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miami Itch Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Gil Yosipovitch
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miami Itch Center, University of Miami Miller School of Medicine, Miami, FL, USA -
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14
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Worley B, Kim K, Jain-Poster K, Reynolds KA, Merkel EA, Kang BY, Dirr MA, Anvery N, Christensen RE, Hisham FI, Ibrahim SA, Asadbeigi SN, Poon E, Alam M. Treatment of traumatic hypertrophic scars and keloids: a systematic review of randomized control trials. Arch Dermatol Res 2023; 315:1887-1896. [PMID: 36781457 DOI: 10.1007/s00403-023-02535-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 12/08/2022] [Accepted: 01/12/2023] [Indexed: 02/15/2023]
Abstract
Exaggerated healing and remodeling after skin injury may cause hypertrophic and keloidal scars, which are associated with functional and quality of life impairment. There is limited guidance available regarding the relative effectiveness of therapies for hypertrophic scars and keloids. In this review, we aim to compare the effectiveness of treatments for hypertrophic scars and keloids. MEDLINE, Embase, Scopus, and the Cochrane Collaboration database were searched from inception to March 2019 for randomized control trials of treatments for hypertrophic and keloid scars that included 20 or more patients. Outcomes evaluated included the standardized mean reduction in scarring and adverse events. The type of scar and the demographic features were analyzed for their effect on clinical outcome. Based on 25 included clinical trials, intralesional injection (64.1% [95% CI 60.8-67.5%]) may be more effective than physical (29.9% [95% CI 28.9-30.9%]) or topical treatments (34% [95% CI 31.8-36.8%]). Combination of 5-fluorouracil and triamcinolone (9:1 dilution) appeared superior among intralesional treatments for keloids. Ablative laser and pulsed-dye laser were the most useful laser treatments. Regression modeling showed laser treatment response was linked to Fitzpatrick skin type (p = 0.002). Adverse events were uncommon for all treatments and mostly transient. Intralesional treatments for keloid and hypertrophic scars may be the most reliable treatment option to improve pathologic scars, while laser treatment may have specific benefits for Fitzpatrick skin types I-III over types IV-VI. Management of pathological scars is an area of critical need, where appropriate treatment can have a significant impact on quality of life.
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Affiliation(s)
- Brandon Worley
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N Saint Clair, Suite 1600, Chicago, IL, 60611, USA
| | - Kathyrn Kim
- University of Illinois at Chicago College of Medicine, Chicago, IL, USA
| | - Ketan Jain-Poster
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N Saint Clair, Suite 1600, Chicago, IL, 60611, USA
| | - Kelly A Reynolds
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N Saint Clair, Suite 1600, Chicago, IL, 60611, USA
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Emily A Merkel
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N Saint Clair, Suite 1600, Chicago, IL, 60611, USA
| | - Bianca Y Kang
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N Saint Clair, Suite 1600, Chicago, IL, 60611, USA
| | - McKenzie A Dirr
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N Saint Clair, Suite 1600, Chicago, IL, 60611, USA
| | - Noor Anvery
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N Saint Clair, Suite 1600, Chicago, IL, 60611, USA
| | - Rachel E Christensen
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N Saint Clair, Suite 1600, Chicago, IL, 60611, USA
| | - Farhana Ikmal Hisham
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N Saint Clair, Suite 1600, Chicago, IL, 60611, USA
| | - Sarah A Ibrahim
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N Saint Clair, Suite 1600, Chicago, IL, 60611, USA
| | - Sepideh Nikki Asadbeigi
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N Saint Clair, Suite 1600, Chicago, IL, 60611, USA
| | - Emily Poon
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N Saint Clair, Suite 1600, Chicago, IL, 60611, USA
| | - Murad Alam
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N Saint Clair, Suite 1600, Chicago, IL, 60611, USA.
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
- Department of Otolaryngology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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15
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Kheir WJ, Khalil AA, Ibrahim P, Rashid E, El Moussawi Z, El Hadi D, Kahale F, Awwad S, Bou Ghannam A, Alameddine RM. Ophthalmic injuries from the beirut blast: Managing long-term consequences. Exp Eye Res 2023:109546. [PMID: 37394086 DOI: 10.1016/j.exer.2023.109546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 06/14/2023] [Accepted: 06/19/2023] [Indexed: 07/04/2023]
Abstract
The 2020 Beirut Port explosion was one of the largest non-nuclear urban explosions in history, and resulted in a plethora of oculofacial injuries. In this retrospective study, we present the two year follow up ophthalmic outcomes of the survivors of the blast. Only 16 out of 39 patients continued follow up at our center, with 13 having delayed complications and 7 requiring further surgery. The most common delayed complications related to the eyelid, lacrimal system, and orbit. Treatment of disfiguring facial and peri-ocular scarring with laser-assisted drug delivery of topical 5-fluorouracil showed great promise and significantly improved patients' functional and well as cosmetic outcomes.
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Affiliation(s)
- Wajiha J Kheir
- Department of Ophthalmology, American University of Beirut Medical Center, Lebanon
| | - Ali A Khalil
- Department of Ophthalmology, American University of Beirut Medical Center, Lebanon
| | - Perla Ibrahim
- Department of Ophthalmology, American University of Beirut Medical Center, Lebanon
| | - Elza Rashid
- Department of Ophthalmology, American University of Beirut Medical Center, Lebanon
| | - Zeinab El Moussawi
- Department of Ophthalmology, American University of Beirut Medical Center, Lebanon
| | - Dalia El Hadi
- Department of Ophthalmology, American University of Beirut Medical Center, Lebanon
| | - Francesca Kahale
- Department of Ophthalmology, American University of Beirut Medical Center, Lebanon
| | - Shady Awwad
- Department of Ophthalmology, American University of Beirut Medical Center, Lebanon
| | - Alaa Bou Ghannam
- Department of Ophthalmology, American University of Beirut Medical Center, Lebanon
| | - Ramzi M Alameddine
- Department of Ophthalmology, American University of Beirut Medical Center, Lebanon.
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16
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Xia Y, Wang Y, Hao Y, Shan M, Liu H, Liang Z, Kuang X. Deciphering the single-cell transcriptome network in keloids with intra-lesional injection of triamcinolone acetonide combined with 5-fluorouracil. Front Immunol 2023; 14:1106289. [PMID: 37275903 PMCID: PMC10235510 DOI: 10.3389/fimmu.2023.1106289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 05/08/2023] [Indexed: 06/07/2023] Open
Abstract
Objectives Keloid is a highly aggressive fibrotic disease resulting from excessive extracellular matrix deposition after dermal injury. Intra-lesional injection of triamcinolone acetonide (TAC) in combination with 5-fluorouracil (5-FU) is a commonly used pharmacological regimen and long-term repeated injections can achieve sustained inhibition of keloid proliferation. However, the molecular mechanisms underlying the inhibitory effect on keloids remain insufficiently investigated. Methods and materials This study performed single-cell RNA sequencing analysis of keloids treated with TAC+5-FU injections, keloids, and skins to explore patterns of gene expression regulation and cellular reprogramming. Results The results revealed that TAC+5-FU interrupted the differentiation trajectory of fibroblasts toward pro-fibrotic subtypes and induced keloid atrophy possibly by inhibiting the FGF signaling pathway in intercellular communication. It also stimulated partial fibroblasts to develop the potential for self-replication and multidirectional differentiation, which may be a possible cellular source of keloid recurrence. T cell dynamics demonstrated elevated expression of secretory globulin family members, which may be possible immunotherapeutic targets. Schwann cell populations achieved functional changes by increasing the proportion of apoptotic or senescence-associated cell populations and reducing cell clusters that promote epidermal development and fibroblast proliferation. Conclusions Our findings elucidated the molecular and cellular reprogramming of keloids by intra-lesional injection of TAC+5-FU, which will provide new insights to understand the mechanism of action and therapeutic targets.
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Affiliation(s)
- Yijun Xia
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Youbin Wang
- Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Yan Hao
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Mengjie Shan
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Hao Liu
- Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Zhengyun Liang
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Xinwen Kuang
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
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17
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Matar DY, Ng B, Darwish O, Wu M, Orgill DP, Panayi AC. Skin Inflammation with a Focus on Wound Healing. Adv Wound Care (New Rochelle) 2023; 12:269-287. [PMID: 35287486 PMCID: PMC9969897 DOI: 10.1089/wound.2021.0126] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 03/09/2022] [Indexed: 11/12/2022] Open
Abstract
Significance: The skin is the crucial first-line barrier against foreign pathogens. Compromise of this barrier presents in the context of inflammatory skin conditions and in chronic wounds. Skin conditions arising from dysfunctional inflammatory pathways severely compromise the quality of life of patients and have a high economic impact on the U.S. health care system. The development of a thorough understanding of the mechanisms that can disrupt skin inflammation is imperative to successfully modulate this inflammation with therapies. Recent Advances: Many advances in the understanding of skin inflammation have occurred during the past decade, including the development of multiple new pharmaceuticals. Mechanical force application has been greatly advanced clinically. Bioscaffolds also promote healing, while reducing scarring. Critical Issues: Various skin inflammatory conditions provide a framework for analysis of our understanding of the phases of successful wound healing. The large burden of chronic wounds on our society continues to focus attention on the chronic inflammatory state induced in many of these skin conditions. Future Directions: Better preclinical models of disease states such as chronic wounds, coupled with enhanced diagnostic abilities of human skin, will allow a better understanding of the mechanism of action. This will lead to improved treatments with biologics and other modalities such as the strategic application of mechanical forces and scaffolds, which ultimately results in better outcomes for our patients.
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Affiliation(s)
- Dany Y. Matar
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Biology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Brian Ng
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Oliver Darwish
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, California Northstate University College of Medicine, Elk Grove, California, USA
| | - Mengfan Wu
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Plastic Surgery, Peking University Shenzhen Hospital, Shenzhen, China
| | - Dennis P. Orgill
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Adriana C. Panayi
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
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18
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Hong YK, Chang YH, Lin YC, Chen B, Guevara BEK, Hsu CK. Inflammation in Wound Healing and Pathological Scarring. Adv Wound Care (New Rochelle) 2023; 12:288-300. [PMID: 36541356 DOI: 10.1089/wound.2021.0161] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Significance: The aberrant inflammation during wound healing results in pathological scarring, such as hypertrophic scars and keloids. This adversely affects the quality of life of patients due to the disfiguring appearance as well as the symptoms of itch and pain. This review summarizes the up-to-date knowledge of the immunopathogenesis and treatment options for pathological scars. Recent Advances: With the advent of new technologies, combined with in vitro and in vivo wound models, several inflammatory cells have been shown to have both direct and indirect effects on both wound healing and pathological scarring. Critical Issues: Expansion of pro-fibrotic immune cells such as M2 macrophages, dendritic cells, mast cells, and Th2 cells leads to fibroblast transition to myofibroblasts via transforming growth factor-β1 signaling pathway. Appropriate management of such inflammatory responses during wound healing remains a critical issue during clinical practice. Future Directions: Regulating inflammation response during wound healing may be a potential therapeutic option for avoiding or reducing pathological scars.
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Affiliation(s)
- Yi-Kai Hong
- Department of Dermatology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,International Research Center of Wound Repair and Regeneration (iWRR), National Cheng Kung University, Tainan, Taiwan
| | - Yi-Han Chang
- Department of Dermatology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yu-Chen Lin
- Department of Dermatology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,International Research Center of Wound Repair and Regeneration (iWRR), National Cheng Kung University, Tainan, Taiwan
| | - Brandon Chen
- Department of Dermatology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Bryan Edgar K Guevara
- International Research Center of Wound Repair and Regeneration (iWRR), National Cheng Kung University, Tainan, Taiwan.,Department of Dermatology, Southern Philippines Medical Center, Davao, Philippines
| | - Chao-Kai Hsu
- Department of Dermatology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,International Research Center of Wound Repair and Regeneration (iWRR), National Cheng Kung University, Tainan, Taiwan.,Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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19
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Mbiine R, Kayiira A, Wayengera M, Guyton MI, Kiwanuka N, Alenyo R, Kalanzi EW, Muwonge H, Nakanwagi C, Joloba M, Galukande M. Safety and feasibility of autologous adipose-derived stromal vascular fraction in the treatment of keloids: a phase one randomized controlled pilot trial. AMERICAN JOURNAL OF STEM CELLS 2023; 12:23-36. [PMID: 37215278 PMCID: PMC10195396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 04/22/2023] [Indexed: 05/24/2023]
Abstract
INTRODUCTION Autologous adipose-derived stromal vascular fraction (SVF) has been described to have therapeutic benefits in the treatment of keloids. However, most of the evidence on its efficacy is based on observational studies the majority of which are conducted in high-income countries and yet the highest burden of keloids is in low- and middle-income countries (LMICs). OBJECTIVES We set out to determine the safety and feasibility of using autologous adipose derived stromal vascular fraction in the treatment of keloids in LMICs. METHODS In this phase II randomized controlled pilot clinical trial conducted in the Plastic Surgery Unit of Kirruddu National Referral Hospital in Kampala Uganda, 8 patients were assigned a 1:1 ratio to either SVF or triamcinolone acetonide (TAC) arms. In the SVF arm, a median (Inter quartile range) amount of stromal cell infiltration of 2.7×106 (11×106) was administered, while the controls received 10 mg/ml TAC at a ratio of 1:1 TAC to keloid volume. Primary endpoints were adverse event development based on the Common Terminology Criteria for Adverse Events (CTCAE) v5.0 tool and feasibility assessment based on ≥ 70% recruitment feasibility and ≥ 80% interventional feasibility rates. RESULTS The participants' mean age was 27.9 (±6.5) years, with a female predilection of 5 (63%). Overall, no adverse events were reported in the SVF arm, while ulceration in a single patient in the TAC arm, which was a grade II adverse event, was reported. Recruitment feasibility of 80% and interventional feasibility with 100% completion were reported. CONCLUSION Based on our findings, an autologous adipose-derived stromal vascular fraction is feasible and safe for the treatment of keloids in LMICs.
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Affiliation(s)
- Ronald Mbiine
- Department of Surgery, Makerere University College of Health SciencesKampala, Uganda
| | | | - Misaki Wayengera
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, Makerere University College of Health SciencesKampala, Uganda
| | - Munabi Ian Guyton
- Department of Human Anatomy, School of Biomedical Sciences, Makerere University College of Health ScienceKampala, Uganda
| | - Noah Kiwanuka
- School of Public Health, Makerere University College of Health SciencesKampala, Uganda
| | - Rose Alenyo
- Department of Surgery, Makerere University College of Health SciencesKampala, Uganda
| | - Edris Wamala Kalanzi
- Department of Plastic Surgery, Kirruddu National Referral HospitalKampala, Uganda
| | - Haruna Muwonge
- Department of Physiology, Makerere University College of Health SciencesKampala, Uganda
| | | | - Moses Joloba
- School of Biomedical Sciences, Makerere University College of Health SciencesKampala, Uganda
| | - Moses Galukande
- Department of Surgery, Makerere University College of Health SciencesKampala, Uganda
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20
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Comparison of Ultrasound-Assisted Low-Dose Versus Medium-Dose 5-Fluorouracil and Triamcinolone Acetonide in the Treatment of Hypertrophic Scar. Dermatol Ther 2023. [DOI: 10.1155/2023/5245805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Intralesional 5-fluorouracil (5-FU) and triamcinolone acetonide (TAC) injection is effective for the treatment of hypertrophic scar. The side effects of current that recommended 45 mg/ml (high-dose) 5-FU have been reported. However, no previous study has investigated the efficacy and safety of low-dose (2.5 mg/ml) 5-FU with 4 mg/ml TAC or medium-dose (10 mg/ml) 5-FU with 4 mg/ml TAC for treatment of hypertrophic scar. Herein, a retrospective comparative study was conducted. The records of 70 patients, treated with low-dose (2.5 mg/ml) 5-FU and 4 mg/ml TAC every 4 weeks (Group 1) or medium-dose (10 mg/ml) 5-FU and 4 mg/ml TAC every 4 weeks (Group 2), were analyzed. The Vancouver Scar Scale (VSS), vascularity, and thickness of hypertrophic scar at baseline and at 7th-treatment (each group received 6 treatment sessions) were compared. The ultrasound showed the large vascular distribution in scar margins. Both groups gained clinical improvement in VSS, vascularity, and thickness. Group 2 (medium-dose) exhibited significantly better improvement than Group 1 (low-dose). However, the overall side effects rate was 11.4% in Group 1, significantly lower than 31.4% in Group 2. Scar margins were suggested to be target sites for injection. Medium-dose (10 mg/ml) 5-FU + 4 mg/ml TAC could effectively reduce the thickness of hypertrophic scar; however, the side effects rate was also higher in medium-dose group than in low-dose group.
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21
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Optimal Timing of Fractional CO 2 Laser on Cleft Lip Scars: A Single-Blind Randomized Controlled Cohort Study. Dermatol Surg 2023; 49:145-148. [PMID: 36689573 DOI: 10.1097/dss.0000000000003688] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 11/23/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To determine the optimal time to apply a fractional CO 2 laser for the treatment of postsecondary repair scars in patients with cleft lip. METHODS Forty-two patients with linear scarring after cleft lip repair were recruited from November 2021 to October 2022. A single-blind, randomized, controlled cohort study was conducted to examine the impact of fractional CO 2 laser treatment compared with conventional conservative treatment. Thirty patients started laser treatment at 1 month ( n = 10), 3 months ( n = 10), and 6 months ( n = 10) postoperatively, and 12 patients were in the control group. Each patient was treated with high-energy low-density fractional CO 2 laser treatment 3 times at an interval of 1 month. The Vancouver Scar Scale (VSS) was used for scar evaluation to determine vascularity, pigmentation, pliability, and height. RESULTS The VSS scores decreased significantly after laser treatment ( p < .05), with the most significant improvement in scars in the group that started treatment 1 month after the surgery. CONCLUSION Early postoperative fractional CO 2 laser treatment of cleft lip scars is more effective than later treatment.
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22
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Muacevic A, Adler JR, Ludlow K, Merideth D, Haynes W, Shrivastava V. Relevant Dermatoses Among U.S. Military Service Members: An Operational Review of Management Strategies and Telemedicine Utilization. Cureus 2023; 15:e33274. [PMID: 36741595 PMCID: PMC9891841 DOI: 10.7759/cureus.33274] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 12/26/2022] [Indexed: 01/04/2023] Open
Abstract
Despite skin being the largest and most exposed organ of the human body, skin issues can be challenging to diagnose in deployed military service members. Common reasons deployed soldiers seek dermatological evaluation include infections, inflammatory skin conditions, and skin growth. Due to limited access to specialized care in deployed settings, dermatological conditions are undertreated and underdiagnosed. As a result, dermatological conditions are a leading contributor to decreased combat effectiveness among deployed medical forces. To lessen the burden of dermatological diseases, military providers should promptly identify operational skin diseases and alleviate modifiable barriers faced by service members. In a post-pandemic era with novel Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and monkeypox infections, the duty to effectively treat operational skin lesions is ever important. The need for military dermatologists continues to rise as the global landscape continues to evolve with unprecedented infections and increased bioterrorism threats. Teledermatology offers many solutions to mitigate the high demand for dermatologists during pandemics. Dermatological consultations account for the highest number of telemedicine visits in the US Military Health System (MHS). As such, increased utilization of teledermatology will reduce infection-related dermatological sequelae and prevent the medical evacuation of service members from military operations. This review collates and categorizes relevant dermatological conditions encountered among deployed personnel. This report outlines the standard of care and modified treatments recommended according to potential barriers faced in operational settings.
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23
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Wu W, Zhao Y, Chen Y, Zhong A. Comparing the Efficacy of Multiple Drugs Injection for the Treatment of Hypertrophic Scars and Keloid: A Network Meta-Analysis. Aesthetic Plast Surg 2023; 47:465-472. [PMID: 36536095 PMCID: PMC9945066 DOI: 10.1007/s00266-022-03163-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 10/25/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND There is no consensus regarding the choice of injected drugs for pathological scars. Although the clinical efficacy of different drug treatments was shown in many randomized controlled trials, the efficacies of many drugs are inconsistent. Therefore, this study aimed to determine how different effective drugs are for treating pathological scars. It is anticipated that the study findings may serve as guidelines for plastic surgeons. METHODS Relevant literature was extracted from the following databases Cochrane Library, Embase, PubMed, Web of Science, CNKI, Weipu, and Wanfang until June 2022, such as randomized clinical trials (RCTs) evaluating different injected drugs for the treatment of pathological scars, including BTA, TAC, 5-Fu, VER, and BLE. RESULTS This network meta-analysis of 1539 patients from 23 articles revealed that the most effective treatment for a pathological scar was TAC + BTA. The effective rate of TAC + BTA combination therapy was significantly different from that of the BTA, TAC, 5-Fu, VER, and BLM monotherapies. TAC+5-FU was more effective than TAC, 5-FU, VER, or BLM alone, and BTA was more effective than both TAC and 5-Fu. The effectiveness of VER and BLM was the same, but both were better than TAC and 5-Fu. No big differences were found between any of the other local injection therapies. CONCLUSIONS According to this network meta-analysis, a combination of keloid and hypertrophic scar injection treatment is recommended, especially BTA+TAC. However, this network meta-analysis has some limitations and must be further verified by larger samples and higher quality RCTs. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Affiliation(s)
- Wenhao Wu
- Department of Plastic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 PR China
| | - Yang Zhao
- Department of Plastic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 PR China
| | - Yuxuan Chen
- Department of Plastic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 PR China
| | - Aimei Zhong
- Department of Plastic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 PR China
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Homer NA, Hanafy MS, Baer SC, Watson AH, Somogyi M, Shore JW, Blaydon S, Durairaj VD, Cui Z, Nakra T. 5-Fluorouracil With Microneedling Modulates Wound Healing in a Murine Model: An Immunohistochemical Analysis of Mechanism and Dose Efficacy. Ophthalmic Plast Reconstr Surg 2022; 38:596-601. [PMID: 35604385 DOI: 10.1097/iop.0000000000002227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study is to assess the dose-dependent immunohistopathological effects of intradermal microneedle-delivered 5-fluorouracil (5-FU) for postincisional wound healing in a murine model. METHODS A prospective experimental study was performed. Twelve hairless mice were randomized into 4 treatment groups for postincisional wound treatment: microneedling with topical saline, or microneeding with topically-applied 5-FU at concentrations of 25 mg/ml, 50 mg/ml, or 100 mg/ml. Two surgical wounds were created on each animal. Combination wound treatments were performed on postoperative days 14 and 28, and cutaneous biopsies were obtained on day 56. Specimens were analyzed by a dermatopathologist, blinded to the treatment group, for collagen thickness, lymphocytic infiltration, histiocytic response, sub-epidermal basement membrane zone thickness, and myofibroblast density. RESULTS Histopathologic evaluation showed increased collagen thickness, lymphocyte infiltration, and granuloma density in the groups undergoing microneedling treatment with 5-FU, compared to saline. Immunohistochemical analysis revealed a trend toward thicker basement membranes with higher concentrations of 5-FU used, reaching statistical significance between controls and those treated with 100 mg/ml 5-FU ( p = 0.0493). A trend toward decreasing myofibroblast density with increasing doses of 5-FU was noted. No postincisional or treatment complications were observed. CONCLUSIONS Our results demonstrate that microneedling is an effective topical subepithelial drug delivery system, and further suggest a beneficial dose-dependent immunomodulatory effect of 5-FU on intermediate wound healing when used in combination with microneedling. We recommend a 5-FU dose at the mid-range 50 mg/ml concentration to simultaneously maximize efficacy and minimize complication risk.
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Affiliation(s)
- Natalie A Homer
- Division of Ophthalmic Plastic and Orbital Surgery, Department of Ophthalmology, UC Davis Eye Center, Sacramento, California
| | - Mahmoud S Hanafy
- Division of Molecular Pharmaceutics and Drug Delivery, College of Pharmacy, The University of Texas at Austin, Austin, Texas
| | | | - Alison H Watson
- Oculoplastic and Orbital Surgery Service, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Marie Somogyi
- TOC Eye and Face, Austin, Texas
- Department of Ophthalmology, Dell Medical School, The University of Texas at Austin, Austin, Texas
| | - John W Shore
- Department of Ophthalmology, Dell Medical School, The University of Texas at Austin, Austin, Texas
| | - Sean Blaydon
- TOC Eye and Face, Austin, Texas
- Department of Ophthalmology, Dell Medical School, The University of Texas at Austin, Austin, Texas
| | - Vikram D Durairaj
- TOC Eye and Face, Austin, Texas
- Department of Ophthalmology, Dell Medical School, The University of Texas at Austin, Austin, Texas
| | - Zhengrong Cui
- Division of Molecular Pharmaceutics and Drug Delivery, College of Pharmacy, The University of Texas at Austin, Austin, Texas
| | - Tanuj Nakra
- TOC Eye and Face, Austin, Texas
- Department of Ophthalmology, Dell Medical School, The University of Texas at Austin, Austin, Texas
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Use of 5 Fluorouracil Injections in Traumatic Cicatricial Mal-positions of Eyelids. Plast Reconstr Surg 2022; 150:713e-714e. [PMID: 35839483 DOI: 10.1097/prs.0000000000009431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ezzat Mohamad N, Abd El Raheem TA, Mahmoud RH, Osama Hamed N. Evaluating serum level of thymidylate synthase in post burn keloid patients before and after intralesional injection of 5-fluorouracil. Scars Burn Heal 2022; 8:20595131211049043. [PMID: 35035999 PMCID: PMC8753068 DOI: 10.1177/20595131211049043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Keloids are fibrous lesions formed at the site of trauma due to types I and
III collagen irregular production. The presence of thymidylate synthase (TS)
is a must for DNA synthesis and repairs causing cell death. 5-fluorouracil
(5-FU) is a fluorinated pyrimidine analogue acting as an anti-metabolic
agent that inhibits thymidylate synthase and interferes with ribo-nucleic
acid (RNA) synthesis. Objectives we aimed to evaluate the level of thymidylate synthase in post burn keloid
patients before and after intralesional injection of 5-fluorouracil. Methods The study included 20 keloid patients and 20 healthy subjects as a control.
Serum TS was estimated using commercially available enzyme-linked
immunosorbent assay (ELISA) kits before and after treatment with
5-fluorouracil. Results There was a statistically significant difference in TS levels before and
after 5-FU treatment (p < 0.05). Also, results have shown that 5-FU
injection has good satisfactory results in treatment of keloid causing
reduction in scar volume and symptoms improvement (90% of the patients
improved). On the other hand, there was no statistically significant
difference in TS levels and the outcomes of the treatment. Conclusion Our findings suggest that intralesional 5-FU injection in keloid has very
satisfactory results. However, thymidylate synthase enzyme has a minimal
role in evaluating the treatment of keloid, so further studies are required
to elaborate the relation between this enzyme and keloid scars.
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Affiliation(s)
- Noha Ezzat Mohamad
- Dermatology and Venereology Department, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | | | - Rania Hosny Mahmoud
- Department of Chemistry, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Nehal Osama Hamed
- Dermatology and Venereology Department, Faculty of Medicine, Fayoum University, Fayoum, Egypt
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Sakhiya J, Sakhiya D, Kaklotar J, Hirapara B, Purohit M, Bhalala K, Daruwala F, Dudhatra N. Intralesional Agents in Dermatology: Pros and Cons. J Cutan Aesthet Surg 2021; 14:285-295. [PMID: 34908770 PMCID: PMC8611707 DOI: 10.4103/jcas.jcas_109_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Since introduced in 1961, intralesional (IL) agent has become an essential part of the dermatological practice. The term IL referred to the direct delivery of agent percutaneously into skin lesions. This therapeutic approach is relatively safe, easy to perform and applicable for a broad range of dermatological conditions. On the other hand, immediate side effects, including pain during administration, bleeding, high risk of infection and allergic reaction, and subsequent side effects involving skin changes such as atrophy, telangiectasia, pigmentary changes, and striae are usually associated with this modality. This review paper highlights the pros and cons of IL agents in modern dermatology practice.
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Affiliation(s)
- Jagdish Sakhiya
- Sakhiya Skin Clinic, 2nd Floor, Ayush Doctor House, Station-Lal Darwaja Road, Surat, Gujarat, India
| | - Dhruv Sakhiya
- B.J. Medical College, New Civil Hospital Asarwa, Ahmedabad, Gujarat, India
| | - Jitesh Kaklotar
- Sakhiya Skin Clinic, 2nd Floor, Ayush Doctor House, Station-Lal Darwaja Road, Surat, Gujarat, India
| | - Bansi Hirapara
- Sakhiya Skin Clinic, 2nd Floor, Ayush Doctor House, Station-Lal Darwaja Road, Surat, Gujarat, India
| | - Madhav Purohit
- Sakhiya Skin Clinic, 2nd Floor, Ayush Doctor House, Station-Lal Darwaja Road, Surat, Gujarat, India
| | - Krishna Bhalala
- Sakhiya Skin Clinic, 2nd Floor, Ayush Doctor House, Station-Lal Darwaja Road, Surat, Gujarat, India
| | - Feral Daruwala
- Sakhiya Skin Clinic, 2nd Floor, Ayush Doctor House, Station-Lal Darwaja Road, Surat, Gujarat, India
| | - Nimish Dudhatra
- Sakhiya Skin Clinic, 2nd Floor, Ayush Doctor House, Station-Lal Darwaja Road, Surat, Gujarat, India
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Talei B, Raskin J, Borrelli M, Desales A. Contracture Treatment With 5-FU. EAR, NOSE & THROAT JOURNAL 2021; 100:876S-878S. [PMID: 34414812 DOI: 10.1177/01455613211039037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We present a case of a 53-year-old female patient who was treated with 5-Fluorouracil (5-FU) after postsurgical contracture. A review of the literature regarding the use of 5-FU injections as a minimally invasive way to treat contracture was performed. We describe that the use of 5-FU injections is the preferred method for the effective treatment of contracture with minimal risk to the patient.
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Affiliation(s)
- Ben Talei
- 482686Beverly Hills Center for Plastic Surgery, Los Angeles, CA, USA
| | - Jonathan Raskin
- 6918Oakland University William Beaumont School of Medicine, Detroit, MI, USA.,22494Cedars Sinai Sinus Center of Excellence, Los Angeles, CA, USA
| | - Michela Borrelli
- 22494Cedars Sinai Sinus Center of Excellence, Los Angeles, CA, USA.,Cedars-Sinai Division of Otolaryngology, Los Angeles, CA, USA
| | - Alexis Desales
- 22494Cedars Sinai Sinus Center of Excellence, Los Angeles, CA, USA.,Cedars-Sinai Division of Otolaryngology, Los Angeles, CA, USA
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Laser Speckle Contrast Imaging for the Objective Assessment of Blood Perfusion in Keloids Treated With Dual-Wavelength Laser Therapy. Dermatol Surg 2021; 47:e117-e121. [PMID: 33795568 DOI: 10.1097/dss.0000000000002836] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Most of the widely used methods for the assessment of keloid treatment are subjective grading scales based on the opinion of an individual clinician or patient. There is a growing need for objective methods to evaluate keloid treatment. OBJECTIVE This study aimed to evaluate the value of laser speckle contrast imaging (LSCI) as an objective method for the assessment of dual-wavelength laser therapy for keloids. METHODS This prospective study included 21 patients with 54 keloids. All patients were treated with a combined 585-nm pulsed dye laser and 1,064 nm neodymium-doped yttrium aluminum garnet dual-wavelength laser at 4 weeks to 6 weeks intervals. Keloids were assessed using the Vancouver Scar Scale (VSS) and LSCI. RESULTS The total VSS score significantly decreased after 4 sessions of treatment (p < .05). Blood perfusion in keloids as measured by LSCI was significantly reduced after treatment (p < .05). The improvement of chest keloids in terms of the total VSS score and blood perfusion was significantly greater than that of scapular keloids (p < .05). There was a positive correlation between decreased perfusion and reduced total VSS score (R2 = 0.84). CONCLUSION Blood perfusion in keloids significantly decreased after dual-wavelength laser therapy. Laser speckle contrast imaging is a promising objective method for assessing the improvement of keloids treated with laser therapy.
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Albalat W, Nabil S, Khattab F. Assessment of various intralesional injections in keloid: Comparative analysis. J DERMATOL TREAT 2021; 33:2051-2056. [PMID: 33849382 DOI: 10.1080/09546634.2021.1914307] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
AIM Intralesional triamcinolone is a gold standard in treating the keloids to comparation its effectiveness versus intralesional 5-fluorouracil intralesional verapamil and intralesional platelet-rich plasma. PATIENTS AND METHODS Several 160-cases were categorized into four groups of each Group-Containing 40 cases. Group-A (control) treated with intralesional triamcinolone and Group-B intralesional verapamil, Group-C intralesional 5-fluorouracil, and Group-D intralesional platelet-rich plasma. Patients were assessed for clinical response based on a decrease in the patient and observer scar assessment scale (POSAS) at baseline and the end of treatment. RESULTS The mean base-line POSAS score was 91 ± 10.98 SD check-in Group-A, 90 ± 10.85 in Group-B, 89 ± 10.06 in Group-C, and 92 ± 10.84 in Group-D.POSAS score after 24 weeks 36 ± 12.74 in Group-A, 29 ± 10.91 in Group-B, 39 ± 13.74 in Group-C, 36 ± 12.74 in Group-D. Statistically, a significant difference was observed between groups. CONCLUSION Intralesional verapamil reported to be the most effective therapy and platelet-rich plasma was effective as intralesional triamcinolone acetonide with no serious side effects and 5-fluorouracil was less effective in treating the keloids.
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Affiliation(s)
- Waleed Albalat
- Dermatology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Sara Nabil
- Dermatology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Fathia Khattab
- Dermatology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Sun P, Lu X, Zhang H, Hu Z. The Efficacy of Drug Injection in the Treatment of Pathological Scar: A Network Meta-analysis. Aesthetic Plast Surg 2021; 45:791-805. [PMID: 31853608 DOI: 10.1007/s00266-019-01570-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 12/01/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pathological scars mainly include hyperplastic scars and keloids, and there is no uniform treatment standard for the treatment of pathological scar in clinic now. Drug injection in the treatment of pathological scar is widely used because of its advantages of less trauma and simple operation. Therefore, we used a network meta-analysis to compare the curative effect of four kinds of drugs which are commonly used in the treatment of pathological scar such as botulinum toxin type A, corticosteroids (including diprospan and triamcinolone acetonide (TAC)), verapamil and 5-fluorouracil (5-FU), systematically. It is hoped that our study will provide evidence for the choice of drugs in the treatment of pathological scar by injection. METHODS Relevant articles from Wanfang, VIP, CNKI, PubMed, Cochrane Library and Embase databases were extracted by us. They were included into a network meta-analysis to compare the four kinds of drugs which are commonly used in the treatment of pathological scar. RESULTS The network meta-analysis included a total of 1513 patients from 23 studies. Through meta-analysis, we found that the efficacy of botulinum toxin type A combined with corticosteroid drugs was best in the treatment of pathological scar by injection. There was no significant difference between botulinum toxin type A, corticosteroids combined with 5 Fu, verapamil and 5-FU. The efficacy of corticosteroids combined with 5-FU was better than that of corticosteroids alone and verapamil alone, but there was no significant difference between them and 5-FU. Further, the order of efficacy predicted by the SUCRA curve was as follows: botulinum toxin type A combined with corticosteroids > corticosteroids combined with 5-FU > botulinum toxin type A > corticosteroids > 5-FU > verapamil. Moreover, no publication bias was found in the funnel diagram. CONCLUSION In the injection treatment of pathological scar, we recommend the combined injection of two drugs, especially botulinum toxin type A combined with corticosteroids. The effective treatment of botulinum toxin type A combined with corticosteroids in the treatment of pathological scar is as follows: Patients were treated once monthly with intralesional injection of TAC (0.1 ml/cm3) mixed with botulinum toxin type A (2.5 IU/cm3) for a total of 3 treatments. However, there are still limitations in this network meta-analysis, and its conclusion still needs to be further confirmed by more randomized controlled trials. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Pengfei Sun
- Department of Plastic Surgery, Zibo Central Hospital, No. 54 The Communist Youth League Road, Zibo, Shandong Province, People's Republic of China
| | - Xiaosheng Lu
- Department of Plastic Surgery, Affiliated Hospital of Weifang Medical University, No. 2428 Yuhe Road, Weifang, Shandong Province, People's Republic of China
| | - Huachang Zhang
- Department of Plastic Surgery, Zibo Central Hospital, No. 54 The Communist Youth League Road, Zibo, Shandong Province, People's Republic of China
| | - Zhensheng Hu
- Department of Plastic Surgery, Qilu Hospital of Shandong University, Jinan, People's Republic of China.
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Deng K, Xiao H, Liu X, Ogawa R, Xu X, Liu Y. Strontium-90 brachytherapy following intralesional triamcinolone and 5-fluorouracil injections for keloid treatment: A randomized controlled trial. PLoS One 2021; 16:e0248799. [PMID: 33755674 PMCID: PMC7987169 DOI: 10.1371/journal.pone.0248799] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 03/04/2021] [Indexed: 02/05/2023] Open
Abstract
Background Keloid disease is hard to fully eradicate. Recurrence and other unsatisfactory results were found in many patients. No current therapeutic modality has been determined to be most effective for treating keloid scars. Intralesional corticosteroid injections is most commonly recommended for primary management of small and young keloids as well as hypertrophic scars. However, it’s difficult for patients to adhere to long-term triamcinolone acetonide injection therapy because of the pain, inconvenience or complications including hormonal imbalance or irregular menstruation. Objective We aimed to determine whether and how Strontium-90 brachytherapy as an adjuvant radiation could affect keloid recurrence after intralesional triamcinolone and 5-fluorouracil injections. Methods We included keloid patients from March 2019 to September 2019 and randomly allocated them to two groups after 3 intralesional triamcinolone and 5-fluorouracil injections at 3 weeks interval. The experimental group received Strontium-90 brachytherapy at a total dose of 15-20Gy, while the control group didn’t receive any adjuvant treatment. We performed both Vancouver Scar Scale scoring and Color Doppler ultrasound examination to monitor and evaluate lesions regularly. A one-year follow-up was completed for each patient. Results 31 patients who had 42 keloids in total were recruited. We found intralesional triamcinolone and 5-fluorouracil injections could effectively reduce the thickness and modify the hardness of small and young keloids. Strontium-90 brachytherapy reduced the one-year recurrence rate from 85.7 percent to 44.4 percent after 3 intralesional triamcinolone and 5-fluorouracil injections. The lesions’ thickness or elasticity was not affected by Strontium-90 brachytherapy. Conclusion Strontium-90 brachytherapy as an adjuvant radiation could effectively reduce small sized keloids recurrence after intralesional triamcinolone and 5-fluorouracil injections. It worked by enhancing the lesions’ stability post-injection. Trial registration The clinical trial registration number: ChiCTR2000030141. Name of trial registry: Chinese Clinical Trial Registry (http://www.chictr.org.cn/)
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Affiliation(s)
- Ke Deng
- Department of Plastic and Burn Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Haitao Xiao
- Department of Plastic and Burn Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Xiaoxue Liu
- Department of Plastic and Burn Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Rei Ogawa
- Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School, Tokyo, Japan
| | - Xuewen Xu
- Department of Plastic and Burn Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Yong Liu
- Department of Plastic and Burn Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
- * E-mail:
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Hutchison DM, Hakimi AA, Wijayaweera A, Seo S, Hong EM, Pham TT, Bircan M, Sivoraphonh R, Dunn B, Kobayashi MR, Kim S, Wong BJF. Electrochemical treatment of ex vivo human abdominal skin and potential use in scar management: A pilot study. Scars Burn Heal 2021; 7:2059513120988532. [PMID: 33796338 PMCID: PMC7970177 DOI: 10.1177/2059513120988532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Scar treatments aim to address pathologic collagen deposition; however, they can be expensive or difficult to control. Electrochemical therapy (ECT) offers a simple alternative treatment. The purpose of this study is to examine the acid-base and histological changes in ex vivo human abdominal skin following ECT. METHODS Forty-two ex vivo human panniculus tissue sections collected from six individuals were tumesced with normal saline. ECT was performed by inserting two platinum needle electrodes connected to a DC power supply into each specimen. Voltage was varied (3-6 V) and applied for 5 minutes. Each specimen was sectioned across both electrode insertion sites and immediately stained with pH sensitive dye. The width of dye color change for each dosimetry pair was calculated. Hematoxylin and eosin staining was used to evaluate samples. RESULTS AND DISCUSSION ECT caused a spatially localised and dose-dependent increased area of acidic and basic pH around the anode and cathode, respectively. A significantly greater mean width of pH change was generated at the cathode compared to the anode in all treatment groups. Histological evaluation displayed broad condensation and hyalinisation of dermal collagen. CONCLUSION ECT triggered dermal pH alterations and changed the underlying structural framework of the specimen. This technology may serve as a low-cost, minimally invasive local soft-tissue remodeling technique with potential application in scar management. LEVEL OF EVIDENCE 5. LAY SUMMARY Electrochemical therapy is a novel treatment that causes spatially selective dermal injury in areas of interest. This study measures the effects of electrochemical therapy when applied to abdominal skin. Electrochemical therapy appears to have beneficial effects by causing a highly localised reduction in collagen content or local softening of tissue, which is consistent with other studies on scar therapies, including chemexfoliation, radiofrequency technologies, and lasers. However, electrochemical therapy can be performed at a fraction of the costs of these aforementioned modalities.
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Affiliation(s)
- Dana M Hutchison
- Beckman Laser Institute & Medical
Clinic, University of California - Irvine, Irvine, CA, USA
| | - Amir A Hakimi
- Beckman Laser Institute & Medical
Clinic, University of California - Irvine, Irvine, CA, USA
| | - Avin Wijayaweera
- Beckman Laser Institute & Medical
Clinic, University of California - Irvine, Irvine, CA, USA
| | - Soohong Seo
- Department of Dermatology, Korea
University Anam Hospital, Seoul, South Korea
| | - Ellen M Hong
- Beckman Laser Institute & Medical
Clinic, University of California - Irvine, Irvine, CA, USA
| | - Tiffany T Pham
- Beckman Laser Institute & Medical
Clinic, University of California - Irvine, Irvine, CA, USA
| | - Melissa Bircan
- Beckman Laser Institute & Medical
Clinic, University of California - Irvine, Irvine, CA, USA
| | - Ryan Sivoraphonh
- Beckman Laser Institute & Medical
Clinic, University of California - Irvine, Irvine, CA, USA
| | - Brandyn Dunn
- Department of Otolaryngology - Head and
Neck Surgery, School of Medicine, University of California - Irvine, Orange, CA,
USA
| | - Mark R Kobayashi
- Department of Plastic Surgery, School of
Medicine, University of California - Irvine, Orange, CA, USA
| | - Sehwan Kim
- Beckman Laser Institute Korea, School of
Medicine, Dankook University, Cheoan, Chungnam, Republic of Korea
| | - Brian JF Wong
- Beckman Laser Institute & Medical
Clinic, University of California - Irvine, Irvine, CA, USA
- Department of Otolaryngology - Head and
Neck Surgery, School of Medicine, University of California - Irvine, Orange, CA,
USA
- Department of Biomedical Engineering,
University of California - Irvine, Irvine, CA, USA
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de Oliveira GV, Gold MH. Hydrocolloid dressings can be used to treat hypertrophic scars: An outpatient dermatology service devoted to treat keloids and challenging scars. J Cosmet Dermatol 2020; 19:3344-3348. [PMID: 33103841 DOI: 10.1111/jocd.13792] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 10/07/2020] [Indexed: 11/30/2022]
Abstract
Since we first described the rationale for the use of hydrocolloid dressings to treat keloids and hypertrophic scars, this technique has been used as an occlusive therapy alternative to the use of silicone sheets in our outpatient clinic. In this paper, we describe the use of these dressings on two patients with challenging scars: a large postburn hypertrophic scar on a young patient's hand and arm, with a growing keloid on the wrist, and a progressive scar on the lower eyelid, developing after a complication of a cosmetic blepharoplasty procedure, leading to ectropium. The methods on the proper use of these dressings are reviewed here in detail. Larger clinical trials are needed to further evaluate this technique in the treatment of hypertrophic scars and keloids.
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Affiliation(s)
- Gisele Viana de Oliveira
- Ambulatory of Keloids and Hypertrophic scars treatment, Mario Penna/Luxemburgo Hospitals-, Belo Horizonte, MG, Brazil
| | - Michael H Gold
- Gold Skin Care Center, Tennessee Clinical Research Center, Nashville, TN, USA
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Kumar AS, Kamalasanan K. Drug delivery to optimize angiogenesis imbalance in keloid: A review. J Control Release 2020; 329:1066-1076. [PMID: 33091533 DOI: 10.1016/j.jconrel.2020.10.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 10/16/2020] [Accepted: 10/17/2020] [Indexed: 12/12/2022]
Abstract
The wound healing process involves three continuous stages. Where, any imbalance can lead to the formation of unwanted keloids, hypertrophic scar, or tumors. Keloids are any unpleasant, non-compliant comorbidity affecting a major section of people around the globe who acquire it either genetically or by pathological means as a result of a skin injury. Angiogenesis is unavoidable in the healing process after an injury or disruption of skin to promote tissue regeneration. Uncontrolled angiogenesis during the healing process can initiate the unwanted response in the wound that facilitate keloid. Angiogenic therapy is adapted to accelerate healing after an injury. Else ways, there exists a risk of keloid formation due to excessive angiogenesis during the wound healing process. There are numerous strategies to treat keloid. Anti-angiogenic factors are provided to patients post-surgery to prevent the keloid formation; however, they come into the picture after the formation of keloid. The available strategies to treat keloids are steroidal injections, surgical excision of the keloid, radiotherapy, pressure therapy, the use of cryosurgery, and many more. The available treatments are not promising in reducing the recurrent rate of keloids as there are chances of high re-occurrences with similar/larger lesions on the removed keloid site. In this review, we are discussing the importance of controlled angiogenesis with the help of controlled drug delivery strategies enabling the wound healing process without the induction of keloid.
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Affiliation(s)
- Aishwari S Kumar
- Department of Pharmaceutics, Amrita School of Pharmacy, Amrita Vishwa Vidyapeetham, AIMS Health Sciences Campus, AIMS Ponekkara PO, Kochi, Kerala, 682041, India
| | - Kaladhar Kamalasanan
- Department of Pharmaceutics, Amrita School of Pharmacy, Amrita Vishwa Vidyapeetham, AIMS Health Sciences Campus, AIMS Ponekkara PO, Kochi, Kerala, 682041, India.
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Jiang ZY, Liao XC, Liu MZ, Fu ZH, Min DH, Yu XT, Guo GH. Efficacy and Safety of Intralesional Triamcinolone Versus Combination of Triamcinolone with 5-Fluorouracil in the Treatment of Keloids and Hypertrophic Scars: A Systematic Review and Meta-analysis. Aesthetic Plast Surg 2020; 44:1859-1868. [PMID: 32342167 DOI: 10.1007/s00266-020-01721-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 04/09/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Although keloids and hypertrophic scars are common benign hyperproliferative growths of dermal fibroblasts, the clinical problems including physical and psychological problems are significant and impairing, with few proven treatments. Intralesional triamcinolone acetonide (TAC) and combination of TAC with 5-fluorouracil (5-FU) are widely used to treat keloids and hypertrophic scars, but their efficacy and safety remain controversial. METHODS We systematically searched MEDLINE, EMBASE, Cochrane Library, and CNKI for relevant trials. RESULTS The mean scar height and the erythema score in the TAC + 5-FU group were lower than those in the TAC group after treatment (P < 0.05). The effectiveness based on observer assessment after treatment in the TAC + 5-FU group was superior than that in the TAC group (P < 0.05); further, the subgroup analysis showed the TAC + 5-FU group was also superior than the TAC group in the treatment of hypertrophic scars (P = 0.01), and there were no significant differences in the treatment of keloid (P = 0.12). The effectiveness based on patient self-assessment after treatment in the TAC + 5-FU group was also superior than the TAC group (P < 0.05). The overall complication rate in the TAC + 5-FU group was lower than the TAC group (P < 0.05). CONCLUSIONS Combination of TAC with 5-FU is more effective and safer than TAC alone therapy in the treatment of keloids and hypertrophic scars. Data on keloids alone or hypertrophic scars alone are, however, limited. A better understanding of effective after intralesional combination of TAC with 5-FU in the treatment of keloids alone or hypertrophic scars alone is imperative. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Zheng-Ying Jiang
- The Department of Burn, The First Affiliated Hospital of Nanchang University, No.17 Yong Wai Street, Nanchang, 330006, Jiangxi, People's Republic of China
| | - Xin-Cheng Liao
- The Department of Burn, The First Affiliated Hospital of Nanchang University, No.17 Yong Wai Street, Nanchang, 330006, Jiangxi, People's Republic of China
| | - Ming-Zhuo Liu
- The Department of Burn, The First Affiliated Hospital of Nanchang University, No.17 Yong Wai Street, Nanchang, 330006, Jiangxi, People's Republic of China
| | - Zhong-Hua Fu
- The Department of Burn, The First Affiliated Hospital of Nanchang University, No.17 Yong Wai Street, Nanchang, 330006, Jiangxi, People's Republic of China
| | - Ding-Hong Min
- The Department of Burn, The First Affiliated Hospital of Nanchang University, No.17 Yong Wai Street, Nanchang, 330006, Jiangxi, People's Republic of China
| | - Xiao-Ting Yu
- The Department of Burn, The First Affiliated Hospital of Nanchang University, No.17 Yong Wai Street, Nanchang, 330006, Jiangxi, People's Republic of China
| | - Guang-Hua Guo
- The Department of Burn, The First Affiliated Hospital of Nanchang University, No.17 Yong Wai Street, Nanchang, 330006, Jiangxi, People's Republic of China.
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Levenberg A, Vinshtok Y, Artzi O. Potentials for implementing pressure-controlled jet injection in management of keloids with intralesional 5FU and corticosteroids. J Cosmet Dermatol 2020; 19:1966-1972. [PMID: 32603031 DOI: 10.1111/jocd.13522] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/07/2020] [Accepted: 05/26/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Needle-free jet injection implements kinetic energy of liquid jet for transcutaneous delivery of drugs into soft tissues. Combination therapy of intralesional 5-fluorouracil and triamcinolone offers efficacious treatment for keloids with a reduced adverse effect of the drug monotherapy. This study evaluates safety and efficacy of the drug combination administered to keloid scars via intralesional jet injections. METHODS A retrospective analysis of the keloid treatments was performed. Efficacy was assessed by reviewing pre- and post-treatment scores of the Vancouver Scar Scale (VSS) and Patient and Observer Scar Assessment Scale (POSAS) and by comparing baseline and photographs taken 3 months after the treatments. Safety and tolerability were collected and analyzed. RESULTS Twenty-one subjects (M/F = 11/10) with 39 keloids received the treatments. Treatments were well-tolerated by all patients at mean injection pain of 2.0 ± 1.0 per Numeric Pain Rating Scale (NPRS). Self-resolved lesion ulceration was observed in 4 patients. Post-treatment evaluation demonstrated a 53% decrease in total VSS score (P < 0.05) and in all sub-categories. Mean patient score of POSAS decreased in the color, stiffness, thickness, and irregularity components. Pain and pruritus lessened by 69% and 79% (P < 0.05 in both), respectively, among the patients with complaints prior to the treatment. Independent reviewers reported an average 51%-75% reduction in keloids. CONCLUSIONS Improved appearance of keloids and symptomatic relief was achieved by intralesional administration of combined 5-fluorouracil and corticosteroid through the high-pressure jet injections. The synergy between the drug combination and the jet physical impact provided clinical effect.
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Affiliation(s)
- Alex Levenberg
- Department of Plastic Surgery, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | - Ofir Artzi
- Center for Aesthetic Dermatology, Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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Keloid and Hypertrophic Scar Formation, Prevention, and Management: Standard Review of Abnormal Scarring in Orthopaedic Surgery. J Am Acad Orthop Surg 2020; 28:e408-e414. [PMID: 32109921 DOI: 10.5435/jaaos-d-19-00690] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Keloid and hypertrophic scar formation after orthopaedic surgical closure is a complex issue. The nature and location of procedures maximize wound tension, leave foreign bodies, and diminish dermal supply, all potentiating keloid formation. There is little discussion regarding the pathophysiology and management of this recurrent problem in orthopaedic literature. Keloid formation is a fibroproliferative disorder resulting in extensive production of extracellular matrix and collagen, but prevention and treatment is poorly understood. Patient and surgical factors contributing to the development of this condition are discussed. The treatments include both medical and surgical therapies that work at a biologic level and attempt to produce a cosmetic and complication-free management strategy. Medical options that have been investigated include combinations of intralesional steroid therapy, laser therapy, and biologics. Preventive surgical closure and excision remain mainstays of treatment. Radiation therapy has also been used in refractory cases with mixed results. Despite medical therapies and surgical excision aimed at treating the resulting scar, recurrence rate is very high for all modalities that have been studied to this point. Future work is being done to better understand the pathophysiology leading to keloid and hypertrophic scar formation in an effort to find preventive methods as compared to treatment strategies.
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Park J, Kim YC. Topical delivery of 5-fluorouracil-loaded carboxymethyl chitosan nanoparticles using microneedles for keloid treatment. Drug Deliv Transl Res 2020; 11:205-213. [PMID: 32383003 DOI: 10.1007/s13346-020-00781-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Keloids are induced by skin injuries such as surgeries, skin piercings, burns, and trauma. The intra-lesional injection of 5-fluorouracil (5-FU) is a promising therapy to treat keloid. However, local 5-FU injections have caused several side effects such as pain at administration and hyperpigmentation. This study suggests a safer and more effective 5-FU delivery system. We used microneedles to treat keloid because this method has the feasibility of self-administration without pain. In this study, 5-FU-loaded carboxymethyl chitosan (CMC) nanoparticles were prepared and characterized by various analytical methods and then coated on stainless solid microneedles. The blank CMC nanoparticles caused an increase in cell viability on human normal fibroblasts to 150%. In particular, the 5-FU-loaded CMC nanoparticles showed a significant inhibitory effect on the human keloid fibroblast to 16%. The intercellular uptake of the 5-FU-loaded CMC nanoparticles was observed on both human normal and keloid fibroblasts by using a confocal microscope. In addition, it was found that the nanoparticles showed an inhibition of TGF-β1 by ELISA. For topical drug delivery, it was confirmed that the nanoparticles coated onto the microneedles were dissolved and diffused at the administration site in the porcine dorsal skin model. According to these results, the suggested microneedle-mediated drug delivery system not only inhibits the human keloid fibroblasts by delivering drugs effectively into the keloids but also has the feasibility to self-administer without pain. Therefore, this new system including 5-FU-loaded CMC nanoparticles and microneedles has the potential to treat keloid scars. Graphical abstract.
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Affiliation(s)
- Juhyun Park
- Department of Chemical and Biomolecular Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Yeu-Chun Kim
- Department of Chemical and Biomolecular Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea.
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Zhou LL, Richer V. Treating Keloids With Intralesional 5-Fluorouracil and Triamcinolone Acetonide: Aren’t We There Yet? J Cutan Med Surg 2020; 24:205-206. [DOI: 10.1177/1203475419897577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Linghong L. Zhou
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
| | - Vincent Richer
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
- Pacific Derm, Vancouver, BC, Canada
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Feng Y, Sun ZL, Yuan FL. Comments on "A new approach in the treatment of pediatric hypertrophic burn scars: Tixel-associated topical triamcinolone acetonide and 5-fluorouracil delivery". J Cosmet Dermatol 2019; 19:1804. [PMID: 31793718 DOI: 10.1111/jocd.13231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 11/12/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Yi Feng
- Department of Burns and Plastic Surgery, The Affiliated Hospital of Jiangnan University, Wuxi, China.,Department of Pharmacology, Medical School, Yangzhou University, Yangzhou, China
| | - Zi-Li Sun
- Department of Burns and Plastic Surgery, The Affiliated Hospital of Jiangnan University, Wuxi, China.,Wuxi Clinical Medicine School of Integrated Chinese and Western Medicine, Nanjing University of Chinese Medicine, Wuxi, China
| | - Feng-Lai Yuan
- Department of Burns and Plastic Surgery, The Affiliated Hospital of Jiangnan University, Wuxi, China
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Artzi O, Koren A, Niv R, Mehrabi JN, Mashiah J, Friedman O. A new approach in the treatment of pediatric hypertrophic burn scars: Tixel‐associated topical triamcinolone acetonide and 5‐fluorouracil delivery. J Cosmet Dermatol 2019; 19:131-134. [DOI: 10.1111/jocd.13192] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 09/25/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Ofir Artzi
- Department of Dermatology Tel Aviv Sourasky Medical Center Tel Aviv Israel
- Dr. Artzi Treatment and Research Center Tel Aviv Israel
| | - Amir Koren
- Department of Dermatology Tel Aviv Sourasky Medical Center Tel Aviv Israel
- Dr. Artzi Treatment and Research Center Tel Aviv Israel
| | - Roni Niv
- Dr. Artzi Treatment and Research Center Tel Aviv Israel
| | | | - Jacob Mashiah
- Department of Dermatology Tel Aviv Sourasky Medical Center Tel Aviv Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
- Pediatric Dermatology Clinic Dana‐Dwek Children's Hospital Tel Aviv Sourasky medical center Tel Aviv Israel
| | - Or Friedman
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
- The Plastic Reconstructive Surgery Department Tel Aviv Sourasky Medical Center Tel Aviv Israel
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Abstract
Pharmacogenomics, a key part of precision medicine, has the potential to tailor drug therapy with the high safety margins and optimized response. Before the Human Genome Project in 2003, articles on pharmacogenomics were limited. The last 15 years have seen significant growth in the field, with gene variant discoveries that play essential roles in individuals' drug response. Dermatology has started to take advantage of this information. This overview shows how pharmacogenomic databases have expanded in the treatment of skin diseases and provides a list of current dermatologic drugs with their FDA-approved biomarkers and clinical implementation.
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Affiliation(s)
- Le Hanh Dung Do
- a Pham Ngoc Thach University of Medicine , Ho Chi Minh city , Vietnam
| | - Howard Maibach
- b Department of Dermatology, School of Medicine , University of California , San Francisco , CA , USA
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The Scar Bane, Without the Pain: A New Approach in the Treatment of Elevated Scars: Thermomechanical Delivery of Topical Triamcinolone Acetonide and 5-Fluorouracil. Dermatol Ther (Heidelb) 2019; 9:321-326. [PMID: 31041665 PMCID: PMC6522605 DOI: 10.1007/s13555-019-0298-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Indexed: 02/08/2023] Open
Abstract
Introduction Keloids are challenging to treat due to their inadequate response to treatment and high recurrence rate. Intralesional triamcinolone acetonide (TAC) injection with or without 5-fluorouracil (5FU) is considered the first-line treatment for keloids. Three significant disadvantages of intralesional injections are the pain associated with the procedure, the uneven topography, and epidermal atrophy. Fractionated ablative carbon dioxide (CO2) laser-assisted drug delivery (LADD) of the topical solution can help facilitate transdermal drug delivery and shows promise in scar remodeling. This study examined the use of a thermomechanical device (Tixel, Novoxel) to facilitate the transdermal delivery of TAC and 5-FU in the treatment of keloid scars. Methods Seven patients each received eight topical thermal ablations, with one ablation performed every 2–3 weeks. TAC and 5FU were applied after each ablation. Outcomes were evaluated using the Vancouver Scar Scale (VSS), and pain was assessed using the Visual Analog Scale (VAS). Results Mean keloid VSS reduced from 8.6 ± 1.2 to 5 ± 2.7 after the eight treatments. Mean treatment pain VAS score was 2.4 ± 0.7. Patients rated their satisfaction level as moderate–high. No severe adverse reactions were noted. Conclusion Thermomechanical drug delivery of TAC and 5-FU is safe and effective. This is a promising option for the treatment of keloid scars, particularly in the pediatric population.
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Kruglikov IL, Scherer PE. Caveolin-1 as a target in prevention and treatment of hypertrophic scarring. NPJ Regen Med 2019; 4:9. [PMID: 31044089 PMCID: PMC6486604 DOI: 10.1038/s41536-019-0071-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 04/02/2019] [Indexed: 12/11/2022] Open
Abstract
Reduced expression of caveolin-1 (Cav-1) is an important pathogenic factor in hypertrophic scarring (HTS). Such a reduction can be found in connection with the main known risk factors for HTS, including dark skin, female gender, young age, burn site and severity of the injury. The degree of overexpression of Cav-1 associated with different therapeutic options for HTS correlates with clinical improvements in HTS. This makes endo- or exogenous induction of Cav-1 not only an important therapeutic target for HTS, but also highlights its use as a preventive target to reduce or avoid HTS formation.
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Affiliation(s)
| | - Philipp E. Scherer
- Touchstone Diabetes Center, University of Texas Southwestern Medical Center, Dallas, TX 75390-8549 USA
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46
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Tawfik AA, Fathy M, Badawi A, Abdallah N, Shokeir H. Topical 5 fluorouracil cream vs combined 5 fluorouracil and fractional erbium YAG laser for treatment of severe hypertrophic scars. Clin Cosmet Investig Dermatol 2019; 12:173-180. [PMID: 30936735 PMCID: PMC6421878 DOI: 10.2147/ccid.s191137] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Topical 5 fluorouracil (5-FU) has been reported as one of the standard treatments for hypertrophic scars (HTS). Ablative fractional laser was found to have promising results in the delivery of topical drugs into the skin by creating vertical channels through which the drugs can penetrate the skin. So far there have been no comparative studies performed to compare both modalities in the same patient and same anatomical region, especially in severe HTS. Objective The aim of this study was to compare the effectiveness of topical 5-FU and combined topical 5-FU and laser in treating severe HTS. Patients and methods Twenty-four severe HTS lesions were treated by 5-FU monotherapy and 5-FU combined with ablative fractional erbium YAG laser. Each lesion was divided into two parts. One part was treated with topical 5-FU twice weekly for 8 months. The other part was treated with combined topical 5-FU and ablative fractional erbium YAG laser once per month for 8 months. The scars’ improvement was evaluated by Vancouver scar scale (VSS) and skin analysis camera. Results The assessment by VSS showed a significant reduction in the mean height, pliability, and vascularity of the lesions which were treated with combined approaches compared to 5-FU monotherapy. Pain and ulceration occurred at a higher rate in the combination therapy group. Conclusion Treatment of severe HTS with combined 5-FU and ablative fractional erbium YAG laser is more effective than 5-FU alone.
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Affiliation(s)
- Abeer Attia Tawfik
- Dermatology Unit, Department of Medical Applications of Lasers (MAL), National Institute of Laser Enhanced Sciences, Cairo University, Giza, Egypt,
| | - Maha Fathy
- Al-Houd Al Marsoud Hospital, Cairo, Egypt,
| | - Ashraf Badawi
- Dermatology Unit, Department of Medical Applications of Lasers (MAL), National Institute of Laser Enhanced Sciences, Cairo University, Giza, Egypt, .,Dermatology and Allergology Department, University of Szeged, Szeged, Hungary
| | - Noha Abdallah
- Dermatology Unit, Department of Medical Applications of Lasers (MAL), National Institute of Laser Enhanced Sciences, Cairo University, Giza, Egypt,
| | - Hisham Shokeir
- Dermatology Unit, Department of Medical Applications of Lasers (MAL), National Institute of Laser Enhanced Sciences, Cairo University, Giza, Egypt,
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Srivastava S, Patil A, Prakash C, Kumari H. Comparison of Intralesional Triamcinolone Acetonide, 5-Fluorouracil, and Their Combination in Treatment of Keloids. World J Plast Surg 2018; 7:212-219. [PMID: 30083505 PMCID: PMC6066718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Despite the myriad options available, there is no universally accepted treatment for keloids. This study has compared intralesional triamcinolone acetonide, 5-fluorouracil, and their combination in treatment of keloids. METHODS In this randomized parallel group study, 60 patients were enrolled and randomly allocated to three groups. Patients received intralesional injections of triamcinolone acetonide (TAC) in Group TAC, 5-fluorouracil (5FU) in Group 5FU and a combination in Group T+F every 3 weeks till 24 weeks or till the keloid resolved. RESULTS There was a reduction in all parameters at every successive assessment in all three groups. Improvement in terms of height, vascularity and pliability was fastest with 5FU, TAC and T+F group, respectively, which was statistically significant. Decrease in pigmentation was significantly faster with T+F. Reduction in pruritus, however, was significantly faster with 5FU than the other groups, but the difference in reduction of pain among the three groups was not significant. Telangiectasias and skin atrophy were seen most commonly in TAC group, while skin ulceration was a common problem in 5FU group. CONCLUSION TAC, 5FU and their combination are all effective in keloid scars. A combination of TAC+5FU seems to offer the balanced benefit of faster and more efficacious response with lesser adverse effects when compared to individual drugs.
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Affiliation(s)
| | - Aditya Patil
- Corresponding Author: Aditya Patil, Sawai Man Singh Medical College and Hospital, 301, A-17, Roop Garden, Shanti Path, Tilak Nagar, Jaipur- 302004 Jaipur, India, E-mail:
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48
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Rajabi-Estarabadi A, Iglesia S, Griggs JW, Gurnani P, Smith SC, Collins CI, Nouri K. Cells to Surgery Quiz: April 2018. J Invest Dermatol 2018; 138:e37. [PMID: 29579460 DOI: 10.1016/j.jid.2018.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Ali Rajabi-Estarabadi
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Sofia Iglesia
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Jacob W Griggs
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Pooja Gurnani
- Florida International University Herbert Wertheim College of Medicine, Miami, Florida, USA
| | - Samuel C Smith
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Cassandra If Collins
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Keyvan Nouri
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
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Hariprakash JM, Vellarikkal SK, Keechilat P, Verma A, Jayarajan R, Dixit V, Ravi R, Senthivel V, Kumar A, Sehgal P, Sonakar AK, Ambawat S, Giri AK, Philip A, Sivadas A, Faruq M, Bharadwaj D, Sivasubbu S, Scaria V. Pharmacogenetic landscape of DPYD variants in south Asian populations by integration of genome-scale data. Pharmacogenomics 2017; 19:227-241. [PMID: 29239269 DOI: 10.2217/pgs-2017-0101] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
AIM Adverse drug reactions to 5-Fluorouracil(5-FU) is frequent and largely attributable to genetic variations in the DPYD gene, a rate limiting enzyme that clears 5-FU. The study aims at understanding the pharmacogenetic landscape of DPYD variants in south Asian populations. MATERIALS & METHODS Systematic analysis of population scale genome wide datasets of over 3000 south Asians was performed. Independent evaluation was performed in a small cohort of patients. RESULTS Our analysis revealed significant differences in the the allelic distribution of variants in different ethnicities. CONCLUSIONS This is the first and largest genetic map the DPYD variants associated with adverse drug reaction to 5-FU in south Asian population. Our study highlights ethnic differences in allelic frequencies.
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Affiliation(s)
- Judith M Hariprakash
- GN Ramachandran Knowledge Center for Genome Informatics, CSIR Institute of Genomics & Integrative Biology, Mathura Road, Delhi 110025, India
| | - Shamsudheen K Vellarikkal
- Genomics & Molecular Medicine, CSIR Institute of Genomics & Integrative Biology, Mathura Road, Delhi 110025, India
| | - Pavithran Keechilat
- Department of Medical Oncology, Amrita Institute of Medical Sciences & Research Centre, Amrita University, Kochi-682041, India
| | - Ankit Verma
- Genomics & Molecular Medicine, CSIR Institute of Genomics & Integrative Biology, Mathura Road, Delhi 110025, India
| | - Rijith Jayarajan
- Genomics & Molecular Medicine, CSIR Institute of Genomics & Integrative Biology, Mathura Road, Delhi 110025, India
| | - Vishal Dixit
- Genomics & Molecular Medicine, CSIR Institute of Genomics & Integrative Biology, Mathura Road, Delhi 110025, India
| | - Rowmika Ravi
- Genomics & Molecular Medicine, CSIR Institute of Genomics & Integrative Biology, Mathura Road, Delhi 110025, India
| | - Vigneshwar Senthivel
- Genomics & Molecular Medicine, CSIR Institute of Genomics & Integrative Biology, Mathura Road, Delhi 110025, India
| | - Anoop Kumar
- Genomics & Molecular Medicine, CSIR Institute of Genomics & Integrative Biology, Mathura Road, Delhi 110025, India
| | - Paras Sehgal
- Genomics & Molecular Medicine, CSIR Institute of Genomics & Integrative Biology, Mathura Road, Delhi 110025, India
| | - Akhilesh K Sonakar
- Genomics & Molecular Medicine, CSIR Institute of Genomics & Integrative Biology, Mathura Road, Delhi 110025, India
| | - Sakshi Ambawat
- Genomics & Molecular Medicine, CSIR Institute of Genomics & Integrative Biology, Mathura Road, Delhi 110025, India
| | - Anil K Giri
- Genomics & Molecular Medicine, CSIR Institute of Genomics & Integrative Biology, Mathura Road, Delhi 110025, India
| | - Arun Philip
- Department of Medical Oncology, Amrita Institute of Medical Sciences & Research Centre, Amrita University, Kochi-682041, India
| | - Akhila Sivadas
- Department of Medical Oncology, Amrita Institute of Medical Sciences & Research Centre, Amrita University, Kochi-682041, India
| | - Mohammed Faruq
- Genomics & Molecular Medicine, CSIR Institute of Genomics & Integrative Biology, Mathura Road, Delhi 110025, India
| | - Dwaipayan Bharadwaj
- School of Biotechnology, Jawaharlal Nehru University, New Delhi 110067, India
| | - Sridhar Sivasubbu
- Genomics & Molecular Medicine, CSIR Institute of Genomics & Integrative Biology, Mathura Road, Delhi 110025, India
| | - Vinod Scaria
- GN Ramachandran Knowledge Center for Genome Informatics, CSIR Institute of Genomics & Integrative Biology, Mathura Road, Delhi 110025, India
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Srivastava S, Patil AN, Prakash C, Kumari H. Comparison of Intralesional Triamcinolone Acetonide, 5-Fluorouracil, and Their Combination for the Treatment of Keloids. Adv Wound Care (New Rochelle) 2017; 6:393-400. [PMID: 29098115 DOI: 10.1089/wound.2017.0741] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Accepted: 06/19/2017] [Indexed: 11/12/2022] Open
Abstract
Objective: Despite the myriad options available, there is no universally accepted treatment for keloids. Our objective was to compare three regimens and establish superiority in terms of objective and subjective outcomes. Approach: In this randomized parallel group study, 60 patients were enrolled and randomly allocated to three groups. Patients received intralesional injections of triamcinolone acetonide (TAC) in Group TAC, 5-fluorouracil (5FU) in Group 5FU, and a combination in Group T + F every 3 weeks till 24 weeks or till the keloid resolved. Results: There was a reduction in all parameters at every successive assessment in all three groups. Improvement in terms of height, vascularity, and pliability was fastest with 5FU, TAC, and T + F group, respectively, which was statistically significant. Decrease in pigmentation was significantly faster with T+F. Reduction in pruritus, however, was significantly faster with 5FU than the other groups, but the difference in reduction of pain among the three groups was not significant. Telangiectasias and skin atrophy were seen most commonly in TAC group, while skin ulceration was a common problem in 5FU group. Conclusion: TAC, 5FU, and their combination are all effective in keloid scars. A combination of TAC +5FU seems to offer the balanced benefit of faster and more efficacious response with lesser adverse effects when compared to individual drugs.
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Affiliation(s)
- Sunil Srivastava
- Department of Plastic Surgery, Sawai Man Singh Medical College and Hospital, Rajasthan University of Health Sciences, Jaipur, India
| | - Aditya Nanasaheb Patil
- Department of Plastic Surgery, Sawai Man Singh Medical College and Hospital, Rajasthan University of Health Sciences, Jaipur, India
| | - Chaitra Prakash
- Department of Dermatology, Sawai Man Singh Medical College and Hospital, Rajasthan University of Health Sciences, Jaipur, India
| | - Hiranmayi Kumari
- Department of Plastic Surgery, Sawai Man Singh Medical College and Hospital, Rajasthan University of Health Sciences, Jaipur, India
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