Scars, when in good evolution, result in a smooth, thin and discreet tissue. Keloid scars, however, are a type of abnormal and exacerbated repair response to tissue injury, whether in surgical interventions or in vari...Scars, when in good evolution, result in a smooth, thin and discreet tissue. Keloid scars, however, are a type of abnormal and exacerbated repair response to tissue injury, whether in surgical interventions or in various injuries, which present in a prominent and gross way. In this context, there is an excess of collagen deposition in the tissue repair process, which can lead to the formation of keloids. The diagnosis of the condition presented is made by the medical professional or by the patient himself after the surgical intervention or skin injury. Under this analysis, protruding, rough and bad-looking scars are identified. In addition, we highlight the existence of keloids similar to large tumors, described as Jorge Lobo disease. The treatment encompasses massages, compressions, corticosteroids, chemotherapy, collagenase and cryotherapy. At first, we used corticosteroid-based massages, and then we started using compressive dressings until we started intrakeloid infiltrations with injectable triamcinolone. Triamcinolone 10 mg injectable—1/10—in 0.9% saline, with syringe and fixed needle 0.3 mm × 8 mm, intralesional infiltrate, in this context, proved to be effective for its treatment when applied sequentially and linearly. In cases where the medication was applied, there was an improvement after 21 days of application and a definitive improvement 2 months after the injury. In comparison, on the other hand, patients who were not subjected to the application of the medication may improve after 4 months of the injury or worsen compared to the initial case. We have come to the conclusion that this procedure may be one of the chosen ones for the treatment of keloid scars, being one of the most recommended for cases of keloid already installed.展开更多
Keloids are tissue repair formed by exuberant fibrosis appearing after a skin wound, burn, vaccination or post inflammatory (folliculitis or acne lesion). This condition causes standard aesthetic prejudice to those wh...Keloids are tissue repair formed by exuberant fibrosis appearing after a skin wound, burn, vaccination or post inflammatory (folliculitis or acne lesion). This condition causes standard aesthetic prejudice to those who are affected. Its management is difficult and its evolution meshes recurrences. We report here a case of giant keloid in the right ear lobe after a piercing and its support.展开更多
Background:Keloids are an extreme form of abnormal scarring that result from a pathological fibroproliferative wound healing process.The molecular mechanisms driving keloid pathology remain incompletely understood,hin...Background:Keloids are an extreme form of abnormal scarring that result from a pathological fibroproliferative wound healing process.The molecular mechanisms driving keloid pathology remain incompletely understood,hindering development of targeted,effective therapies.Recent studies in our laboratory demonstrated that keloid keratinocytes exhibit adhesion abnormalities and display a transcriptional signature reminiscent of cells undergoing epithelial-mesenchymal transition(EMT),suggesting a role for EMT in keloid pathology.In the current study,we further define the EMT-like phenotype of keloid scars and investigate regulation of EMT-related genes in keloid.Methods:Primary keratinocytes from keloid scar and normal skin were cultured in the presence or absence of transforming growth factor beta 1(TGF-β1)+/-inhibitors of TGF-β1 and downstream signaling pathways.Gene expression was measured using quantitative polymerase chain reaction.Migration was analyzed using an in vitro wound healing assay.Proteins in keloid scar and normal skin sections were localized by immunohistochemistry.Statistical analyses utilized SigmaPlot(SyStat Software,San Jose,CA)or SAS?(SAS Institute,Cary,NC).Results:In keloid and normal keratinocytes,TGF-β1 regulated expression of EMT-related genes,including hyaluronan synthase 2,vimentin,cadherin-11,wingless-type MMTV integration site family,member 5A,frizzled 7,ADAM metallopeptidase domain 19,and interleukin-6.Inhibition of canonical TGF-β1 signaling in keloid keratinocytes significantly inhibited expression of these genes,and TGF-β1 stimulation of normal keratinocytes increased their expression.The inhibition of the extracellular signal-regulated kinase 1/2(ERK1/2)signaling pathway or the p38 mitogen-activated protein kinase pathway attenuated TGF-β1-induced expression of subsets of these genes.Migration of keloid keratinocytes,previously shown to be increased compared with normal keratinocytes,was significantly reduced by inhibition of TGF-β1 or ERK1/2 signaling.Biomarkers of EMT,including reduced E-cadherin and increased activeβ-catenin,were observed in keloid epidermis in vivo.However,evidence of basement membrane breakdown in keloid scar was not observed.Conclusions:The results suggest that keloid keratinocytes exist in an EMT-like metastable state,similar to activated keratinocytes in healing wounds.The EMT-like gene expression pattern of keloid keratinocytes is regulated by canonical and non-canonical TGF-β1 signaling pathways.Therefore,interventions targeting TGF-β1-regulated EMT-like gene expression in keloid keratinocytes may serve to suppress keloid scarring.展开更多
Aim: The sternal region, cervico-mandibular region and the intra-mammary region have been the bane of many cutaneous surgeons, with a higher propensity for poor scarring and wound complications. In this article, the a...Aim: The sternal region, cervico-mandibular region and the intra-mammary region have been the bane of many cutaneous surgeons, with a higher propensity for poor scarring and wound complications. In this article, the author undertakes a review of different methods of breaking up scars by utilizing zigs and zags, and conducts a pigskin study to measure the reduction in tension that can be achieved by using a simple zigzag technique while performing excisions. Methods: A pigskin study conducted into the use of the simple zigzag to reduce the tension (and thereby scarring) of surgical wounds is reported here, and comparison and review is undertaken of the biomechanics of elliptical excisions and traditional Z-plasties. Results: Using a simple zigzag reduces tension across the midpoint of the scar more effectively than a Z-plasty or a simple elliptical excision. Conclusion: The techniques of breaking up a scar or incision line by using zigs and zags, in a means to reduce scarring, are not new. However, each of these techniques has specific advantages and disadvantages that need consideration by the surgeon. In this paper, a pigskin study is conducted into the use of the simple zigzag to reduce the tension (and thereby reduce the risk of poor scarring) of surgical wounds.展开更多
In this case report, we present a male patient who arrived at the hospital for the first time at the age of 8 with giant keloids in both ears and diagnosed by the Dermatology and Plastic Surgery as having the “Diseas...In this case report, we present a male patient who arrived at the hospital for the first time at the age of 8 with giant keloids in both ears and diagnosed by the Dermatology and Plastic Surgery as having the “Disease of Jorge Lobo”, which is a fungal infection due to the story of the endemic characteristics. After the first surgical intervention, he received guidance from the team for keloids and left the hospital using elastic mesh and a request to change the place where he lived to reduce his contact with the fungi. Fourteen years later, the patient returned to the Plastic Surgery Service having even larger keloids in both ears, twice the size than the first time. We did the second surgical intervention to remove it, but with the patient’s commitment that he would correctly comply with the guidelines determined by the surgical team. After finishing all the steps and a post-operative for the case, we observed the satisfaction and the increase of the patient’s mood, happier and without the embarrassment of that physical defect.展开更多
The various fibroproliferative disorders affecting humans have in common excess fibroblast activity and persistent overexpression or dysregulated activity of transforming growth factor beta (TGF-β). Cancer has many s...The various fibroproliferative disorders affecting humans have in common excess fibroblast activity and persistent overexpression or dysregulated activity of transforming growth factor beta (TGF-β). Cancer has many similar characteristics. Antineoplastic drugs can downregulate fibroblast activity and cytokine growth factors. This study evaluates the effect of six antineoplastic drugs on keloid and Dupuytren’s disease fibroblasts. Keloid, normal scar, Dupuytren’s affected palmar fascia, and normal palmar fascia fibroblasts were grown and seeded into Fibroblast Populated Collagen Lattices (FPCLs). The FPCLs were treated with one of six antineoplastic drugs or left untreated as controls. At 7 days, supernatants were extracted from all FPCLs and assayed for expression of Transforming Growth Factor beta (TGF)-β<sub>1</sub> and TGF-β<sub>2</sub>. All six antineoplastic drugs significantly inhibited FPCL contraction in both fibroproliferative conditions compared with the untreated controls (p β<sub>1</sub> and TGF-β<sub>2</sub> expression was downregulated in the supernatants of all FPCLs by the drug exposure. Cytotoxicity did not occur in these studies and was not the reason for the results. Although antineoplastic drugs can have significant side effects when given systemically, these results may be minimized when given to small areas involved in fibroproliferative scarring or when given topically or intralesionally. These in vitro results suggest that antineoplastic drugs may have a utility for treating various fibroproliferative disorders and warrant further investigation.展开更多
文摘Scars, when in good evolution, result in a smooth, thin and discreet tissue. Keloid scars, however, are a type of abnormal and exacerbated repair response to tissue injury, whether in surgical interventions or in various injuries, which present in a prominent and gross way. In this context, there is an excess of collagen deposition in the tissue repair process, which can lead to the formation of keloids. The diagnosis of the condition presented is made by the medical professional or by the patient himself after the surgical intervention or skin injury. Under this analysis, protruding, rough and bad-looking scars are identified. In addition, we highlight the existence of keloids similar to large tumors, described as Jorge Lobo disease. The treatment encompasses massages, compressions, corticosteroids, chemotherapy, collagenase and cryotherapy. At first, we used corticosteroid-based massages, and then we started using compressive dressings until we started intrakeloid infiltrations with injectable triamcinolone. Triamcinolone 10 mg injectable—1/10—in 0.9% saline, with syringe and fixed needle 0.3 mm × 8 mm, intralesional infiltrate, in this context, proved to be effective for its treatment when applied sequentially and linearly. In cases where the medication was applied, there was an improvement after 21 days of application and a definitive improvement 2 months after the injury. In comparison, on the other hand, patients who were not subjected to the application of the medication may improve after 4 months of the injury or worsen compared to the initial case. We have come to the conclusion that this procedure may be one of the chosen ones for the treatment of keloid scars, being one of the most recommended for cases of keloid already installed.
文摘Keloids are tissue repair formed by exuberant fibrosis appearing after a skin wound, burn, vaccination or post inflammatory (folliculitis or acne lesion). This condition causes standard aesthetic prejudice to those who are affected. Its management is difficult and its evolution meshes recurrences. We report here a case of giant keloid in the right ear lobe after a piercing and its support.
基金This study was supported by the Medical Research Grants(#85300 and#85500)from the Shriners Hospitals for Children.The funding agency had no role in study data collection and analysis,data interpretation,or writing of the manuscript
文摘Background:Keloids are an extreme form of abnormal scarring that result from a pathological fibroproliferative wound healing process.The molecular mechanisms driving keloid pathology remain incompletely understood,hindering development of targeted,effective therapies.Recent studies in our laboratory demonstrated that keloid keratinocytes exhibit adhesion abnormalities and display a transcriptional signature reminiscent of cells undergoing epithelial-mesenchymal transition(EMT),suggesting a role for EMT in keloid pathology.In the current study,we further define the EMT-like phenotype of keloid scars and investigate regulation of EMT-related genes in keloid.Methods:Primary keratinocytes from keloid scar and normal skin were cultured in the presence or absence of transforming growth factor beta 1(TGF-β1)+/-inhibitors of TGF-β1 and downstream signaling pathways.Gene expression was measured using quantitative polymerase chain reaction.Migration was analyzed using an in vitro wound healing assay.Proteins in keloid scar and normal skin sections were localized by immunohistochemistry.Statistical analyses utilized SigmaPlot(SyStat Software,San Jose,CA)or SAS?(SAS Institute,Cary,NC).Results:In keloid and normal keratinocytes,TGF-β1 regulated expression of EMT-related genes,including hyaluronan synthase 2,vimentin,cadherin-11,wingless-type MMTV integration site family,member 5A,frizzled 7,ADAM metallopeptidase domain 19,and interleukin-6.Inhibition of canonical TGF-β1 signaling in keloid keratinocytes significantly inhibited expression of these genes,and TGF-β1 stimulation of normal keratinocytes increased their expression.The inhibition of the extracellular signal-regulated kinase 1/2(ERK1/2)signaling pathway or the p38 mitogen-activated protein kinase pathway attenuated TGF-β1-induced expression of subsets of these genes.Migration of keloid keratinocytes,previously shown to be increased compared with normal keratinocytes,was significantly reduced by inhibition of TGF-β1 or ERK1/2 signaling.Biomarkers of EMT,including reduced E-cadherin and increased activeβ-catenin,were observed in keloid epidermis in vivo.However,evidence of basement membrane breakdown in keloid scar was not observed.Conclusions:The results suggest that keloid keratinocytes exist in an EMT-like metastable state,similar to activated keratinocytes in healing wounds.The EMT-like gene expression pattern of keloid keratinocytes is regulated by canonical and non-canonical TGF-β1 signaling pathways.Therefore,interventions targeting TGF-β1-regulated EMT-like gene expression in keloid keratinocytes may serve to suppress keloid scarring.
文摘Aim: The sternal region, cervico-mandibular region and the intra-mammary region have been the bane of many cutaneous surgeons, with a higher propensity for poor scarring and wound complications. In this article, the author undertakes a review of different methods of breaking up scars by utilizing zigs and zags, and conducts a pigskin study to measure the reduction in tension that can be achieved by using a simple zigzag technique while performing excisions. Methods: A pigskin study conducted into the use of the simple zigzag to reduce the tension (and thereby scarring) of surgical wounds is reported here, and comparison and review is undertaken of the biomechanics of elliptical excisions and traditional Z-plasties. Results: Using a simple zigzag reduces tension across the midpoint of the scar more effectively than a Z-plasty or a simple elliptical excision. Conclusion: The techniques of breaking up a scar or incision line by using zigs and zags, in a means to reduce scarring, are not new. However, each of these techniques has specific advantages and disadvantages that need consideration by the surgeon. In this paper, a pigskin study is conducted into the use of the simple zigzag to reduce the tension (and thereby reduce the risk of poor scarring) of surgical wounds.
文摘In this case report, we present a male patient who arrived at the hospital for the first time at the age of 8 with giant keloids in both ears and diagnosed by the Dermatology and Plastic Surgery as having the “Disease of Jorge Lobo”, which is a fungal infection due to the story of the endemic characteristics. After the first surgical intervention, he received guidance from the team for keloids and left the hospital using elastic mesh and a request to change the place where he lived to reduce his contact with the fungi. Fourteen years later, the patient returned to the Plastic Surgery Service having even larger keloids in both ears, twice the size than the first time. We did the second surgical intervention to remove it, but with the patient’s commitment that he would correctly comply with the guidelines determined by the surgical team. After finishing all the steps and a post-operative for the case, we observed the satisfaction and the increase of the patient’s mood, happier and without the embarrassment of that physical defect.
文摘The various fibroproliferative disorders affecting humans have in common excess fibroblast activity and persistent overexpression or dysregulated activity of transforming growth factor beta (TGF-β). Cancer has many similar characteristics. Antineoplastic drugs can downregulate fibroblast activity and cytokine growth factors. This study evaluates the effect of six antineoplastic drugs on keloid and Dupuytren’s disease fibroblasts. Keloid, normal scar, Dupuytren’s affected palmar fascia, and normal palmar fascia fibroblasts were grown and seeded into Fibroblast Populated Collagen Lattices (FPCLs). The FPCLs were treated with one of six antineoplastic drugs or left untreated as controls. At 7 days, supernatants were extracted from all FPCLs and assayed for expression of Transforming Growth Factor beta (TGF)-β<sub>1</sub> and TGF-β<sub>2</sub>. All six antineoplastic drugs significantly inhibited FPCL contraction in both fibroproliferative conditions compared with the untreated controls (p β<sub>1</sub> and TGF-β<sub>2</sub> expression was downregulated in the supernatants of all FPCLs by the drug exposure. Cytotoxicity did not occur in these studies and was not the reason for the results. Although antineoplastic drugs can have significant side effects when given systemically, these results may be minimized when given to small areas involved in fibroproliferative scarring or when given topically or intralesionally. These in vitro results suggest that antineoplastic drugs may have a utility for treating various fibroproliferative disorders and warrant further investigation.
