Keloids: Pathogenesis, Clinical Features, and Management

Chuma J Chike-Obi; Patrick D Cole; Anthony E Brissett

doi:10.1055/s-0029-1224797

Seminars in Plastic Surgery, Inhaltsverzeichnis

Semin Plast Surg 2009; 23(3): 178-184
DOI: 10.1055/s-0029-1224797

Keloids: Pathogenesis, Clinical Features, and Management

Chuma J. Chike-Obi¹ , Patrick D. Cole¹ , Anthony E. Brissett²

¹Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
²Bobby R. Alford Department of Otorhinolaryngology, Baylor College of Medicine, Houston, Texas

Abstract

ABSTRACT

Cutaneous wound healing is a complex response to skin injury. Deregulation of this process can lead to excessive scar formation, as seen in keloids. Keloids are common skin lesions that are difficult to treat and are associated with high recurrence rates despite the large number of available treatment options. With increased knowledge of the disease process and further scientific advancements, future approaches will hopefully improve keloid treatment. In this article, we review the epidemiology, genetic basis, etiology, clinical features, pathogenesis, and management of keloids.

KEYWORDS

Keloid - hypertrophic scar - treatment

Volltext

Referenzen

REFERENCES

1 Bayat A, Bock O, Mrowietz U, Ollier W E, Ferguson M W. Genetic susceptibility to keloid disease and hypertrophic scarring: transforming growth factor beta1 common polymorphisms and plasma levels. Plast Reconstr Surg. 2003; 111 535-543 discussion 544-546
2 Brissett A E, Sherris D A. Scar contractures, hypertrophic scars, and keloids. Facial Plast Surg. 2001; 17 263-272
3 Marneros A G, Krieg T. Keloids—clinical diagnosis, pathogenesis, and treatment options. J Dtsch Dermatol Ges. 2004; 2 905-913
4 Messadi D V, Le A, Berg S, Huang G, Zhuang W, Bertolami C N. Effect of TGF-beta 1 on PDGF receptors expression in human scar fibroblasts. Front Biosci. 1998; 3 a16-a22
5 Sayah D N, Soo C, Shaw W W et al.. Downregulation of apoptosis-related genes in keloid tissues. J Surg Res. 1999; 87 209-216
6 De Felice B, Ciarmiello L F, Mondola P et al.. Differential p63 and p53 expression in human keloid fibroblasts and hypertrophic scar fibroblasts. DNA Cell Biol. 2007; 26 541-547
7 Lu F, Gao J, Ogawa R, Hyakusoku H. Variations in gap junctional intercellular communication and connexin expression in fibroblasts derived from keloid and hypertrophic scars. Plast Reconstr Surg. 2007; 119 844-851
8 Chevray P M, Manson P N. Keloid scars are formed by polyclonal fibroblasts. Ann Plast Surg. 2004; 52 605-608
9 Berman B, Flores F. The treatment of hypertrophic scars and keloids. Eur J Dermatol. 1998; 8 591-595
10 Ichioka S, Ando T, Shibata M, Sekiya N, Nakatsuka T. Oxygen consumption of keloids and hypertrophic scars. Ann Plast Surg. 2008; 60 194-197
11 Sasaki A, Mueller R V, Xi G, Sipe R, Buck D, Hollinger J. Mast cells: an unexpected finding in the modulation of cutaneous wound repair by charged beads. Plast Reconstr Surg. 2003; 111 1446-1453
12 Sharquie K E, Al-Dhalimi M A. Keloid in Iraqi patients: a clinicohistopathologic study. Dermatol Surg. 2003; 29 847-851
13 Lee S S, Yosipovitch G, Chan Y H, Goh C L. Pruritus, pain, and small nerve fiber function in keloids: a controlled study. J Am Acad Dermatol. 2004; 51 1002-1006
14 Aköz T, Gideroğlu K, Akan M. Combination of different techniques for the treatment of earlobe keloids. Aesthetic Plast Surg. 2002; 26 184-188
15 Kelly A P. Medical and surgical therapies for keloids. Dermatol Ther. 2004; 17 212-218
16 Ramakrishnan K M, Thomas K P, Sundararajan C R. Study of 1,000 patients with keloids in South India. Plast Reconstr Surg. 1974; 53 276-280
17 Marneros A G, Norris J E, Olsen B R, Reichenberger E. Clinical genetics of familial keloids. Arch Dermatol. 2001; 137 1429-1434
18 Marneros A G, Norris J E, Watanabe S, Reichenberger E, Olsen B R. Genome scans provide evidence for keloid susceptibility loci on chromosomes 2q23 and 7p11. J Invest Dermatol. 2004; 122 1126-1132
19 Bayat A, Arscott G, Ollier W E, Ferguson M W, Mc Grouther D A. Description of site-specific morphology of keloid phenotypes in an Afrocaribbean population. Br J Plast Surg. 2004; 57 122-133
20 Poochareon V N, Berman B. New therapies for the management of keloids. J Craniofac Surg. 2003; 14 654-657
21 Chen M A, Davidson T M. Scar management: prevention and treatment strategies. Curr Opin Otolaryngol Head Neck Surg. 2005; 13 242-247
22 Mustoe T A, Cooter R D, Gold M H et al.. International clinical recommendations on scar management. Plast Reconstr Surg. 2002; 110 560-571
23 Berman B, Kaufman J. Pilot study of the effect of postoperative imiquimod 5% cream on the recurrence rate of excised keloids. J Am Acad Dermatol. 2002; 47(4, Suppl) S209-S211
24 Niessen F B, Spauwen P H, Schalkwijk J, Kon M. On the nature of hypertrophic scars and keloids: a review. Plast Reconstr Surg. 1999; 104 1435-1458
25 Alster T S, Tanzi E L. Hypertrophic scars and keloids: etiology and management. Am J Clin Dermatol. 2003; 4 235-243
26 Rudy S J. Imiquimod (Aldara): modifying the immune response. Dermatol Nurs. 2002; 14 268-270
27 Weeks C E, Gibson S J. Induction of interferon and other cytokines by imiquimod and its hydroxylated metabolite R-842 in human blood cells in vitro. J Interferon Res. 1994; 14 81-85
28 Jacob S E, Berman B, Nassiri M, Vincek V. Topical application of imiquimod 5% cream to keloids alters expression genes associated with apoptosis. Br J Dermatol. 2003; 149(Suppl 66) 62-65
29 Malhotra A K, Gupta S, Khaitan B K, Sharma V K. Imiquimod 5% cream for the prevention of recurrence after excision of presternal keloids. Dermatology. 2007; 215 63-65
30 Bilu D, Sauder D N. Imiquimod: modes of action. Br J Dermatol. 2003; (149 Suppl 66) 5-8
31 Berman B, Duncan M R. 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(4 Pt 1) 694-702
32 Duncan M R, Berman B. Persistence of a reduced-collagen-producing phenotype in cultured scleroderma fibroblasts after short-term exposure to interferons. J Clin Invest. 1987; 79 1318-1324
33 Davison S P, Mess S, Kauffman L C, Al-Attar A. Ineffective treatment of keloids with interferon alpha-2b. Plast Reconstr Surg. 2006; 117 247-252
34 al-Khawajah M M. Failure of interferon-alpha 2b in the treatment of mature keloids. Int J Dermatol. 1996; 35 515-517
35 Wong T W, Chiu H C, Yip K M. Intralesional interferon alpha-2b has no effect in the treatment of keloids. Br J Dermatol. 1994; 130 683-685
36 Wendling J, Marchand A, Mauviel A, Verrecchia F. 5-Fluorouracil blocks transforming growth factor-beta-induced alpha 2 type I collagen gene (COL1A2) expression in human fibroblasts via c-Jun NH2-terminal kinase/activator protein-1 activation. Mol Pharmacol. 2003; 64 707-713
37 Nanda S, Reddy B S. Intralesional 5-fluorouracil as a treatment modality of keloids. Dermatol Surg. 2004; 30 54-56, discussion 56–57
38 Gupta S, Kalra A. Efficacy and safety of intralesional 5-fluorouracil in the treatment of keloids. Dermatology. 2002; 204 130-132
39 Uppal R S, Khan U, Kakar S, Talas G, Chapman P, McGrouther A D. The effects of a single dose of 5-fluorouracil on keloid scars: a clinical trial of timed wound irrigation after extralesional excision. Plast Reconstr Surg. 2001; 108 1218-1224
40 Lee D A. Antifibrosis agents and glaucoma surgery. Invest Ophthalmol Vis Sci. 1994; 35 3789-3791
41 Sanders K W, Gage-White L, Stucker F J. Topical mitomycin C in the prevention of keloid scar recurrence. Arch Facial Plast Surg. 2005; 7 172-175
42 Sewall G K, Robertson K M, Connor N P, Heisey D M, Hartig G K. Effect of topical mitomycin on skin wound contraction. Arch Facial Plast Surg. 2003; 5 59-62
43 Prutkin L. Wound healing and vitamin A acid. Acta Derm Venereol. 1972; 52 489-492
44 Christophers E. Growth stimulation of cultured postembryonic epidermal cells by vitamin A acid. J Invest Dermatol. 1974; 63 450-455
45 Janssen de Limpens A M. The local treatment of hypertrophic scars and keloids with topical retinoic acid. Br J Dermatol. 1980; 103 319-323
46 Daly T J, Weston W L. Retinoid effects on fibroblast proliferation and collagen synthesis in vitro and on fibrotic disease in vivo. J Am Acad Dermatol. 1986; 15(4 Pt 2) 900-902
47 Al-Attar A, Mess S, Thomassen J M, Kauffman C L, Davison S P. Keloid pathogenesis and treatment. Plast Reconstr Surg. 2006; 117 286-300
48 Ogawa R, Miyashita T, Hyakusoku H, Akaishi S, Kuribayashi S, Tateno A. Postoperative radiation protocol for keloids and hypertrophic scars: statistical analysis of 370 sites followed for over 18 months. Ann Plast Surg. 2007; 59 688-691
49 Ogawa R, Mitsuhashi K, Hyakusoku H, Miyashita T. Postoperative electron-beam irradiation therapy for keloids and hypertrophic scars: retrospective study of 147 cases followed for more than 18 months. Plast Reconstr Surg. 2003; 111 547-553, discussion 554–555
50 Nouri K, Vidulich K, Rivas M P. Lasers for scars: a review. J Cosmet Dermatol. 2006; 5 14-22
51 Apfelberg D B, Maser M R, Lash H, White D, Weston J. Preliminary results of argon and carbon dioxide laser treatment of keloid scars. Lasers Surg Med. 1984; 4 283-290
52 Apfelberg D B, Maser M R, White D N, Lash H. Failure of carbon dioxide laser excision of keloids. Lasers Surg Med. 1989; 9 382-388
53 Norris J E. The effect of carbon dioxide laser surgery on the recurrence of keloids. Plast Reconstr Surg. 1991; 87 44-49, discussion 50–53
54 Atiyeh B S. Nonsurgical management of hypertrophic scars: evidence-based therapies, standard practices, and emerging methods. Aesthetic Plast Surg. 2007; 31 468-492 discussion 493-494
55 Rusciani L, Paradisi A, Alfano C, Chiummariello S, Rusciani A. Cryotherapy in the treatment of keloids. J Drugs Dermatol. 2006; 5 591-595
56 Har-Shai Y, Amar M, Sabo E. Intralesional cryotherapy for enhancing the involution of hypertrophic scars and keloids. Plast Reconstr Surg. 2003; 111 1841-1852
57 Borgognoni L. Biological effects of silicone gel sheeting. Wound Repair Regen. 2002; 10 118-121
58 de Oliveira G V, Nunes T A, Magna L A et al.. Silicone versus nonsilicone gel dressings: a controlled trial. Dermatol Surg. 2001; 27 721-726
59 Chang C W, Ries W R. Nonoperative techniques for scar management and revision. Facial Plast Surg. 2001; 17 283-288
60 Chernoff W G, Cramer H, Su-Huang S. The efficacy of topical silicone gel elastomers in the treatment of hypertrophic scars, keloid scars, and post-laser exfoliation erythema. Aesthetic Plast Surg. 2007; 31 495-500
61 Mustoe T A. Evolution of silicone therapy and mechanism of action in scar management. Aesthetic Plast Surg. 2008; 32 82-92
62 Sawada Y, Sone K. Treatment of scars and keloids with a cream containing silicone oil. Br J Plast Surg. 1990; 43 683-688

Chuma J Chike-ObiM.D.

Division of Plastic Surgery, Baylor College of Medicine

6701 Fannin, CC610.00, Houston, TX 77030-2399

eMail: cjchikeo@bcm.edu