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Qadir M, Fatima S, Shaikh S, Zeeshan S. Dermatofibrosarcoma protuberans of the breast. BMJ Case Rep 2024; 17:e258846. [PMID: 38604740 PMCID: PMC11015273 DOI: 10.1136/bcr-2023-258846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024] Open
Abstract
Dermatofibrosarcoma protuberans (DFSP) of the breast is an infrequent soft tissue sarcoma that usually affects young to middle-aged women. Our case report describes a unique occurrence of DFSP of the breast in an adolescent girl, which was initially being managed as a keloid for 2 years under dermatology despite being refractory to treatment. Once the diagnosis of DFSP was confirmed through punch biopsy, our patient underwent surgical excision of the lesion under general anaesthesia. Our patient was at an increased risk of damage to the ductal system due to proximity of the lesion to the nipple-areolar complex, warranting the need for early recognition and treatment. As demonstrated by our case, DFSP of the breast can be difficult to diagnose since it resembles a range of benign and malignant pathologies of the breast.
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Affiliation(s)
- Muskaan Qadir
- Medical College, Aga Khan University, Karachi, Pakistan
| | - Saira Fatima
- Pathology, Aga Khan University, Karachi, Sindh, Pakistan
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2
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Webinar zur S2k-Leitlinie „Therapie pathologischer Narben (hypertrophe Narben und Keloide)“. Chirurgie (Heidelb) 2024; 95:335. [PMID: 38507050 DOI: 10.1007/s00104-024-02044-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
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3
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Affiliation(s)
- Vicky Ren
- Department of Dermatology, Baylor College of Medicine, Houston, TX, USA
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Zhou B, Zhou N, Liu Y, Dong E, Peng L, Wang Y, Yang L, Suo H, Tao J. Identification and validation of CCR5 linking keloid with atopic dermatitis through comprehensive bioinformatics analysis and machine learning. Front Immunol 2024; 15:1309992. [PMID: 38476235 PMCID: PMC10927814 DOI: 10.3389/fimmu.2024.1309992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 02/02/2024] [Indexed: 03/14/2024] Open
Abstract
There is sufficient evidence indicating that keloid is strongly associated with atopic dermatitis (AD) across ethnic groups. However, the molecular mechanism underlying the association is not fully understood. The aim of this study is to discover the underlying mechanism of the association between keloid and AD by integrating comprehensive bioinformatics techniques and machine learning methods. The gene expression profiles of keloid and AD were downloaded from the Gene Expression Omnibus (GEO) database. A total of 449 differentially expressed genes (DEGs) were found to be shared in keloid and AD using the training datasets of GEO (GSE158395 and GSE121212). The hub genes were identified using the protein-protein interaction network and Cytoscape software. 20 of the most significant hub genes were selected, which were mainly involved in the regulation of the inflammatory and immune response. Through two machine learning algorithms of LASSO and SVM-RFE, CCR5 was identified as the most important key gene. Subsequently, upregulated CCR5 gene expression was confirmed in validation GEO datasets (GSE188952 and GSE32924) and clinical samples of keloid and AD. Immune infiltration analysis showed that T helper (Th) 1, 2 and 17 cells were significantly enriched in the microenvironment of both keloid and AD. Positive correlations were found between CCR5 and Th1, Th2 and Th17 cells. Finally, two TFs of CCR5, NR3C2 and YY1, were identified, both of which were downregulated in keloid and AD tissues. Our study firstly reveals that keloid and AD shared common inflammatory and immune pathways. Moreover, CCR5 plays a key role in the pathogenesis association between keloid and AD. The common pathways and key genes may shed light on further mechanism research and targeted therapy, and may provide therapeutic interventions of keloid with AD.
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Affiliation(s)
- Bin Zhou
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, Hubei, China
- Hubei Engineering Research Center for Skin Repair and Theranostics, Wuhan, Hubei, China
| | - Nuoya Zhou
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, Hubei, China
- Hubei Engineering Research Center for Skin Repair and Theranostics, Wuhan, Hubei, China
| | - Yan Liu
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, Hubei, China
- Hubei Engineering Research Center for Skin Repair and Theranostics, Wuhan, Hubei, China
| | - Enzhu Dong
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, Hubei, China
- Hubei Engineering Research Center for Skin Repair and Theranostics, Wuhan, Hubei, China
| | - Lianqi Peng
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, Hubei, China
- Hubei Engineering Research Center for Skin Repair and Theranostics, Wuhan, Hubei, China
| | - Yifei Wang
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, Hubei, China
- Hubei Engineering Research Center for Skin Repair and Theranostics, Wuhan, Hubei, China
| | - Liu Yang
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, Hubei, China
- Hubei Engineering Research Center for Skin Repair and Theranostics, Wuhan, Hubei, China
| | - Huinan Suo
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, Hubei, China
- Hubei Engineering Research Center for Skin Repair and Theranostics, Wuhan, Hubei, China
| | - Juan Tao
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, Hubei, China
- Hubei Engineering Research Center for Skin Repair and Theranostics, Wuhan, Hubei, China
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Kivi MK, Jafarzadeh A, Hosseini-Baharanchi FS, Salehi S, Goodarzi A. The efficacy, satisfaction, and safety of carbon dioxide (CO2) fractional laser in combination with pulsed dye laser (PDL) versus each one alone in the treatment of hypertrophic burn scars: a single-blinded randomized controlled trial. Lasers Med Sci 2024; 39:69. [PMID: 38376542 DOI: 10.1007/s10103-024-03976-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 01/02/2024] [Indexed: 02/21/2024]
Abstract
The tendency to use less-invasive laser-based methods with far more obvious effectiveness has been taken into consideration today for improvement of burning scars. The present study thus aimed to assess the efficacy of two laser-based techniques including pulsed dye laser (PDL) and ablative fractional CO2 laser (AFCL) and its combination on improving different aspects of burning scars regardless of the types of scar as hypertrophic or keloid scars. This randomized single-blinded clinical trial was performed on patients suffering hypertrophic or keloid burning scars. The patients were randomly assigned into three groups scheduling for treatment with PDL alone, AFCL alone, or its combination. All patients were visited before and 40 days after the last treatment session, and their scars were assessed. In all groups, significant improvement was revealed in the Vancouver scar scale (VSS) score, the color of scar, vascular bed in the scar, the and height of scar and its pliability; however, the improvement in each item was more highlighted in the group receiving a combination therapy with PDL and AFCL techniques. In this regard, the highest improvement was found in vascular bed and pliability in the combination therapy group as compared to other groups. Although the superiority of the combined group was not statistically significant, due to the high percentage of improvement in total VSS and most of its indicators, it can be clinically significant. The efficacy of the treatment protocols was different considering subgroups of mature and immature scars (less than 1 year), so that more improvement in pliability of scar, vascularity, and color of scar was found in the group scheduling for PDL + AFCL as compared to those who were treated with PDL alone in immature scar group but not in mature scar group. Combined treatment can be much more effective in improving the appearance and pathological characteristics of scars than each individual treatment. This effectiveness can be seen mainly in immature scars.
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Affiliation(s)
- Maedeh Karimi Kivi
- Medical Students Association, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Alireza Jafarzadeh
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Fatemeh Sadat Hosseini-Baharanchi
- Minimally Invasive Surgery Research Center & Department of Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Sadaf Salehi
- Medical Students Association, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Azadeh Goodarzi
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran.
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Hong L, Junjie C, Pengyu Z, Ping L, Wei C. The mechanism of oxidative stress in keloid fibroblasts and the experimental study of early application of angiotensin-converting enzyme inhibitor. Indian J Dermatol Venereol Leprol 2023; 89:842-849. [PMID: 37067128 DOI: 10.25259/ijdvl_323_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 10/12/2022] [Indexed: 03/31/2023]
Abstract
Objective To investigate the protective effects of an angiotensin-converting enzyme inhibitor after inducing oxidative stress on keloid fibroblasts. Methods Primary keloid fibroblasts were isolated and cultured by enzyme digestion combined with the tissue adhesion method in vitro, and the third to fifth generations of cells were selected for the experiment. For 24 hours, keloid fibroblasts were treated with different concentrations of hydrogen peroxide. Different concentrations of angiotensin-converting enzyme inhibitor were added to the keloid fibroblast culture medium, and then the cells were treated with hydrogen peroxide for 24 hours. Results With the increase of hydrogen peroxide concentration, the growth of keloid fibroblasts was inhibited and the levels of malondialdehyde, superoxide dismutase, and reactive oxygen species increased gradually, accompanied by an increase in the expression of nicotinamide adenine dinucleotide phosphate oxidase and collagen I mRNA. The expression of nicotinamide adenine dinucleotide phosphate oxidase-mRNA in keloid fibroblasts and the formation of reactive oxygen species in keloid fibroblasts were induced by different concentrations of angiotensin II, and the most significant effect was at 10-5 mmol/mL. The effects of diphenyleneiodonium chloride (NOX inhibitor), N-acetylcysteine (reactive oxygen species inhibitor) and nicotinamide adenine dinucleotide phosphate oxidase (NADPH oxidase) RNA treatment on angiotensin II-induced nicotinamide adenine dinucleotide phosphate oxidase and collagen I increased significantly. Hydrogen peroxide and angiotensin II alone or combined can induce NADPH oxidase and reactive oxygen species expression in keloid fibroblasts. When the angiotensin-converting enzyme inhibitor was added, the expression of NADPH oxidase and reactive oxygen species in keloid induced by hydrogen peroxide and angiotensin II could be inhibited. Conclusion Oxidative stress can lead to increased expression of reactive oxygen species, NADPH oxidase and collagen I in keloid fibroblasts, suggesting oxidative stress mediates the migration of human keloid fibroblasts and extracellular matrix synthesis.
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Affiliation(s)
- Li Hong
- Department of Medical Cosmetology, Chengdu Second People's Hospital, Chengdu, China
| | - Chen Junjie
- Department of Aesthetic and Plastic Burn Surgery, West China Hospital of Sichuan University, Huaxi, China
| | - Zhao Pengyu
- Department of Medical Cosmetology, Chengdu Second People's Hospital, Chengdu, China
| | - Liu Ping
- Department of Medical Cosmetology, Chengdu Second People's Hospital, Chengdu, China
| | - Chen Wei
- Department of Medical Cosmetology, Chengdu Second People's Hospital, Chengdu, China
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Liang BMH. Modification of clip-on earring as pressure earring. J Am Acad Dermatol 2023; 89:e199-e200. [PMID: 34400205 DOI: 10.1016/j.jaad.2021.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 07/26/2021] [Accepted: 08/03/2021] [Indexed: 11/20/2022]
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Dore R. Dark Skin Representation in Mobile Applications for Dermatology Education: A Scoping Review. Skinmed 2023; 21:242-247. [PMID: 37771013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
There is increasing recognition regarding the need to represent ethnic diversity within dermatology education. Past evaluation of dermatology textbooks has demonstrated that depiction of dark skin makes up to 4.5%-19.9% of total photographs. The present study reviewed the representation of dark skin photography and diseases in dermatologic educational resources provided through mobile application technology. Of the 518 mobile applications reviewed, 18 were included in this analysis. A total of 6,645 in-app photographs were categorized in Fitzpatrick skin types I-IV (5,975 photographs, 89.9%), Fitzpatrick skin types V and VI (459 photographs, 6.9%), or uncertain (211 photographs, 3.2%). The degree of photographs depicting Fitzpatrick skin types V and VI ranged from 0.0% to 17.7% between different mobile applications. This was significantly different from past results derived from photographic depictions in dermatology textbooks-suggestive of fewer depictions within applications (P < 0.001). In addition, the number of mobile applications presenting educational information regarding four conditions that affect people with darker skin tones varied considerably: central centrifugal cicatricial alopecia (3 applications, 16.7%), melasma (9 applications, 50.0%), acral lentiginous melanoma (8 applications, 44.4%), and keloid scarring (11 applications, 61.1%). Overall, there is a limited depiction of darker skin tones and conditions that affect those with darker skin tones within educational mobile applications aimed at students and professionals in dermatology.
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Affiliation(s)
- Rhys Dore
- The Paediatric Department, Royal London Hospital, Whitechapel Road, Whitechapel, London, United Kingdom;
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Choi S, Ham S, Lee YI, Kim J, Lee WJ, Lee JH. Silibinin Downregulates Types I and III Collagen Expression via Suppression of the mTOR Signaling Pathway. Int J Mol Sci 2023; 24:14386. [PMID: 37762688 PMCID: PMC10531945 DOI: 10.3390/ijms241814386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 09/13/2023] [Accepted: 09/20/2023] [Indexed: 09/29/2023] Open
Abstract
Keloid scars are fibro-proliferative conditions characterized by abnormal fibroblast proliferation and excessive extracellular matrix deposition. The mammalian target of the rapamycin (mTOR) pathway has emerged as a potential therapeutic target in keloid disease. Silibinin, a natural flavonoid isolated from the seeds and fruits of the milk thistle, is known to inhibit the mTOR signaling pathway in human cervical and hepatoma cancer cells. However, the mechanisms underlying this inhibitory effect are not fully understood. This in vitro study investigated the effects of silibinin on collagen expression in normal human dermal and keloid-derived fibroblasts. We evaluated the effects of silibinin on the expressions of collagen types I and III and assessed its effects on the suppression of the mTOR signaling pathway. Our findings confirmed elevated mTOR phosphorylation levels in keloid scars compared to normal tissue specimens. Silibinin treatment significantly reduced collagen I and III expressions in normal human dermal and keloid-derived fibroblasts. These effects were accompanied by the suppression of the mTOR signaling pathway. Our findings suggest the potential of silibinin as a promising therapeutic agent for preventing and treating keloid scars. Further studies are warranted to explore the clinical application of silibinin in scar management.
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Affiliation(s)
- Sooyeon Choi
- Department of Dermatology & Cutaneous Biology, Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (S.C.); (S.H.); (Y.I.L.)
| | - Seoyoon Ham
- Department of Dermatology & Cutaneous Biology, Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (S.C.); (S.H.); (Y.I.L.)
| | - Young In Lee
- Department of Dermatology & Cutaneous Biology, Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (S.C.); (S.H.); (Y.I.L.)
- Scar Laser and Plastic Surgery Center, Yonsei Cancer Hospital, Seoul 03722, Republic of Korea; (J.K.); (W.J.L.)
| | - Jihee Kim
- Scar Laser and Plastic Surgery Center, Yonsei Cancer Hospital, Seoul 03722, Republic of Korea; (J.K.); (W.J.L.)
- Department of Dermatology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin 16995, Republic of Korea
| | - Won Jai Lee
- Scar Laser and Plastic Surgery Center, Yonsei Cancer Hospital, Seoul 03722, Republic of Korea; (J.K.); (W.J.L.)
- Department of Plastic Surgery, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Ju Hee Lee
- Department of Dermatology & Cutaneous Biology, Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (S.C.); (S.H.); (Y.I.L.)
- Scar Laser and Plastic Surgery Center, Yonsei Cancer Hospital, Seoul 03722, Republic of Korea; (J.K.); (W.J.L.)
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10
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Fabi SG, Park JY, Goldie K, Wu W. Microtoxin for Improving Pore Size, Skin Laxity, Sebum Control, and Scars: A Roundtable on Integrating Intradermal Botulinum Toxin Type A Microdoses Into Clinical Practice. Aesthet Surg J 2023; 43:1015-1024. [PMID: 36857534 PMCID: PMC10481112 DOI: 10.1093/asj/sjad044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 02/17/2023] [Accepted: 02/21/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND In aesthetic clinical practice, botulinum toxin type A (BoNT-A) is best known for its use as a neuromodulator for the treatment of dynamic facial lines; however, when injected intradermally as microdroplets, BoNT-A can improve skin quality and overall skin appearance. OBJECTIVES To discuss key aspects of microtoxin use in clinical practice and provide expert guidance on utilization. METHODS As part of a continuing medical education lecture series and roundtable, the authors discussed key aspects of microtoxin patient selection, injection technique, and safety. RESULTS The experiences of expert faculty are shared here. Clinical experience is consistent with reported data. Microtoxin can be used to reduce pore size, sebum production, rosacea, acne, and fine lines, and to improve jawline and neck definition. Intradermal injection can also be employed for the improvement of transverse neck lines as well as for the safe prevention and management of scars and keloids. CONCLUSIONS Expanding the use of BoNT-A, a predictable, minimally invasive, and affordable treatment to address commonly encountered complaints is appealing. The authors have found that making patients aware of microtoxin as a treatment option results in an increased interest in and utilization of BoNT-A, and high satisfaction among appropriately selected patients.
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Affiliation(s)
- Sabrina Guillen Fabi
- Corresponding Author: Dr Sabrina Guillen Fabi, 9339 Genesee Ave Unit 300, San Diego, CA 92121, USA. E-mail:
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11
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Zhang M, Chen H, Qian H, Wang C. Characterization of the skin keloid microenvironment. Cell Commun Signal 2023; 21:207. [PMID: 37587491 PMCID: PMC10428592 DOI: 10.1186/s12964-023-01214-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 07/02/2023] [Indexed: 08/18/2023] Open
Abstract
Keloids are a fibroproliferative skin disorder that develops in people of all ages. Keloids exhibit some cancer-like behaviors, with similar genetic and epigenetic modifications in the keloid microenvironment. The keloid microenvironment is composed of keratinocytes, fibroblasts, myofibroblasts, vascular endothelial cells, immune cells, stem cells and collagen fibers. Recent advances in the study of keloids have led to novel insights into cellular communication among components of the keloid microenvironment as well as potential therapeutic targets for treating keloids. In this review, we summarized the nature of genetic and epigenetic regulation in keloid-derived fibroblasts, epithelial-to-mesenchymal transition of keratinocytes, immune cell infiltration into keloids, the differentiation of keloid-derived stem cells, endothelial-to-mesenchymal transition of vascular endothelial cells, extracellular matrix synthesis and remodeling, and uncontrolled angiogenesis in keloids with the aim of identifying new targets for therapeutic benefit. Video Abstract.
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Affiliation(s)
- Mengwen Zhang
- The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, China
| | - Hailong Chen
- The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, China
| | - Huan Qian
- The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, China
| | - Chen Wang
- The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, China.
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12
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Bekkers VZ, Bik L, van Huijstee JC, Wolkerstorfer A, Prens EP, van Doorn MBA. Efficacy and safety of needle-free jet injector-assisted intralesional treatments in dermatology-a systematic review. Drug Deliv Transl Res 2023; 13:1584-1599. [PMID: 36884194 PMCID: PMC10126042 DOI: 10.1007/s13346-023-01295-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2023] [Indexed: 03/09/2023]
Abstract
Needle-free jet injectors are used for the intralesional treatment of various dermatological indications. However, a systematic review that evaluates the efficacy and safety of these treatments has not been published. The objectives of this study are to evaluate the efficacy and safety of needle-free jet injections for dermatological indications and to provide evidence-based treatment recommendations. An electronic literature search was conducted in April 2022. Two reviewers independently selected studies based on predefined criteria and performed a methodological quality assessment using the Cochrane Collaborations risk-of-bias 2.0 assessment tool and Newcastle-Ottawa Scale. Thirty-seven articles were included, involving 1911 participants. Dermatological indications included scars, alopecia areata, hyperhidrosis, nail diseases, non-melanoma skin cancer, common warts, local anesthesia, and aesthetic indications. Keloids and other types of scars (hypertrophic, atrophic, and burn scars) were investigated most frequently (n = 7). The included studies reported favorable efficacy and safety outcomes for intralesional jet injector-assisted treatment with triamcinolone acetonide/hexacetonide, 5-fluorouracil, bleomycin, or hyaluronic acid. Two high-quality studies showed good efficacy and tolerability of intralesional jet injections with a combination of 5-fluorouracil and triamcinolone acetonide in hypertrophic scars and with saline in boxcar and rolling acne scars. No serious adverse reactions and good tolerability were reported in the included studies. Overall, the methodological quality of the included studies was low. Limited evidence suggests that needle-free jet injector-assisted intralesional treatment is efficacious and safe for hypertrophic and atrophic acne scars. More well-powered RCTs investigating the efficacy and safety of jet injector treatment in dermatology are warranted to make further evidence-based recommendations.
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Affiliation(s)
| | - Liora Bik
- Department of Dermatology, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | - Albert Wolkerstorfer
- Department of Dermatology, Amsterdam University Medical Center, Location AMC, Amsterdam, the Netherlands
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13
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Hom DB, Bernstein JD. Reducing Risks of Facial Scarring. Facial Plast Surg Clin North Am 2023; 31:195-207. [PMID: 37001923 DOI: 10.1016/j.fsc.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
Risk factors for the formation of facial scars include skin type, ethnicity, scar location, and certain medical conditions that contribute to poor or delayed healing. Risk of scar can be reduced with appropriate surgical planning, including proper placement and design of incisions, meticulous skin closure, aseptic technique, and wound care to improve healing. Common pathologic scars include hypertrophic scars and keloid scars, each of which has unique approaches to surgical revision and medical treatment due to their respective risks of recurrence. Topical scar therapies, medical therapies, and surgical revision techniques for improvement in final scar appearance are discussed.
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Affiliation(s)
- David B Hom
- Department of Otolaryngology-Head and Neck Surgery, University of California - San Diego, 200 West Arbor Drive, Mail Code 8895, San Diego, CA 92103, USA.
| | - Jeffrey D Bernstein
- Department of Otolaryngology-Head and Neck Surgery, University of California - San Diego, 200 West Arbor Drive, Mail Code 8895, San Diego, CA 92103, USA
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14
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Delaleu J, Charvet E, Petit A. Keloid disease: Review with clinical atlas. Part I: Definitions, history, epidemiology, clinics and diagnosis. Ann Dermatol Venereol 2023; 150:3-15. [PMID: 36494213 DOI: 10.1016/j.annder.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 05/06/2022] [Accepted: 08/30/2022] [Indexed: 12/12/2022]
Abstract
Keloids are chronic progressive dermal pseudo-tumors that can grow considerably in volume and surface area but do not invade other tissues. They are usually triggered by dermal injury or inflammation, but they are not scars in the normal sense of the word, since they enlarge and progress over decades. The phenomenon usually referred to as "hypertrophic scars" represents a kind of keloidal process that does not extend beyond the initial site of injury and spontaneously regresses in 12-24 months. The multiplication of keloids and hypertrophic scars in a single patient is known as keloid disease. Keloid disease is due to a familial predisposition (autosomal dominant) that preferentially affects people of non-European ancestry, especially those of sub-Saharan African descent. Keloid disease has a deep impact on quality of life, not only because of disfiguring lesions, but also because of the frequency of associated intense neurogenic pruritus and pain, as well as recurrent bouts of suppuration. Diagnosis relies primarily on a good knowledge of the clinical characteristics of keloids, thus warranting the inclusion of a clinical atlas in the first part of the review. The second part will deal with the pathology, pathophysiology and treatment of keloid disease.
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Affiliation(s)
- J Delaleu
- Service de dermatologie, APHP Hôpital Saint-Louis, Paris, France
| | - E Charvet
- Service de dermatologie, APHP Hôpital Saint-Louis, Paris, France
| | - A Petit
- Service de dermatologie, APHP Hôpital Saint-Louis, Paris, France.
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15
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Jacobs J, Lebhar J, Diamond C, Rundle C, Stamey C. Skin of Color Representation in Clinical Trials: An Analysis of Clinicaltrials.gov From 2008-2022. J Drugs Dermatol 2023; 22:310-311. [PMID: 36877873 DOI: 10.36849/jdd.7087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
There is a plethora of dermatologic clinical trials; however, little is known regarding the representation of skin of color (SOC) populations. We evaluated the 15 most prevalent skin conditions in SOC patients and their representation in clinical trials over 14 years (2008-2022) to address the lack of research regarding dermatologic clinical trials and SOC inclusion. There have been 1,419 clinical trials conducted over the last 14 years regarding the 15 dermatologic conditions most commonly affecting SOC. Despite the prevalence of these conditions in SOC, Black/African American participation was greater than 50% in clinical trials for two conditions, keloids (77.9%) and seborrheic dermatitis (55.3%). Due to the disparities in inclusion, clinical trial data is difficult to extrapolate the results to SOC patients, limiting therapeutic options and potentially contributing to worse outcomes for such patients. Our study confirms that there is limited data available in clinical trials with respect to race, ethnicity, and FST. Further, it highlights how essential it is for SOC to be both adequately represented and reported in research regarding dermatologic skin conditions to ensure equality and equity in dermatologic care. J Drugs Dermatol. 2023;22(3) doi:10.36849/JDD.7087.
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Inamadar A, Mutalik S. Giant acquired digital fibrokeratoma. BMJ Case Rep 2023; 16:e254499. [PMID: 36731948 PMCID: PMC9896208 DOI: 10.1136/bcr-2022-254499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
- Arun Inamadar
- Department of Dermatology, Venereology & Leprosy, Shri BM Patil Medical College, Bijapur, India
| | - Sharad Mutalik
- Department of Dermatology, Venereology & Leprosy, Joshi Hospital, Pune, Maharashtra, India
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17
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Snehi S, Kaur A, Chaudhry C, Kaushik S. Congenital glaucoma as a presenting feature of Rubinstein-Taybi syndrome in an infant with a novel pathogenic variant in the CREBBP gene. BMJ Case Rep 2023; 16:e251543. [PMID: 36653044 PMCID: PMC9853153 DOI: 10.1136/bcr-2022-251543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Rubinstein-Taybi syndrome, also known as broad thumb-hallux syndrome, is a rare autosomal dominant genetic disorder. This multiorgan syndrome is linked to a pathogenic mutation in the CREBBP or EBP300 genes.We present a patient with a hitherto unreported constellation of anterior segment abnormalities, including congenital glaucoma, congenital corneal keloid, cataract, and distinct facial and systemic features including a high-arched palate, low-set posteriorly rotated ears, Café-au-lait spots on the back, broad terminal phalanges of hands and feet, and bilateral cryptorchidism. The characteristic dysgenetic angle features and ultrasound biomicroscopic findings described in this case report show the occurrence of concomitant congenital keloid with glaucoma.Genetic testing revealed a heterozygous one-base pair duplication in exon 3 of the CREBBP gene (c.886dupC), a novel frameshift pathogenic mutation in the CREBBP gene that has not been previously reported in a clinical setting.
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Affiliation(s)
- Sagarika Snehi
- Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Anupriya Kaur
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Chakshu Chaudhry
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sushmita Kaushik
- Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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18
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Frazier WT, Proddutur S, Swope K. Common Dermatologic Conditions in Skin of Color. Am Fam Physician 2023; 107:26-34. [PMID: 36689965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Individuals with skin of color represent a diverse population of racial and ethnic backgrounds, including but not limited to Black or African American, American Indian or Alaska Native, Asian American or Pacific Islander, Hispanic or Latino, and Middle Eastern or North African. Dermatologic health disparities exist in part because of systemic racism and are exacerbated by inadequate physician training and a lack of high-quality research on skin diagnoses that disproportionately affect people with skin of color. These conditions, which include postinflammatory hyperpigmentation, keloids, dermatosis papulosa nigra, pseudofolliculitis barbae, and acne keloidalis nuchae, are usually diagnosed clinically and not associated with an underlying systemic disease. They can have significant impacts on mental health and quality of life and are often underdiagnosed or undertreated in skin of color. Hydroquinone 4% is considered the standard treatment for postinflammatory hyperpigmentation. Standard treatment for keloids includes combination intralesional therapy with triamcinolone and fluorouracil. If treatment is preferred for dermatosis papulosa nigra, options include scissor excision, cryotherapy, curettage, electrodesiccation, and laser therapies. Shaving cessation is the best initial treatment for pseudofolliculitis barbae. Individuals with acne keloidalis nuchae should avoid frequent close shaves or short haircuts on the nuchal area of the scalp.
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Affiliation(s)
- Winfred Taylor Frazier
- University of Pittsburgh Medical Center St. Margaret Family Medicine Residency Program, Pittsburgh, Pennsylvania
| | - Sanketh Proddutur
- University of Pittsburgh Medical Center St. Margaret Family Medicine Residency Program, Pittsburgh, Pennsylvania
| | - Kayley Swope
- University of Pittsburgh Medical Center St. Margaret Family Medicine Residency Program, Pittsburgh, Pennsylvania
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19
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Reilly JM, Spektor P, De La Torre M, Paranandi S, Bogner J. Tattoo Removal in People of Color Who Were Formerly Incarcerated or Were Gang Members: Complications and Best Practices. J Health Care Poor Underserved 2023; 34:1414-1426. [PMID: 38661764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
There are limited data about the tattoo removal process in formerly gang-involved and incarcerated people of color. This single center retrospective study was conducted on patients treated at Homeboy Industries' Ya'Stuvo Tattoo Removal Clinic between January 2016-December 2018. It reviewed data on 2,118 tattoos, and a representative sample of 502 patients was used to conduct our analysis. Treatment on 118 of the tattoos (5.57%) resulted in at least one complication (hypo-or hyper-pigmentation, keloids, or scarring). Patients who experienced tattoo removal complications (7.3%) were less likely to return to complete the removal process. More complications were experienced with higher fluences of energy, on tattoos placed by professional artists, on colored tattoos, and tattoos on clients who had a greater number of treatments. The study highlights complications and best practices in tattoo removal in people of color, a process critical to the reintegration and gang disengagement of this vulnerable population.
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20
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Fan R, Yan X, Zhang W. Relationship between asporin and extracellular matrix behavior: A literature review. Medicine (Baltimore) 2022; 101:e32490. [PMID: 36595867 PMCID: PMC9794316 DOI: 10.1097/md.0000000000032490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Asporin (ASPN), as a member of the small leucine-rich repeat proteoglycan family, is a type of protein that is found in the extracellular matrix. Collagen deposition or transformation is involved in a variety of pathological processes. ASPN is identified in cancerous tissue, pathological cardiac tissue, articular cartilage, keloid, and fibrotic lung tissue, and it has a role in the development of cancer, cardiovascular, bone and joint, keloid, and pulmonary fibrosis by interfering with collagen metabolism. This review article summarizes the data on ASPN expressions in mouse and human and highlights that overexpress of ASPN might play a role in a variety of diseases. Although our knowledge of ASPN is currently limited, these instances may help us better understand how it interacts with diseases.
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Affiliation(s)
- Rui Fan
- First School of Clinical Medicine, Shandong University of Traditional Chinese Medicine, Shandong, China
| | - Xiaoyan Yan
- Department of Geriatrics, Shandong University of Traditional Chinese Medicine Affiliated Hospital, Shandong, China
| | - Wei Zhang
- Department of Respiratory and Critical Care Medicine, Shandong University of Traditional Chinese Medicine Affiliated Hospital, Shandong, China
- * Correspondence: Wei Zhang, Department of Respiratory and Critical Care Medicine, Shandong University of Traditional Chinese Medicine Affiliated Hospital, Shandong 250014, China (e-mail: )
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21
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Hermenean A, Oatis D, Herman H, Ciceu A, D’Amico G, Trotta MC. Galectin 1-A Key Player between Tissue Repair and Fibrosis. Int J Mol Sci 2022; 23:ijms23105548. [PMID: 35628357 PMCID: PMC9142121 DOI: 10.3390/ijms23105548] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/13/2022] [Accepted: 05/13/2022] [Indexed: 12/20/2022] Open
Abstract
Galectins are ten family members of carbohydrate-binding proteins with a high affinity for β galactose-containing oligosaccharides. Galectin-1 (Gal-1) is the first protein discovered in the family, expressed in many sites under normal and pathological conditions. In the first part of the review article, we described recent advances in the Gal-1 modulatory role on wound healing, by focusing on the different phases triggered by Gal-1, such as inflammation, proliferation, tissue repair and re-epithelialization. On the contrary, Gal-1 persistent over-expression enhances angiogenesis and extracellular matrix (ECM) production via PI3K/Akt pathway activation and leads to keloid tissue. Therefore, the targeted Gal-1 modulation should be considered a method of choice to treat wound healing and avoid keloid formation. In the second part of the review article, we discuss studies clarifying the role of Gal-1 in the pathogenesis of proliferative diabetic retinopathy, liver, renal, pancreatic and pulmonary fibrosis. This evidence suggests that Gal-1 may become a biomarker for the diagnosis and prognosis of tissue fibrosis and a promising molecular target for the development of new and original therapeutic tools to treat fibrosis in different chronic diseases.
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Affiliation(s)
- Anca Hermenean
- Faculty of Medicine, Vasile Goldis Western University of Arad, 310414 Arad, Romania;
- “Aurel Ardelean” Institute of Life Sciences, Vasile Goldis Western University of Arad, 310414 Arad, Romania; (H.H.); (A.C.); (G.D.)
- Correspondence:
| | - Daniela Oatis
- Faculty of Medicine, Vasile Goldis Western University of Arad, 310414 Arad, Romania;
| | - Hildegard Herman
- “Aurel Ardelean” Institute of Life Sciences, Vasile Goldis Western University of Arad, 310414 Arad, Romania; (H.H.); (A.C.); (G.D.)
| | - Alina Ciceu
- “Aurel Ardelean” Institute of Life Sciences, Vasile Goldis Western University of Arad, 310414 Arad, Romania; (H.H.); (A.C.); (G.D.)
| | - Giovanbattista D’Amico
- “Aurel Ardelean” Institute of Life Sciences, Vasile Goldis Western University of Arad, 310414 Arad, Romania; (H.H.); (A.C.); (G.D.)
| | - Maria Consiglia Trotta
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy;
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22
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Bacci S. Fine Regulation during Wound Healing by Mast Cells, a Physiological Role Not Yet Clarified. Int J Mol Sci 2022; 23:ijms23031820. [PMID: 35163741 PMCID: PMC8836533 DOI: 10.3390/ijms23031820] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 02/03/2022] [Accepted: 02/04/2022] [Indexed: 11/16/2022] Open
Abstract
Mast cells (MCs) are bone marrow-derived cells capable of secreting many active molecules, ranging from the mediators stored in specific granules, some of which have been known about for several decades (histamine, heparin), to small molecules produced immediately upon stimulation (membrane lipid derivatives, nitric oxide), to a host of constitutively secreted, multifunctional cytokines. With the aid of a wide array of mediators, the activated MCs control the key events of inflammation and therefore participate in the regulation of local immune response. On the basis of the structure, origin, principal subtypes, localization and function of these cells, their involvement in injury repair is therefore to be considered in acute and chronic conditions, respectively. The importance of MCs in regulating the healing processes is underscored by the proposed roles of a surplus or a deficit of their mediators in the formation of exuberant granulation tissue (such as keloids and hypertrophic scars), the delayed closure or dehiscence of wounds and the transition of acute to chronic inflammation.
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Affiliation(s)
- Stefano Bacci
- Research Unit of Histology and Embriology, Department of Biology, University of Florence, 50134 Florence, Italy
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23
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Affiliation(s)
- Narishige Ishikawa
- Department of Respiratory Medicine, Kyorin University School of Medicine, Japan
| | - Takeshi Saraya
- Department of Respiratory Medicine, Kyorin University School of Medicine, Japan
| | - Masaoki Saito
- Department of Respiratory Medicine, Kyorin University School of Medicine, Japan
| | - Haruyuki Ishii
- Department of Respiratory Medicine, Kyorin University School of Medicine, Japan
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24
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Gold MH. Commentary on: Synergic Effect of Botulinum Toxin Type A and Triamcinolone Alleviates Scar Pruritus by Modulating Epidermal Hyperinnervation: A Preliminary Report. Aesthet Surg J 2021; 41:NP1732-NP1733. [PMID: 33822858 DOI: 10.1093/asj/sjab063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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25
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Lin P, Peng R, Zhao M, Zhang G, Li H. RNA-sequencing reveals plantar keloid has potential bone/cartilage characteristics. Exp Dermatol 2021; 30:997-998. [PMID: 33754421 DOI: 10.1111/exd.14333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 02/22/2021] [Accepted: 03/18/2021] [Indexed: 02/05/2023]
Affiliation(s)
- Pingping Lin
- Department of Dermatology and Venereology, Peking University First Hospital, Beijing, China
- Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China
- National Clinical Research Center for Skin and Immune Diseases, Beijing, China
| | - Rui Peng
- Department of Dermatology and Venereology, Peking University First Hospital, Beijing, China
- Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China
- National Clinical Research Center for Skin and Immune Diseases, Beijing, China
| | - Mingming Zhao
- Department of Dermatology and Venereology, Peking University First Hospital, Beijing, China
- Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China
- National Clinical Research Center for Skin and Immune Diseases, Beijing, China
| | - Guohong Zhang
- Department of Pathology, Shantou University Medical College, Shantou, Guangdong, China
| | - Hang Li
- Department of Dermatology and Venereology, Peking University First Hospital, Beijing, China
- Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China
- National Clinical Research Center for Skin and Immune Diseases, Beijing, China
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26
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Nast A, Werner RN, Dressler C, Zidane M, Heratizadeh A, Gaskins M. [Current dermatology guidelines in Germany and Europe : A selection of clinically relevant recommendations]. Hautarzt 2021; 72:600-606. [PMID: 33666670 PMCID: PMC8238738 DOI: 10.1007/s00105-021-04775-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 02/01/2021] [Indexed: 12/18/2022]
Abstract
Clinical practice guidelines are systematically developed decision aids for specific medical conditions. In Germany, national dermatology guidelines are developed chiefly under the aegis of the German Dermatological Society in collaboration with the Professional Association of German Dermatologists. European and international dermatological guidelines also exist and are developed by a range of organisations, such as the European Centre for Guidelines Development, which was founded by the European Dermatology Forum in 2018. In the years 2019 and 2020, new or updated German national guidelines were published on topics such as pathological scars (hypertrophic scars and keloids), cutaneous lupus erythematosus, pyoderma grangrenosum, anal pruritus, anal eczema, anal canal and anal rim carcinomas, as well as the prevention of HPV-associated neoplasms through vaccination, syphilis and the systemic treatment of neurodermitis. A new European guideline on lichen planus closes a gap in the spectrum of guidelines available in Germany. Key recommendations and relevant changes in the guidelines are presented in this article.
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Affiliation(s)
- A Nast
- Division of Evidence-Based Medicine (dEBM), Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
| | - R N Werner
- Division of Evidence-Based Medicine (dEBM), Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - C Dressler
- Division of Evidence-Based Medicine (dEBM), Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - M Zidane
- Division of Evidence-Based Medicine (dEBM), Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - A Heratizadeh
- Abteilung für Immundermatologie und experimentelle Allergologie, Klinik für Dermatologie, Allergologie und Venerologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - M Gaskins
- Division of Evidence-Based Medicine (dEBM), Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
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27
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Liang X, Yang X, Yin S, Malay S, Chung KC, Ma J, Wang K. Artificial Intelligence in Plastic Surgery: Applications and Challenges. Aesthetic Plast Surg 2021; 45:784-790. [PMID: 31897624 DOI: 10.1007/s00266-019-01592-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 12/15/2019] [Indexed: 12/18/2022]
Abstract
New developments in artificial intelligence (AI) offer opportunities to enhance plastic surgery practice, research, and education. In this article, we review relevant AI tools and applications, including machine learning, reinforcement learning, and natural language processing. Our own Markov decision process for keloid treatment illustrates how these models are developed and can be used to enhance decision-making in clinical practice. Finally, we discuss challenges of implementing AI and knowledge gaps that must be addressed to successfully apply AI in plastic surgery. Level of Evidence V 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)
- Xuebing Liang
- 17th Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Xiaoning Yang
- 17th Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Shan Yin
- State Key Laboratory of Information Photonics and Optical Communication, Beijing University of Posts and Telecommunications, Beijing, China
| | - Sunitha Malay
- Section of Plastic Surgery, Department of Surgery, The University of Michigan Health System, Ann Arbor, MI, USA
| | - Kevin C Chung
- Section of Plastic Surgery, Department of Surgery, The University of Michigan Health System, Ann Arbor, MI, USA
| | - Jiguang Ma
- 17th Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Keming Wang
- 17th Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
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Mustoe TA. Invited Discussion On: 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; 44:1869-1870. [PMID: 32519038 DOI: 10.1007/s00266-020-01806-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 05/26/2020] [Indexed: 11/26/2022]
Abstract
Level of Evidence V 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)
- Thomas A Mustoe
- Clinical Faculty, Feinberg School of Medicine, Northwestern University, 737 N. Michigan, Suite 1500, Chicago, IL, 60611, USA.
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29
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Lokes KP, Avetikov DS, Klitynska OV, Brekhlichuk PP, Bun YI. The histotopographic features of formation of keloid scars of maxillofacial localization. Wiad Lek 2020; 73:565-568. [PMID: 32285835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE The aim: Study of the influence of local oxygen deficiency on the features of the formation of keloid scars of the head and neck. PATIENTS AND METHODS Materials and methods: The research material was 17 incisional biopsy specimens of keloid scars, which were the highest age categories of patients from 19 to 63 years. RESULTS Results: It was revealed that at coloring according to Mallory's technique, sections of fibrinoid swelling of collagen fibers were noted near central homogeneous hyaline masses. The lateral areas of the dermis that adjacent to keloid scar tissue, at coloring by the Hart method, in our modification, were characterized by the separation of the hyalinosis zone from the undamaged dermis by coarse bundles of elastic fibers that are colored in dark purple. The undifferentiated dysplasia of the connective tissue has caused the replacement and obstruction of single vascular components, which has complicated the local oxygen deficiency of keloid-altered tissues. CONCLUSION Conclusions: Thus, plasmaragia and the accumulation of protein deposits in the perivascular space determine the inhibition of local hemodynamics, which explains the decrease in oxygen transport to tissues. Decreased oxygenation and increased permeability of the vascular wall causes local hemocirculatory hypoxia.
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Affiliation(s)
| | | | | | | | - Yana I Bun
- Uzhhorod National University, Uzhhorod, Ukraine
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30
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Reznikov RV. [ Keloid of the external auditory canal]. Vestn Otorinolaringol 2020; 85:53-54. [PMID: 32476391 DOI: 10.17116/otorino20208502153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Own clinical observation of the keloid of the external auditory canal is reported. This is a very rare variant of the localization of this tumor. A description of this neoplasm is rare in domestic and foreign literature.
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32
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Li E, Tian Y, Guo Q. [The observation of therapeutic effect of auricle keloid by the operation of through resection]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2016; 30:148-149. [PMID: 27192914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Ashcroft KJ, Syed F, Bayat A. Site-specific keloid fibroblasts alter the behaviour of normal skin and normal scar fibroblasts through paracrine signalling. PLoS One 2013; 8:e75600. [PMID: 24348987 PMCID: PMC3857170 DOI: 10.1371/journal.pone.0075600] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2013] [Accepted: 08/19/2013] [Indexed: 01/31/2023] Open
Abstract
Keloid disease (KD) is an abnormal cutaneous fibroproliferative disorder of unknown aetiopathogenesis. Keloid fibroblasts (KF) are implicated as mediators of elevated extracellular matrix deposition. Aberrant secretory behaviour by KF relative to normal skin fibroblasts (NF) may influence the disease state. To date, no previous reports exist on the ability of site-specific KF to induce fibrotic-like phenotypic changes in NF or normal scar fibroblasts (NS) by paracrine mechanisms. Therefore, the aim of this study was to investigate the influence of conditioned media from site-specific KF on the cellular and molecular behaviour of both NF and NS enabled by paracrine mechanisms. Conditioned media was collected from cultured primary fibroblasts during a proliferative log phase of growth including: NF, NS, peri-lesional keloid fibroblasts (PKF) and intra-lesional keloid fibroblasts (IKF). Conditioned media was used to grow NF, NS, PKF and IKF cells over 240 hrs. Cellular behavior was monitored through real time cell analysis (RTCA), proliferation rates and migration in a scratch wound assay. Fibrosis-associated marker expression was determined at both protein and gene level. PKF conditioned media treatment of both NF and NS elicited enhanced cell proliferation, spreading and viability as measured in real time over 240 hrs versus control conditioned media. Following PKF and IKF media treatments up to 240 hrs, both NF and NS showed significantly elevated proliferation rates (p<0.03) and migration in a scratch wound assay (p<0.04). Concomitant up-regulation of collagen I, fibronectin, α-SMA, PAI-1, TGF-β and CTGF (p<0.03) protein expression were also observed. Corresponding qRT-PCR analysis supported these findings (P<0.03). In all cases, conditioned media from growing marginal PKF elicited the strongest effects. In conclusion, primary NF and NS cells treated with PKF or IKF conditioned media exhibit enhanced expression of fibrosis-associated molecular markers and increased cellular activity as a result of keloid fibroblast-derived paracrine factors.
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Affiliation(s)
- Kevin J. Ashcroft
- Plastic & Reconstructive Surgery Research, Manchester Institute of Biotechnology, University of Manchester, United Kingdom
- Institute of Inflammation & Repair, University of Manchester, Manchester, United Kingdom
| | - Farhatullah Syed
- Plastic & Reconstructive Surgery Research, Manchester Institute of Biotechnology, University of Manchester, United Kingdom
- Institute of Inflammation & Repair, University of Manchester, Manchester, United Kingdom
| | - Ardeshir Bayat
- Plastic & Reconstructive Surgery Research, Manchester Institute of Biotechnology, University of Manchester, United Kingdom
- Institute of Inflammation & Repair, University of Manchester, Manchester, United Kingdom
- Department of Plastic and Reconstructive Surgery, University Hospital South Manchester Foundation Trust, Wythenshawe Hospital, Manchester, United Kingdom
- The University of Manchester, Manchester Academic Health Science Centre, University Hospital South Manchester Foundation Trust, Wythenshawe Hospital, Manchester, United Kingdom
- * E-mail:
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Lü JW, Hu G, Li F, Wang JJ, Yang W, Huang H, Liu JL. [Inhibitory effect of Typhonium gigantewm Engl. on in vitro cultured human keloid fibroblasts]. Zhonghua Zheng Xing Wai Ke Za Zhi 2013; 29:365-369. [PMID: 24409780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To study the inhibitory effect of Typhonium gigantewm Engl. (AEoTGE) on the proliferation and apoptosis of KFB in vitro and to survey the death rate. METHODS Samples of hypertrophic scars were collected and cultured. Only 4-8 passage cells were selected for experiment. Inverted microscope and transmission electron microscope were used to observe the morphogenesis and ultrastructure of KFB. The KFB cells were treated with AEoTGE in different concentrations(3. 125,6.250, 12.500, 25.000, 50. 000,100.000 g/L) for 24 hours. The effect of AEoTGE on the proliferation and the IC50 of KFB was observed with MTT assay and EdU. The effect of AEoTGE on apoptosis of KFB was detected by flow cytometry. RESULTS It showed that AEoTGE could inhibit the proliferation of KFB in an concentration-dependent style within the range of 3. 125-100.000 g/L. The AEoTGE could obviously increase the apoptosis rate of the KFB compared with blank control group(P <0.05). The IC50 of AEoTGE was 35 g/L. FITC-Annexin V/PI showed that apoptosis rate of KFB in the AEoTGE group was (72. 07 +/- 0. 70)% , while it was 23. 5% in blank control group (P < 0. 05). CONCLUSIONS AEoTGE could significantly inhibit the proliferating activity and induce apoptosis of KFB after co-culture for 24 hours. The IC50 is 35 g/L and the rate of apoptosis is (72.07 +/- 0.70)%.
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Affiliation(s)
- Jing-Wei Lü
- Department of Plastic and Aesthetic Surgery, First Affiliated Hospital of Dalian Medical University, Dalian 116021, China
| | - Gang Hu
- Department of Plastic and Aesthetic Surgery, First Affiliated Hospital of Dalian Medical University, Dalian 116021, China
| | - Fang Li
- Department of Plastic and Aesthetic Surgery, First Affiliated Hospital of Dalian Medical University, Dalian 116021, China
| | - Jia-Jing Wang
- Department of Plastic and Aesthetic Surgery, First Affiliated Hospital of Dalian Medical University, Dalian 116021, China
| | - Wei Yang
- Department of Plastic and Aesthetic Surgery, First Affiliated Hospital of Dalian Medical University, Dalian 116021, China
| | - Hui Huang
- Department of Plastic and Aesthetic Surgery, First Affiliated Hospital of Dalian Medical University, Dalian 116021, China
| | - Jing-lan Liu
- Department of Plastic and Aesthetic Surgery, First Affiliated Hospital of Dalian Medical University, Dalian 116021, China
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Stollery N. Trauma injuries. Practitioner 2011; 255:31-33. [PMID: 21776916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Abstract
Complications of bone-anchored hearing devices occur with both soft tissue and bone. Soft tissue complications are much more common and most often involve irritation of the skin surrounding the implant. Other complications include: skin flap necrosis, wound dehiscence, bleeding or hematoma formation, and persistent pain. Bone complications are classified as either early or late. Early complications are due to failure of osseointegration, while late complications are usually the result of either chronic infection or trauma. Pediatric patients are a unique group of implant patients and are more likely to have complications of both soft tissue and bone. Most complications can be managed in the office with topical therapy and wound care, although revision surgery may be required in extensive skin overgrowth cases. Proper patient selection, meticulous surgical technique, and patient hygiene around the implant are the most critical aspects in minimizing complications in patients with osseointegrated implants.
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Donato-Moore S. Buttonhole cannulation technique in a patient with keloid scarred skin on home hemodialysis: a case study. Nephrol Nurs J 2011; 38:60-64. [PMID: 21469555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The buttonhole cannulation technique is the recommended and preferred approach for patients with an arteriovenous fistula on home hemodialysis; however, keloid formation from previous access techniques may preclude buttonhole cannulation. This case study details how buttonhole cannulation can be successful despite keloid formation in a patient on home hemodialysis.
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Garcia C, Poletti E. Surgical Pearl: A model to practice the Mohs surgical technique. J Am Acad Dermatol 2006; 55:313-4. [PMID: 16844518 DOI: 10.1016/j.jaad.2005.09.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2005] [Revised: 05/17/2005] [Accepted: 09/03/2005] [Indexed: 10/22/2022]
Affiliation(s)
- Carlos Garcia
- Department of Dermatology, Dermatologic Surgery and Cutaneous Oncology, Oklahoma University Health Sciences Center, Oklahoma City, OK 73104, USA.
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Kamamoto F, Paggiaro AO, Rodas A, Herson MR, Mathor MB, Ferreira MC. A wound contraction experimental model for studying keloids and wound-healing modulators. Artif Organs 2003; 27:701-5. [PMID: 12911344 DOI: 10.1046/j.1525-1594.2003.07277.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Preventing and treating hypertrophic and keloid scars is difficult because of the lack of knowledge about their genesis. Tissue repair can be studied with biocompatible matrices and ex vivo cultures of different cell types. We used an experimental model where collagen gels populated by human fibroblasts underwent progressive contraction, allowing the study of wound healing remodeling. The fibroblast-populated lattices showed the greater contraction of the gel populated by fibroblasts from keloids versus fibroblasts from normal skin. Moreover, fibroblast growth factor (FGF) and transforming growth factor beta (TGF-beta) involved in scar formation were added to the collagen gels populated by normal skin fibroblasts. TGF-beta caused an increase in gel contraction; FGF did not. The mean percentages of contraction of the gels populated by keloid fibroblasts were very similar to the percentages of gels populated by normal skin fibroblasts with added TGF-beta. These observations confirm the existing hypothesis that TGF-beta may be involved in keloid formation.
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Affiliation(s)
- Fábio Kamamoto
- Laboratório de Cirurgia Plástica, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
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Kanitakis J, Claudy A. Clinical quiz. Rubinstein-Taybi syndrome (synonyms: broad thumbs and great toes, characteristic facies, and mental retardation -- broad thumb-hallux syndrome). Eur J Dermatol 2002; 12:107, 108-9. [PMID: 11809612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
A 28-year-old mentally retarded, institutionalised woman was referred to us for evaluation of multiple plantar warts and ingrown nails of both great toes. The patient was born to unrelated parents of North African origin and had one brother and three half-brothers, all of whom were healthy. Physical examination revealed short stature, slight obesity, facial abnormalities (Fig. 1), short and broad thumbs and big toes (Figs. 2 and 3). A keloid was found on the right forearm, that had developed after surgical correction of a fracture (Fig. 4). Ill-defined hyperpigmented macules were observed on the trunk. The patient also presented pruritic eczematous lesions of the limbs and the back that had been present for some years and were recurrent despite treatment with emollients and local steroids. Androgenetic-type alopecia of moderate severity was seen on the vertex of the scalp. Past medical history included polydactylism of the feet and clinodactyly of the thumbs (both corrected surgically), respiratory tract infections, Wolf-Parkinson-White syndrome and refractive errors necessitating glasses.
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Affiliation(s)
- Jean Kanitakis
- Department of Dermatology, Hôpital édouard-Herriot, 69437 Lyon Cedex 03, France.
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Abstract
We evidenced in vitro proopiomelanocortin (POMC) mRNA-transcription in human dermal fibroblasts using Northern blot hybridization. Modulation of POMC gene expression by cytokines (transforming growth factor-beta, TGF-beta, and tumor necrosis factor-alpha, TNF-alpha) was investigated by incubating human normal fibroblasts with 1 and 10 ng/ml cytokines, either alone or in combination, for 24 hours. Our results show that dermal fibroblasts express POMC at significant levels under unstimulated conditions. POMC steady-state levels were significantly reduced by addition of TGF-beta. On the other hand, TNF-alpha exerted a stimulatory effect on POMC mRNA transcription, partially counteracting the effect of TGF-beta. These data provide the first demonstration of POMC gene expression in cultured skin fibroblasts. The opposite regulatory effect of TGF-beta and TNF-alpha, two cytokines primarily involved in extracellular matrix regulation, suggests a possible role for POMC-derived peptides in fibroblast activity. We also investigated POMC mRNA expression in keloid-derived fibroblasts in culture, and its regulation by TGF-beta added at the highest concentration documented for inhibition. Keloid-derived fibroblasts showed clearly detectable levels of POMC mRNA in basal conditions, and no alteration of POMC gene expression was observed when TGF-beta was added in culture. The altered TGF-beta regulation of POMC mRNA levels suggest that POMC-derived peptides may play a role in the pathogenesis of keloid formation through an autocrine/paracrine network, resulting in modulation of extracellular matrix synthesis.
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Affiliation(s)
- T Lotti
- Department of Dermatology, University of Florence, Italy
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Abstract
Keloids occur only in humans and are characterized by fibroblast overproduction of collagen types I and III. Keloid fibroblasts have been shown to make elevated levels of transforming growth factor beta (TGF-beta), a growth factor known to promote extracellular matrix production and fibrosis. Thus, the pathophysiology underlying keloid formation may be driven by the biological activity of TGF-beta. Tamoxifen, a synthetic, nonsteroidal antiestrogen has been shown to inhibit keloid fibroblast proliferation and decrease collagen production. The purpose of this study was to determine if a mechanism by which tamoxifen decreases keloid collagen production is through a downregulation of TGF-beta. Through a luciferase TGF-beta bioassay we found that 4 microM of tamoxifen generated a 49% reduction in total TGF-beta activity and 8 microM generated an 85% reduction compared with controls. Thus we propose that one of the mechanisms by which tamoxifen decreases keloid fibroblast collagen synthesis is by decreasing TGF-beta production.
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Affiliation(s)
- D Chau
- Department of Surgery, New York University Medical Center, NY 10016, USA
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Abstract
Recently, progress and developments have been made in six skin conditions relevant to black children. Infantile acropustulosis may either be idiopathic or may be a sequela of scabies in young infants. The approach to small- or medium-sized congenital melanocytic nevi in black children must be different because the risk for malignant transformation into melanoma is exceedingly small. Keloids and hypertrophic scars in children are effectively treated with silicone gel sheeting. Tinea capitis caused by Trichophyton tonsurans remains to be a very common infection among black children. The newer systemic antifungal agents have no significant advantage over griseofulvin. Hair problems resulting from grooming practices or hair styling are preventable. For postinflammatory hyperpigmentation, azelaic acid holds promise.
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Affiliation(s)
- T A Laude
- Department of Dermatology, SUNY Health Science Center at Brooklyn, NY 11203, USA
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45
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Lawrence WT, Banes AJ. Plastic surgery research. Clin Plast Surg 1996; 23:173-82. [PMID: 8617026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Several areas of plastic surgery research, both in and out of the basic science laboratory, have been highlighted. Progress is being made in our ability to produce biologic structures to replace destroyed or damaged ones in vitro, our ability to manipulate the genetic structure of cells, and our ability to define and potentially manipulate the wound healing process in normal and abnormal healing states. More is also being learned about the biology of nerve repair, the physiologic response to silicone implants, and the mechanism of reperfusion injury. Virtual surgery may become a major part of the planning, performance, and teaching of surgical procedures in the future. Outcomes need to be better defined to prove the value of what plastic surgeons do to increasingly skeptical third parties, and progress is being made in this area as well. These areas represent only a few aspects of what is new in plastic surgery research, but they at least provide a window into the field and demonstrate the increasing sophistication of work being done in all areas. This work, as well as work in other areas, will undoubtedly affect clinical practices in the near future.
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Affiliation(s)
- W T Lawrence
- Division of Plastic Surgery, University of Massachusetts Medical Center, Worcester, USA
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Gross ML, Millikan LE. Deep fungal infections in the tropics. Dermatol Clin 1994; 12:695-700. [PMID: 7805298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Although tropical deep fungal infections are uncommonly identified in North America, these disorders are a diagnostic and therapeutic challenge to the clinician. Presented in this article is information on the management of patients suffering from mycetoma, chromomycosis, African histoplasmosis, or keloidal blastomycosis.
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Affiliation(s)
- M L Gross
- Department of Dermatology, Tulane University School of Medicine, New Orleans, Louisiana
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47
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Affiliation(s)
- H Weerda
- Department of Otorhinolaryngology and Plastic Surgery, University Hospital, Lübeck, Germany
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48
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Harris H. Acne keloidalis aggravated by football helmets. Cutis 1992; 50:154. [PMID: 1387357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Shetlar MR. Asserts prior claim. J Burn Care Rehabil 1987; 8:461. [PMID: 3436970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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50
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Dowding CM, Horn S. Scars: formation and effects. Nursing 1986; 3:198-202. [PMID: 3636677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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