ABSTRACT
Introdução: Cicatrizes hipertróficas e queloides causam dano estético e funcional e são de difícil tratamento. O objetivo desta revisão foi identificar estudos prospectivos do tratamento com o laser fracionado de CO2, mostrando as alterações clínicas e histológicas e a metodologia utilizada para a avaliação das cicatrizes antes e após intervenção. Métodos: Foi realizada uma revisão eletrônica (LILACS, Medline e SciELO) de estudos publicados entre janeiro de 2004 e dezembro de 2017, com os termos "keloid/queloide", "hypertrophic scar/cicatriz hipertrófica" e "laser CO2", de acordo com o PRISMA Statement, sendo selecionados os estudos que comparassem as cicatrizes antes e depois de tratamento isolado com laser fracionado de CO2. Os dados foram analisados por dois revisores independentes. Resultados: Foram analisados 102 artigos, sendo que 7 cumpriam os critérios estabelecidos. Destes, os 7 analisaram cicatrizes hipertróficas, 2 deles também analisaram queloides, e 3 estudaram alterações histológicas. Houve diferença estatística entre os escores clínicos medidos antes e após tratamento de cicatrizes hipertróficas na maioria dos estudos, com melhora nos sintomas, na flexibilidade e altura da cicatriz. Entre os 2 estudos que analisaram os queloides, 1 deles demonstrou diferença clínica após tratamento. Nas alterações histológicas, houve diferença na orientação e densidade das fibras de colágeno e na espessura da epiderme. Conclusão: O laser fracionado de CO2 deve ser considerado como opção promissora no tratamento de cicatrizes patológicas, visto que melhora os sinais e sintomas clínicos como cor, espessura e prurido.
Introduction: Hypertrophic scars and keloids cause aesthetic and functional damages, and are difficult to treat. This review aimed to identify prospective studies on fractional CO2 laser to present the clinical and histological changes and the methodology used for the evaluation of scars before and after intervention. Methods: We conducted an electronic review (LILACS, Medline, and SciELO) of studies published between January 2004 and December 2017, using the search terms "keloid/queloide," "hypertrophic scar/cicatriz hipertrófica," and "CO2 laser ," according to the PRISMA Statement. Studies that compared scars before and after isolated treatment with fractional CO2 laser were selected. Two independent reviewers analyzed the data. Results: One hundred two articles were analyzed, of which 7 met the inclusion criteria. Of the 7 articles, all analyzed hypertrophic scars, 2 analyzed keloids in addition to hypertrophic scars, and 3 analyzed histological changes. Most studies showed a statistically significant difference in clinical scores between before and after treatment of hypertrophic scars, with improvement in symptoms, flexibility, and scar height. Between the 2 studies that analyzed keloids, 1 reported a clinical difference after treatment. The histological changes showed significant differences in the orientation and density of the collagen fibers, and in the thickness of the epidermis. Conclusion: The use of fractional CO2 laser should be considered as a promising treatment option for pathological scars, as it improves clinical signs and symptoms such as color, thickness, and pruritus.
Subject(s)
Humans , Male , Female , Cicatrix/pathology , Cicatrix, Hypertrophic/diagnosis , Keloid/diagnosis , Lasers/adverse effects , Lasers/standardsABSTRACT
A 6-year-old boy was referred to our hospital with symblepharon and lateral canthal deformity in both eyes, which developed 6 years ago. The patient was born at 27 weeks gestation. He had received cryotherapy for retinopathy of prematurity. One month after cryotherapy, he developed a conjunctival scar with symblepharon in both eyes and underwent symblepharon lysis at another hospital 5 years prior. Ocular examination revealed an extensive conjunctival hypertrophic scar with symblepharon and limitation of extraocular movements. An excisional biopsy, lateral canthoplasty, and symblepharon lysis with conjunctival autograft from the contralateral eye were performed in the left eye. Histopathologic examination revealed diffuse proliferation and infiltration of collagenous tissue.
Subject(s)
Child , Humans , Male , Biopsy , Cicatrix, Hypertrophic/diagnosis , Conjunctiva/pathology , Conjunctival Diseases/diagnosis , Cryotherapy/adverse effects , Diagnosis, Differential , Follow-Up Studies , Retinopathy of Prematurity/therapyABSTRACT
Contexte : les cicatrices chéloïdiennes sont fréquentes chez le sujet noir africain et particulièrement en Côte d'Ivoire. La prise en charge mal codifiée, et la chronicité sont responsable des récidives fréquentes. Objectif: Evaluer la prise en charge des cicatrices chéloïdiennes en vue d'une codification. Matériels et méthodes :Cette étude a été réalisée au Service de Dermatologie du CHU de Treichville. Il s'agit d'une étude thérapeutique à visée pronostique sur une période d'un an. Ont été inclus tous les patients présentant une cicatrice chéloïdienne et ayant donné leur consentement pour participer à l'étude. Résultats : L'étude a permis de noter que:- la moyenne d'âge était de 28 ans sans prédominance de sexe - le traitement le plus utilisé était l'association chirurgie et les infiltrations de corticoïde retard dans 66% des cas. - nous avons obtenu un très bon résultat dans 73% des cas- l'évolution avait été très bonne dans 90,5% avec la triple association : les infiltrations, la chirurgie et la presso thérapie. Conclusion: La méthode thérapeutique associant les infiltrations de corticoïde retard à la chirurgie et à un autre moyen thérapeutique donne de meilleurs résultats. Elle devrait se faire en fonction des caractéristiques cliniques de la cicatrice chéloïdienne
Subject(s)
Black People , Cicatrix, Hypertrophic/diagnosis , Cicatrix, Hypertrophic/therapy , Cote d'Ivoire , Keloid , MaliABSTRACT
Aim: Keloid [KD] and Hypertrophic [HS] scars affected patients and frustrated physicians. This study aimed to analyze clinical, anatomical site and specific morphological characteristics of KD and HS scars that might help understanding their pathophysiology and to reach to the appropriate management
Methods: Total of 125 patients [keloid [n=57], hypertrophic [n=63] and combined [n=5] scars] were recruited from Plastic and Reconstructive Surgery unit at King Abdulaziz University Hospital, Jeddah, Saudi Arabia during period [2000-2005]. Patients were clinically assessed. Seventy-three KD and 87 HS were evaluated morphologically
Results: Abnormal scars were more in females than males [p<0.01], Saudi than non-Saudi [p<0.05], healthy than with co- morbid patient [p<0.000], brown than white, black colored [p<0.000], patients with negative than positive family history [p<0.000]. Commonest age of KD and HS were [20-29 and 10-19 years, respectively]. Commonest etiology of keloid, combined keloid and hypertrophic scars was burn while hypertrophic scar was trauma. Commonest symptoms were pruritus. Keloids, hypertrophic scars were mostly single. Commonest site of keloid was chest [21.9%] while for hypertrophy scars were face [26.4%]. KD and HS showed different morphological appearance in different anatomical areas
Conclusion: Keloid and hypetrophic scars are not uncommon in Saudi Arabia. We demonstrated that female, young age, brown color has significant effect on clinical presentation of keloid and hypertrophic scarring
Subject(s)
Humans , Male , Female , Cicatrix, Hypertrophic/pathology , Diagnosis, Differential , Keloid , Cicatrix, Hypertrophic/diagnosis , Hospitals, UniversityABSTRACT
Clinicians always find it difficult to treat hypertrophic scars and keloids. Various treatment modalities are available. Intralesional corticosteroids, topical applications, cryotherapy, surgery, laser therapy, and silicone sheeting are the widely used options. Radiation therapy can also help in cases of recalcitrant keloids. Most recently, pulsed-dye laser has been successfully used to treat keloids and hypertrophic scars. There are no set guidelines for the treatment of keloids. Treatment has to be individualized depending upon the distribution, size, thickness, and consistency of the lesions and association of inflammation. A combination approach to therapy seems to be the best option.