• Archives of Craniofacial Surgery
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• v.20 no.6
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• pp.354-360
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• 2019

Background: Keloids are benign fibro-proliferative lesion, related to excessive inflammatory reactions in certain anatomical areas, including the auricles. Their specific etiology remains unclear; nonetheless they exhibit tumor-like characteristics of significant recurrence and cause emotional distress, even with various treatment strategies. We applied intermittent magnetic pressure therapy on ear keloids in combination with surgical excision, and present its effectiveness herein. Methods: Ear keloid patients were treated with surgical excision followed by magnetic pressure therapy. The keloid tissues underwent excision and keloid marginal flaps were utilized for wound closure. Intermittent magnetic pressure therapy was applied 2 weeks after the surgical procedure. The pressure therapy consisted of a 3-hour application and 2-hour resting protocol (9 hr/day), and lasted for 6 months. The results were analyzed 6 months after the therapeutic procedures, using the scar assessment scale. Results: Twenty-two ear keloids from 20 patients were finally reviewed. Among the keloids that completed the therapeutic course, 20 ear keloids out of 22 in total (90.9%) were successfully eradicated. Two patients (2 keloids) exhibited slight under-correction. Postoperative complications such as wound dehiscence or surgical site infection were not noted. The scar assessment scale demonstrated a significant improvement in each index. The intermittent pressure therapy led to patient compliance, and avoided pressure-related pain and discomfort. Conclusion: Excision followed by intermittent pressure application using a magnet successfully reduced the burden of fibro-proliferative keloids, and had good patient compliance. The role of intermittent pressure application and resting should be studied with regard to keloid tissue remodeling.

• Journal of Yeungnam Medical Science
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• v.2 no.1
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• pp.23-30
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• 1985

Keloids are abnormally healed skin wounds that develop in the subpapillary layer of the dermis. They are a lesion with wide, raised and deep scars. They exceed the original dimensions of the wound and grow mounds upon mounds of collagen in a pseudotumor fashion. Their treatment may take several forms such as surgery, intralesional injection of steroid, compression, superficial irradiation, and combination therapy. However, absolute method is nothing until now. Recently, the cryosurgery shows relatively good effect in treatment, so we tried the clinical experience with cryosurgery in the treatment of keloids. Material and methods: During the past 2 years, we treated 20 individuals of the keloids with severe itching and pain. The age ranged from 5 to 45 years old. Only 6 cases were biopsied before and after cryotherapy. The cryosurgery set we used was Toitu model CR 201 $N_2O$ gas (tip temperature is $-80^{\circ}C$) and was applied directly on the lesion about 4 to 5 minutes with slight compression. After cryosurgery in keloids, the following results were obtained: 1. It is both quick and easy method. 2. It causes little or no pain and no loss of blood. 3. Integumentary normalization is rapid. The new scar tissue is smaller, and more elastic and soft. 4. The pain, itching and paresthesia commonly associated with keloid is usually disappeared. 5. Other treatment can be used after cryosurgery. 6. Histologic picture after cryosurgery is similar with the result of steroid injection. 7. The mechanism of the cryosurgery in keloids is the result of the direct tissue destroying action and cryoimmunologic reaction.

• Archives of Craniofacial Surgery
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• v.14 no.1
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• pp.58-60
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• 2013

Keloids result from excessive production of fibrous tissue during an abnormal wound healing process. Keloids can occur after trauma, and trauma can range from laceration, piercing, bites, surgery, and burns, to other skin conditions such as acne or folliculitis. We present a case of 68-year-old man, which was characterized with a relatively firm, non-tender, mild pigmented mass in his right earlobe. We performed a local excision, together with microscopic analysis. The mass was eventually diagnosed as a keloid scar in the right earlobe. Postoperative adjuvant pressure therapy using magnets was adopted and the postoperative follow-up was maintained without any recurrence. Auricular keloids should be considered in the differential diagnosis regardless of the cause or the age of patient.

• Applied Microscopy
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• v.3 no.1
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• pp.29-38
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• 1973

Introduction. The human cutaneous scars manifest themselves many ways in different types according to the factors such as the age, sex, race of the patient as well as the location,. kind and heal ing process of the wound. Among the scars it is quiet difficult to verify the clinical course of the hypertrophic or keloidal scars from the true keloids. However, clinical observations indicate that stress, either mechanical or in the forms of chronic infections, can induce a functional change in the fibroblasts causing an excessive production of collagenous matrix. In this study, we preliminary attempt to justify any difference of the cellular structure between keloids and hypertrophic scars by using electron microscope. Material and Methods. A total of 23 cases: 2 scars, 2 hypertrophic scars and 19 keloids are examined. Immediately, the biopsy tissue was fixed in 10% neutral formalin and 4% glutaraldehyde solution in phosphate buffer for 4 hours, post fixed in 1 % osmium tetraoxide for two hours, dehydrated with graded alcohol, and embedded in Epon 812. Thick sections were stained with hematoxylin eosin, periodic acid-Schiff(PAS) and Van Gieson stain. Thin sections were cut and uranyle acetate, lead citratestain and examined with the electron microscope. Result. The morphologic features of keloid showed thick, homogenously eosinophilic bands of collagen and numberous large active fibroblasts. The hypertrophic scar and soft scar are more cellular than keloid and composed thinner collagenous fiber. For this paper in the etiology of keloids can not as be defined, but and interesting keloidal tissue fibroblast showed irregular nucleus with irregular shape dense bodies and fibril materials contained in to the cytoplasm.

• Archives of Plastic Surgery
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• v.42 no.5
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• pp.588-595
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• 2015

Background Radiotherapy treatment after keloidectomy is known to be an effective method for reducing the rate of recurrence. However, to date, the appropriate total radiation dose and fractionation have not yet been confirmed. The authors performed a retrospective analysis to identify the appropriate radiation dose and fractionation in post-keloidectomy radiotherapy. Methods From May 2000 to February 2011, postoperative radiotherapy was performed on 39 lesions in 28 patients after total keloidectomy. The keloid lesions were confined to the ear lobes. Between May 2000 and May 2004, 14 keloids were treated with surgical excision, followed by a total radiation dose of 1,200 cGy in three fractions over four to five days (group 1). Between June 2004 to February 2011, 25 keloids were treated with surgical excision, followed by a total radiation dose of 1,500 cGy in three fractions over four to five days (group 2). Patients were given a survey asking them to report their experiences regarding reoperation, recurrence of symptoms, recurrence of the lesion, and satisfaction with the operation. Results Of the 28 patients who were treated, 20 underwent follow-up. Group 2 had more cases showing elevation with erythematous changes, whereas group 1 had more cases showing progressive stages of elevation than group 2. These differences were statistically significant. Moreover, a correlation was observed between the level of keloid elevation and the extent of symptoms. Conclusions We suggest 1,500 cGy of radiation in three fractions following keloidectomy for ear lobe keloids. A further randomized study is needed to assess the recurrence of keloids after radiotherapy.

• BMB Reports
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• v.52 no.3
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• pp.202-207
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• 2019

Keloids are the most common pathological form of trauma healing, with features that seriously affect appearance and body function, are difficult to treat and have a high recurrence rate. Emerging evidence suggests that miRNAs are involved in a variety of pathological processes and play an important role in the process of fibrosis. In this study, we investigated the function and regulatory network of miR-152-5p in keloids. The miRNA miR-152-5p is frequently downregulated in keloid tissue and primary cells compared to normal skin tissue and fibroblasts. In addition, the downregulation of miR-152-5p is significantly associated with the proliferation, migration and apoptosis of keloid cells. Overexpression of miR-152-5p significantly inhibits the progression of fibrosis in keloids. Smad3 is a direct target of miR-152-5p, and knockdown of Smad3 also inhibits fibrosis progression, consistent with the overexpression of miR-152-5p. The interaction between miR-152-5p and Smad3 occurs through the Erk1/2 and Akt pathways and regulates collagen3 production. In summary, our study demonstrates that miR-152-5p/Smad3 regulatory pathways involved in fibrotic progression may be a potential therapeutic target of keloids.

• Archives of Craniofacial Surgery
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• v.17 no.1
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• pp.5-8
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• 2016

Background: Lobular keloid appears to be a consequence of hypertrophic inflammation secondary to ear piercings performed under unsterile conditions. We wish to understand the pathogenesis of lobular keloids and report operative outcomes with a literature review. Methods: A retrospective review identified 40 cases of lobular keloids between January, 2005 and December, 2010. Patient records were reviewed for preclinical factors such as presence of inflammation after ear piercing prior to keloid development, surgical management, and histopathologic correlation to recurrence. Results: The operation had been performed by surgical core extirpation or simple excision, postoperative lobular compression, and scar ointments. Perivascular infiltration was noted in intra- and extra-keloid tissue in 70% of patients. The postoperative recurrence rate was 10%, and most of the patients satisfied with treatment outcomes. Conclusion: Histological perivascular inflammation is a prominent feature of lobular keloids. Proper surgical treatment, adjuvant treatments, and persistent follow-up observation were sufficient in maintaining a relatively low rates of recurrence.

• Proceedings of the PSK Conference
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• 2003.10b
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• pp.248.1-248.1
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• 2003

Keloids are characterized by abnormal proliferation of fibroblasts and overproduction of collagen. Recently, it is reported that transforming growth factor beta (TGFb) and its signaling molecule, SMAD3 are related to the mitogenic effect of fibroblasts and a stimulatory factor for collagen synthesis. Cationic SLN was developed to improve the complex formation of DNA/SLN and enhance the uptake efficiency to cells. SLN was formulated by DC-Chol, DOPE, trimyristin as a solid core and other surfactant. The physical properties of the SLN and the ATS-SLN complex were characterized. (omitted)

• Medical Lasers
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• v.9 no.1
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• pp.58-61
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• 2020

Keloids are pathologic fibroproliferative conditions characterized by excessive collagen deposition during wound healing. The pathogenesis of keloids is not fully understood, and current treatment options show variable results. In this case report, the patient developed a keloid after bilateral total thyroidectomy, and was treated with a combination approach using fractional ablative laser systems along with cryotherapy and triamcinolone injection. After seven monthly sessions of combination treatment, the patient presented marked improvement of the scar texture and symptoms. Furthermore, there was no recurrence for up to 2 years. We propose this combination as a safe and effective treatment option for keloid patients.

• Archives of Plastic Surgery
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• v.41 no.6
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• pp.620-629
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• 2014

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.