Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
권호 표지
DOI QR코드

DOI QR Code

Recent Developments in the Use of Intralesional Injections Keloid Treatment

  • Perdanasari, Aurelia Trisliana (Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine) ;
  • Lazzeri, Davide (Plastic Reconstructive and Aesthetic Surgery Unit, Villa Salaria Clinic) ;
  • Su, Weijie (Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine) ;
  • Xi, Wenjing (Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine) ;
  • Zheng, Zhang (Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine) ;
  • Ke, Li (Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine) ;
  • Min, Peiru (Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine) ;
  • Feng, Shaoqing (Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine) ;
  • Zhang, Yixin (Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine) ;
  • Persichetti, Paolo (Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University)
  • Received : 2014.05.21
  • Accepted : 2014.09.12
  • Published : 2014.11.15
Download PDF
⟨ Previous Next ⟩

Abstract

Keloid scars are often considered aesthetically unattractive and frustrating problems that occur following injuries. They cause functional and cosmetic deformities, displeasure, itching, pain, and psychological stress and possibly affect joint movement. The combination of these factors ultimately results in a compromised quality of life and diminished functional performance. Various methods have been implemented to improve keloid scars using both surgical and non-surgical approaches. However, it has proven to be a challenge to identify a universal treatment that can deliver optimal results for all types of scars. Through a PubMed search, we explored most of the literature that is available about the intralesional injection treatment of hypertrophic scars and keloids and highlights both current (corticosteroid, 5-fluorouracil, bleomycin, interferon, cryotherapy and verapamil) and future treatments (interleukin-10 and botulinum toxin type A). The reference lists of retrieved articles were also analysed. Information was gathered about the mechanism of each injection treatment, its benefits and associated adverse reactions, and possible strategies to address adverse reactions to provide reliable guidelines for determining the optimal treatment for particular types of keloid scars. This article will benefit practitioners by outlining evidence-based treatment strategies using intralesional injections for patients with hypertrophic scars and keloids.

Keywords

References

  1. Huang C, Murphy GF, Akaishi S, et al. Keloids and hypertrophic scars: update and future directions. Plast Reconstr Surg Glob Open 2013;1:e25. https://doi.org/10.1097/GOX.0b013e31829c4597
  2. Ogawa R. The most current algorithms for the treatment and prevention of hypertrophic scars and keloids. Plast Reconstr Surg 2010;125:557-68. https://doi.org/10.1097/PRS.0b013e3181c82dd5
  3. Klinger M, Marazzi M, Vigo D, et al. Fat injection for cases of severe burn outcomes: a new perspective of scar remodeling and reduction. Aesthetic Plast Surg 2008;32:465-9. https://doi.org/10.1007/s00266-008-9122-1
  4. Park TH, Park JH, Chang CH. Clinical features and outcomes of foot keloids treated using complete surgical excision and full thickness skin grafting followed by corticosteroid injections. J Foot Ankle Res 2013;6:26. https://doi.org/10.1186/1757-1146-6-26
  5. Martin MS, Collawn SS. Combination treatment of CO2 fractional laser, pulsed dye laser, and triamcinolone acetonide injection for refractory keloid scars on the upper back. J Cosmet Laser Ther 2013;15:166-70. https://doi.org/10.3109/14764172.2013.780448
  6. Camacho-Martinez FM, Rey ER, Serrano FC, et al. Results of a combination of bleomycin and triamcinolone acetonide in the treatment of keloids and hypertrophic scars. An Bras Dermatol 2013;88:387-94. https://doi.org/10.1590/abd1806-4841.20131802
  7. Son IP, Park KY, Kim B, et al. Pilot study of the efficacy of 578 nm copper bromide laser combined with intralesional corticosteroid injection for treatment of keloids and hypertrophic scars. Ann Dermatol 2014;26:156-61. https://doi.org/10.5021/ad.2014.26.2.156
  8. Emad M, Omidvari S, Dastgheib L, et al. Surgical excision and immediate postoperative radiotherapy versus cryotherapy and intralesional steroids in the management of keloids: a prospective clinical trial. Med Princ Pract 2010;19:402-5. https://doi.org/10.1159/000316381
  9. Sadeghinia A, Sadeghinia S. Comparison of the efficacy of intralesional triamcinolone acetonide and 5-fluorouracil tattooing for the treatment of keloids. Dermatol Surg 2012;38:104-9. https://doi.org/10.1111/j.1524-4725.2011.02137.x
  10. Al Aradi IK, Alawadhi SA, Alkhawaja FA, et al. Earlobe keloids: a pilot study of the efficacy of keloidectomy with core fillet flap and adjuvant intralesional corticosteroids. Dermatol Surg 2013;39:1514-9.
  11. Anthony ET, Lemonas P, Navsaria HA, et al. The cost effectiveness of intralesional steroid therapy for keloids. Dermatol Surg 2010;36:1624-6. https://doi.org/10.1111/j.1524-4725.2010.01696.x
  12. Niessen FB, Spauwen PH, Schalkwijk J, et al. On the nature of hypertrophic scars and keloids: a review. Plast Reconstr Surg 1999;104:1435-58. https://doi.org/10.1097/00006534-199910000-00031
  13. Davison SP, Dayan JH, Clemens MW, et al. Efficacy of intralesional 5-fluorouracil and triamcinolone in the treatment of keloids. Aesthet Surg J 2009;29:40-6. https://doi.org/10.1016/j.asj.2008.11.006
  14. Gupta S, Sharma VK. Standard guidelines of care: Keloids and hypertrophic scars. Indian J Dermatol Venereol Leprol 2011;77:94-100. https://doi.org/10.4103/0378-6323.74968
  15. Chen MA, Davidson TM. Scar management: prevention and treatment strategies. Curr Opin Otolaryngol Head Neck Surg 2005;13:242-7. https://doi.org/10.1097/01.moo.0000170525.74264.f8
  16. Manuskiatti W, Fitzpatrick RE. Treatment response of keloidal and hypertrophic sternotomy scars: comparison among intralesional corticosteroid, 5-fluorouracil, and 585-nm flashlamp-pumped pulsed-dye laser treatments. Arch Dermatol 2002;138:1149-55. https://doi.org/10.1001/archderm.138.9.1149
  17. Mustoe TA, Cooter RD, Gold MH, et al. International clinical recommendations on scar management. Plast Reconstr Surg 2002;110:560-71. https://doi.org/10.1097/00006534-200208000-00031
  18. Wu WS, Wang FS, Yang KD, et al. Dexamethasone induction of keloid regression through effective suppression of VEGF expression and keloid fibroblast proliferation. J Invest Dermatol 2006;126:1264-71. https://doi.org/10.1038/sj.jid.5700274
  19. Boyadjiev C, Popchristova E, Mazgalova J. Histomorphologic changes in keloids treated with Kenacort. J Trauma 1995;38:299-302. https://doi.org/10.1097/00005373-199502000-00030
  20. Muneuchi G, Suzuki S, Onodera M, et al. Long-term outcome of intralesional injection of triamcinolone acetonide for the treatment of keloid scars in Asian patients. Scand J Plast Reconstr Surg Hand Surg 2006;40:111-6. https://doi.org/10.1080/02844310500430003
  21. Atiyeh BS. Nonsurgical management of hypertrophic scars: evidence-based therapies, standard practices, and emerging methods. Aesthetic Plast Surg 2007;31:468-92. https://doi.org/10.1007/s00266-006-0253-y
  22. Park TH, Seo SW, Kim JK, et al. Clinical characteristics of facial keloids treated with surgical excision followed by intra- and postoperative intralesional steroid injections. Aesthetic Plast Surg 2012;36:169-73. https://doi.org/10.1007/s00266-011-9781-1
  23. Shaffer JJ, Taylor SC, Cook-Bolden F. Keloidal scars: a review with a critical look at therapeutic options. J Am Acad Dermatol 2002;46:S63-97. https://doi.org/10.1067/mjd.2002.120788
  24. Ogawa R, Akaishi S, Izumi M. Histologic analysis of keloids and hypertrophic scars. Ann Plast Surg 2009;62:104-5. https://doi.org/10.1097/SAP.0b013e3181855172
  25. Alster TS, Williams CM. Treatment of keloid sternotomy scars with 585 nm flashlamp-pumped pulsed-dye laser. Lancet 1995;345:1198-200. https://doi.org/10.1016/S0140-6736(95)91989-9
  26. Boutli-Kasapidou F, Tsakiri A, Anagnostou E, et al. Hypertrophic and keloidal scars: an approach to polytherapy. Int J Dermatol 2005;44:324-7. https://doi.org/10.1111/j.1365-4632.2004.02570.x
  27. Apikian M, Goodman G. Intralesional 5-fluorouracil in the treatment of keloid scars. Australas J Dermatol 2004;45:140-3. https://doi.org/10.1111/j.1440-0960.2004.00072.x
  28. Fitzpatrick RE. Treatment of inflamed hypertrophic scars using intralesional 5-FU. Dermatol Surg 1999;25:224-32. https://doi.org/10.1046/j.1524-4725.1999.08165.x
  29. Kontochristopoulos G, Stefanaki C, Panagiotopoulos A, et al. Intralesional 5-fluorouracil in the treatment of keloids: an open clinical and histopathologic study. J Am Acad Dermatol 2005;52:474-9. https://doi.org/10.1016/j.jaad.2004.09.018
  30. Haurani MJ, Foreman K, Yang JJ, et al. 5-Fluorouracil treatment of problematic scars. Plast Reconstr Surg 2009;123:139-48. https://doi.org/10.1097/PRS.0b013e3181904d1b
  31. Wang XQ, Liu YK, Wang ZY, et al. Antimitotic drug injections and radiotherapy: a review of the effectiveness of treatment for hypertrophic scars and keloids. Int J Low Extrem Wounds 2008;7:151-9. https://doi.org/10.1177/1534734608322099
  32. Liu W, Wu X, Gao Z, et al. Remodelling of keloid tissue into normal-looking skin. J Plast Reconstr Aesthet Surg 2008;61:1553-4. https://doi.org/10.1016/j.bjps.2008.08.003
  33. Wu XL, Liu W, Cao YL. Clinical study on keloid treatment with intralesional injection of low concentration 5-fluorouracil. Zhonghua Zheng Xing Wai Ke Za Zhi 2006;22:44-6.
  34. Wang XQ, Liu YK, Qing C, et al. A review of the effectiveness of antimitotic drug injections for hypertrophic scars and keloids. Ann Plast Surg 2009;63:688-92. https://doi.org/10.1097/SAP.0b013e3181978753
  35. Vivas AC, Tang JC, Maderal AD, et al. Hypertrophic scars and keloids, part 1: conventional treatments. Cosmet Dermatol 2012;25:309-16.
  36. Bodokh I, Brun P. Treatment of keloid with intralesional bleomycin. Ann Dermatol Venereol 1996;123:791-4.
  37. Espana A, Solano T, Quintanilla E. Bleomycin in the treatment of keloids and hypertrophic scars by multiple needle punctures. Dermatol Surg 2001;27:23-7.
  38. Aggarwal H, Saxena A, Lubana PS, et al. Treatment of keloids and hypertrophic scars using bleom. J Cosmet Dermatol 2008;7:43-9. https://doi.org/10.1111/j.1473-2165.2008.00360.x
  39. Saray Y, Gulec AT. Treatment of keloids and hypertrophic scars with dermojet injections of bleomycin: a preliminary study. Int J Dermatol 2005;44:777-84. https://doi.org/10.1111/j.1365-4632.2005.02633.x
  40. Naeini FF, Najafian J, Ahmadpour K. Bleomycin tattooing as a promising therapeutic modality in large keloids and hypertrophic scars. Dermatol Surg 2006;32:1023-9.
  41. Templeton SF, Solomon AR, Swerlick RA. Intradermal bleomycin injections into normal human skin. A histopathologic and immunopathologic study. Arch Dermatol 1994;130:577-83. https://doi.org/10.1001/archderm.1994.01690050045006
  42. Xu SJ, Teng JY, Xie J, et al. Comparison of the mechanisms of intralesional steroid, interferon or verapamil injection in the treatment of proliferative scars. Zhonghua Zheng Xing Wai Ke Za Zhi 2009;25:37-40.
  43. Tredget EE, Shankowsky HA, Pannu R, et al. Transforming growth factor-beta in thermally injured patients with hypertrophic scars: effects of interferon alpha-2b. Plast Reconstr Surg 1998;102:1317-28. https://doi.org/10.1097/00006534-199810000-00001
  44. Berman B, Duncan MR. Short-term keloid treatment in vivo with human interferon alfa-2b results in a selective and persistent normalization of keloidal fibroblast collagen, glycosaminoglycan, and collagenase production in vitro. J Am Acad Dermatol 1989;21:694-702. https://doi.org/10.1016/S0190-9622(89)70239-5
  45. Larrabee WF Jr, East CA, Jaffe HS, et al. Intralesional interferon gamma treatment for keloids and hypertrophic scars. Arch Otolaryngol Head Neck Surg 1990;116:1159-62. https://doi.org/10.1001/archotol.1990.01870100053011
  46. Berman B, Flores F. Recurrence rates of excised keloids treated with postoperative triamcinolone acetonide injections or interferon alfa-2b injections. J Am Acad Dermatol 1997;37:755-7. https://doi.org/10.1016/S0190-9622(97)70113-0
  47. Conejo-Mir JS, Corbi R, Linares M. Carbon dioxide laser ablation associated with interferon alfa-2b injections reduces the recurrence of keloids. J Am Acad Dermatol 1998;39:1039-40. https://doi.org/10.1016/S0190-9622(98)70295-6
  48. al-Khawajah MM. Failure of interferon-alpha 2b in the treatment of mature keloids. Int J Dermatol 1996;35:515-7. https://doi.org/10.1111/j.1365-4362.1996.tb01671.x
  49. Jones GJ, Itri LM. Safety and tolerance of recombinant interferon alfa-2a (Roferon-A) in cancer patients. Cancer 1986;57:1709-15. https://doi.org/10.1002/1097-0142(19860415)57:8+<1709::AID-CNCR2820571315>3.0.CO;2-F
  50. Kelly AP. Medical and surgical therapies for keloids. Dermatol Ther 2004;17:212-8. https://doi.org/10.1111/j.1396-0296.2004.04022.x
  51. Layton AM, Yip J, Cunliffe WJ. A comparison of intralesional triamcinolone and cryosurgery in the treatment of acne keloids. Br J Dermatol 1994;130:498-501. https://doi.org/10.1111/j.1365-2133.1994.tb03385.x
  52. Har-Shai Y, Amar M, Sabo E. Intralesional cryotherapy for enhancing the involution of hypertrophic scars and keloids. Plast Reconstr Surg 2003;111:1841-52. https://doi.org/10.1097/01.PRS.0000056868.42679.05
  53. Zouboulis CC, Rosenberger AD, Forster T, et al. Modification of a device and its application for intralesional cryosurgery of old recalcitrant keloids. Arch Dermatol 2004;140:1293-4.
  54. Tziotzios C, Profyris C, Sterling J. Cutaneous scarring: Pathophysiology, molecular mechanisms, and scar reduction therapeutics Part II. Strategies to reduce scar formation after dermatologic procedures. J Am Acad Dermatol 2012;66:13-24. https://doi.org/10.1016/j.jaad.2011.08.035
  55. Copcu E, Sivrioglu N, Oztan Y. Combination of surgery and intralesional verapamil injection in the treatment of the keloid. J Burn Care Rehabil 2004;25:1-7. https://doi.org/10.1097/01.BCR.0000105097.36706.5D
  56. Giugliano G, Pasquali D, Notaro A, et al. Verapamil inhibits interleukin-6 and vascular endothelial growth factor production in primary cultures of keloid fibroblasts. Br J Plast Surg 2003;56:804-9. https://doi.org/10.1016/S0007-1226(03)00384-9
  57. Yang JY, Huang CY. The effect of combined steroid and calcium channel blocker injection on human hypertrophic scars in animal model: a new strategy for the treatment of hypertrophic scars. Dermatol Surg 2010;36:1942-9. https://doi.org/10.1111/j.1524-4725.2010.01759.x
  58. Lawrence WT. Treatment of earlobe keloids with surgery plus adjuvant intralesional verapamil and pressure earrings. Ann Plast Surg 1996;37:167-9. https://doi.org/10.1097/00000637-199608000-00008
  59. D'Andrea F, Brongo S, Ferraro G, et al. Prevention and treatment of keloids with intralesional verapamil. Dermatology 2002;204:60-2. https://doi.org/10.1159/000051812
  60. Margaret Shanthi FX, Ernest K, Dhanraj P. Comparison of intralesional verapamil with intralesional triamcinolone in the treatment of hypertrophic scars and keloids. Indian J Dermatol Venereol Leprol 2008;74:343-8. https://doi.org/10.4103/0378-6323.42899
  61. Liechty KW, Kim HB, Adzick NS, et al. Fetal wound repair results in scar formation in interleukin-10-deficient mice in a syngeneic murine model of scarless fetal wound repair. J Pediatr Surg 2000;35:866-72. https://doi.org/10.1053/jpsu.2000.6868
  62. Hanasono MM, Kita M, Mikulec AA, et al. Autocrine growth factor production by fetal, keloid, and normal dermal fibroblasts. Arch Facial Plast Surg 2003;5:26-30. https://doi.org/10.1001/archfaci.5.1.26
  63. Liu RK, Li CH, Zou SJ. Reducing scar formation after lip repair by injecting botulinum toxin. Plast Reconstr Surg 2010;125:1573-4.
  64. Viera MH, Amini S, Valins W, et al. Innovative therapies in the treatment of keloids and hypertrophic scars. J Clin Aesthet Dermatol 2010;3:20-6.
  65. Gassner HG, Brissett AE, Otley CC, et al. Botulinum toxin to improve facial wound healing: a prospective, blinded, placebo-controlled study. Mayo Clin Proc 2006;81:1023-8. https://doi.org/10.4065/81.8.1023
  66. Zhibo X, Miaobo Z. Botulinum toxin type A affects cell cycle distribution of fibroblasts derived from hypertrophic scar. J Plast Reconstr Aesthet Surg 2008;61:1128-9. https://doi.org/10.1016/j.bjps.2008.05.003
  67. Zhibo X, Miaobo Z. Intralesional botulinum toxin type A injection as a new treatment measure for keloids. Plast Reconstr Surg 2009;124:275e-277e. https://doi.org/10.1097/PRS.0b013e3181b98ee7
  68. Xiao Z, Zhang F, Lin W, et al. Effect of botulinum toxin type A on transforming growth factor beta1 in fibroblasts derived from hypertrophic scar: a preliminary report. Aesthetic Plast Surg 2010;34:424-7. https://doi.org/10.1007/s00266-009-9423-z
  69. Xiao Z, Zhang F, Cui Z. Treatment of hypertrophic scars with intralesional botulinum toxin type A injections: a preliminary report. Aesthetic Plast Surg 2009;33:409-12. https://doi.org/10.1007/s00266-009-9334-z
  70. Haubner F, Leyh M, Ohmann E, et al. Effects of botulinum toxin A on patient-specific keloid fibroblasts in vitro. Laryngoscope 2014;124:1344-51. https://doi.org/10.1002/lary.24456
  71. Maderal AD, Tang JC, Vivas AC, et al. Hypertrophic scars and keloids, part 2: newer and investigational therapies. Cosmet Dermatol 2012;25:373-9.

Cited by

  1. Mechanism of Action, Efficacy, and Adverse Events of Calcium Antagonists in Hypertrophic Scars and Keloids : A Systematic Review vol.41, pp.12, 2014, https://doi.org/10.1097/dss.0000000000000506
  2. Laser Revision and Rehabilitation of Mohs Micrographic Surgical Scars vol.5, pp.3, 2014, https://doi.org/10.1007/s13671-016-0144-7
  3. Keloids and Hypertrophic Scars: A Spectrum of Clinical Challenges vol.17, pp.3, 2014, https://doi.org/10.1007/s40257-016-0175-7
  4. Treat keloids and hypertrophic scars with a combination of interventions to obtain the best results vol.32, pp.12, 2014, https://doi.org/10.1007/s40267-016-0330-5
  5. Comparative study between intralesional injection of bleomycin and 5-fluorouracil in the treatment of keloids and hypertrophic scars vol.20, pp.1, 2016, https://doi.org/10.1016/j.jdds.2015.07.003
  6. A Comparison of the Effectiveness of Triamcinolone and Radiation Therapy for Ear Keloids after Surgical Excision: A Systematic Review and Meta-Analysis vol.137, pp.6, 2016, https://doi.org/10.1097/prs.0000000000002165
  7. An innovative regenerative treatment of scars with dermal micrografts vol.15, pp.3, 2014, https://doi.org/10.1111/jocd.12212
  8. Epidermal Growth Factor (EGF)-Like Repeats and Discoidin I-Like Domains 3 (EDIL3): A Potential New Therapeutic Tool for the Treatment of Keloid Scars vol.14, pp.3, 2014, https://doi.org/10.1007/s13770-017-0034-5
  9. Intralesional Treatment With 5-Fluorouracil and Steroid Improves Allergic Contact Dermatitis Without Causing Skin Atrophy and Rebound Lesions vol.28, pp.3, 2014, https://doi.org/10.1097/der.0000000000000270
  10. Combined effects of long-pulsed neodymium-yttrium-aluminum-garnet laser, diprospan and 5-fluorouracil in the treatment of keloid scars vol.13, pp.6, 2014, https://doi.org/10.3892/etm.2017.4438
  11. Topical cryoanesthesia for the relief of pain caused by steroid injections used to treat hypertrophic scars and keloids vol.96, pp.43, 2014, https://doi.org/10.1097/md.0000000000008353
  12. Triamcinolone acetonide intralesional injection for the treatment of keloid scars: patient selection and perspectives vol.11, pp.None, 2014, https://doi.org/10.2147/ccid.s133672
  13. Lipid nano-bubble combined with ultrasound for anti-keloids therapy vol.28, pp.1, 2014, https://doi.org/10.1080/08982104.2016.1239633
  14. Botulinum Toxin-A and Scar Reduction: A Review vol.35, pp.4, 2014, https://doi.org/10.1177/0748806818776156
  15. Combination therapy for bulky auricular keloids: a clinical experience vol.21, pp.1, 2019, https://doi.org/10.1080/14764172.2018.1439963
  16. Comparison of the efficacy of intralesional bleomycin versus intralesional triamcinolone acetonide in the treatment of keloids vol.32, pp.5, 2019, https://doi.org/10.1111/dth.13036
  17. Gangrenous Keloid of the Ear Pinna Following Intralesional Triamcinolone Injection: Proper Consent Is Essential vol.1, pp.11, 2014, https://doi.org/10.1007/s42399-019-00146-6
  18. Surgical excision combined with fully ablative carbon dioxide laser therapy and triamcinolone injections as a potential treatment for keloids in children vol.37, pp.1, 2014, https://doi.org/10.1111/pde.14053
  19. Pathogenesis and Treatment of Keloids vol.16, pp.1, 2014, https://doi.org/10.1272/manms.16.8
  20. Outcome of triamcinolone acetonide injection for lateral malleolar bursitis vol.28, pp.3, 2014, https://doi.org/10.1177/2309499020952893
  21. Keloid and Hypertrophic Scar Formation, Prevention, and Management : Standard Review of Abnormal Scarring in Orthopaedic Surgery vol.28, pp.10, 2020, https://doi.org/10.5435/jaaos-d-19-00690
  22. Benefits of extracorporeal shock waves for keloid treatment: A pilot study vol.33, pp.4, 2014, https://doi.org/10.1111/dth.13653
  23. Comparison of intralesional triamcinolone acetonide, botulinum toxin type A, and their combination for the treatment of keloid lesions vol.31, pp.5, 2014, https://doi.org/10.1080/09546634.2019.1628171
  24. Potentials for implementing pressure‐controlled jet injection in management of keloids with intralesional 5FU and corticosteroids vol.19, pp.8, 2014, https://doi.org/10.1111/jocd.13522
  25. Nonmuscle Myosin II Activation Regulates Cell Proliferation, Cell Contraction, and Myofibroblast Differentiation in Keloid-Derived Fibroblasts vol.9, pp.9, 2014, https://doi.org/10.1089/wound.2019.0944
  26. Efficacy and Safety of Botulinum Toxin Type A in Preventing Postoperative Scars and Improving the Cosmetic Appearance of Scars: A Systematic Review and Meta-Analysis vol.24, pp.6, 2014, https://doi.org/10.1177/1203475420937963
  27. The efficacy of bleomycin for treating keloid and hypertrophic scar: A systematic review and meta‐analysis vol.19, pp.12, 2014, https://doi.org/10.1111/jocd.13390
  28. Heterotopic ossification after local steroid injection vol.13, pp.12, 2014, https://doi.org/10.1136/bcr-2020-235371
  29. Bioinformatics study on different gene expression profiles of fibroblasts and vascular endothelial cells in keloids vol.100, pp.47, 2014, https://doi.org/10.1097/md.0000000000027777
  30. Intralesional verapamil in the treatment of keloids: A clinical, histopathological, and immunohistochemical study vol.20, pp.1, 2014, https://doi.org/10.1111/jocd.13476
  31. Laser‐assisted topical steroid application versus steroid injection for treating keloids: A split side study vol.20, pp.1, 2014, https://doi.org/10.1111/jocd.13521
  32. Intralesional cryotherapy with triamcinolone and onabotulinumtoxinA injections for umbilical keloid: A case report vol.7, pp.None, 2014, https://doi.org/10.1177/20595131211049040
  33. Management of keloid scars: noninvasive and invasive treatments vol.48, pp.2, 2021, https://doi.org/10.5999/aps.2020.01914
  34. CO 2 Fractional Laser Combined with 5-Fluorouracil Ethosomal Gel Treatment of Hypertrophic Scar Macro-, Microscopic, and Molecular Mechanism of Action in a Rabbit Animal Model vol.24, pp.2, 2014, https://doi.org/10.1089/rej.2019.2204
  35. Keloids: a review of therapeutic management vol.60, pp.6, 2014, https://doi.org/10.1111/ijd.15159
  36. Botulinum toxin type A versus 5-Fluorouracil in treatment of keloid vol.313, pp.7, 2014, https://doi.org/10.1007/s00403-020-02132-8
  37. A retrospective study of hypofractionated radiotherapy for keloids in 100 cases vol.11, pp.1, 2014, https://doi.org/10.1038/s41598-021-83255-4
  38. A selective small-molecule inhibitor of c-Met suppresses keloid fibroblast growth in vitro and in a mouse model vol.11, pp.1, 2014, https://doi.org/10.1038/s41598-021-84982-4