ABSTRACT
Abstract We report a 74-year-old male presented to an outpatient dermatology clinic in Manaus, Amazonas, with a one-year history of pruritic, keloidal lesions on his left lower extremity. Histopathology showed round structures in reticular dermis. Grocott methenamine silver stain revealed numerous round yeasts with thick double walls, occurring singly or in chains connected by tubular projections. The diagnosis was lobomycosis. Although the keloidal lesions presented by this patient are typical of lobomycosis, their linear distribution along the left lower limb is unusual.
Subject(s)
Humans , Male , Aged , Lobomycosis/diagnosis , Lobomycosis/pathology , Keloid/diagnosis , Keloid/pathology , Leg Dermatoses/diagnosis , Leg Dermatoses/pathology , Biopsy , Dermis/microbiology , Dermis/pathologyABSTRACT
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
Abstract: Lobomycosis or lacaziosis is a chronic granulomatous fungal infection caused by Lacazia loboi. Most cases are restricted to tropical regions. Transmission is believed to occur through traumatic inoculation in the skin, mainly in exposed areas. It is characterized by keloid-like nodules. There are only a few hundred cases reported. The differential diagnoses include many skin conditions, and treatment is difficult. The reported case, initially diagnosed as keloid, proved to be refractory to surgical treatment alone. It was subsequently approached with extensive surgery, cryotherapy every three months and a combination of itraconazole and clofazimine for two years. No signs of clinical and histopathological activity were detected during follow-up.
Subject(s)
Humans , Male , Adult , Ear Diseases/pathology , Ear Diseases/therapy , Lobomycosis/pathology , Lobomycosis/therapy , Keloid/pathology , Biopsy , Treatment Outcome , Clofazimine/therapeutic use , Itraconazole/therapeutic use , Cryotherapy/methods , Diagnosis, Differential , Ear Diseases/diagnosis , Lobomycosis/diagnosis , Keloid/diagnosis , Antifungal Agents/therapeutic useABSTRACT
Introdução: Queloides são tumores benignos resultantes de cicatrização anômala da pele, sendo que existem diversos procedimentos disponíveis para o seu tratamento. Objetivo: O objetivo deste trabalho é avaliar os resultados de pacientes submetidos a tratamento de queloides retroauriculares após cirurgias otorrinológicas em nosso serviço. Método: Estudo retrospectivo e prospectivo, através de análise de prontuários, dos pacientes submetidos a tratamento de queloides retroauriculares em nosso serviço. Resultados: Nove pacientes foram avaliados, sendo que 6 foram submetidos a ressecção e betaterapia adjuvante, 2 foram submetidos a ressecção mais aplicação de corticoide local, 1 foi submetido apenas a ressecção sem terapia adjuvante. Não houve recidiva nos casos tratados com betaterapia no pós-operatório precoce, 1 paciente apresentou recidiva mesmo com corticoterapia e betaterapia tardia. Discussão: diversas técnicas tem sido utilizadas para tratamento dos queloides retroauriculares, sendo que a betaterapia é considerada a com melhores resultados, seguida pela utilização de corticoides intralesionais. Conclusão: o tratamento dos queloides retroauriculares continua um desafio. Enquanto novas técnicas não são desenvolvidas, a ressecção seguida de betaterapia precoce ainda é a melhor opção...
Introduction: Keloids are benign tumors arising from abnormal healing of the skin, and there are several procedures available for their treatment. Objective: The objective of this study was to evaluate the outcomes of patients undergoing treatment of keloids after ear, nose, and throat (ENT) surgeries at our service center. Method: We conducted thorough, retrospective and prospective analysis of records of patients undergoing treatment of retroauricular keloids at our center. Results: Nine patients were evaluated, and 6 underwent resection and adjuvant beta-therapy, 2 underwent resection with local application of corticosteroids, and only 1 underwent resection without adjuvant therapy. There was no recurrence of keloids in patients that were treated with beta-therapy in the early postoperative period. One patient had relapsed despite corticosteroid administration and late beta-therapy. Discussion: Several techniques have been used for the treatment of retroauricular keloids, and beta-therapy is thought to yield the best results, followed by the use of intralesional corticosteroids. Conclusion: Treatment of retroauricular keloids remains a challenge. While new techniques are being developed, resection followed by early beta-therapy is still the best treatment option...
Subject(s)
Humans , Male , Female , Child , Adolescent , Young Adult , Adrenal Cortex Hormones/therapeutic use , Keloid/surgery , Keloid/diagnosis , Keloid/therapy , Wound Healing , Retrospective Studies , Recurrence/prevention & controlABSTRACT
Granuloma faciale (GF) is a rare cutaneous disorder characterized by one to several soft, erythematous to livid papules, plaques or nodules, usually occurring on the face. Extrafacial lesions are uncommon. A 52-year-old lady with multiple asymptomatic, variously sized brownish-black colored, firm, sharply circumscribed plaques resembling keloids on both cheeks and extrafacial lesions on the right arm and the right breast is presented for its unusual keloidal appearance and typical histopathological findings. She failed to respond to oral dapsone 100 mg daily administered for 3 months. Local infiltration of triamcinolone combined with cryotherapy led to only partial flattening of the lesions. All the skin lesions were excised surgically followed by flap transfer grafting on both cheeks. The cosmetic outcome was highly satisfactory.
Subject(s)
Arm/pathology , Biopsy , Breast Diseases/pathology , Facial Dermatoses/pathology , Female , Granuloma/diagnosis , Humans , Keloid/diagnosis , Middle Aged , Surgical FlapsABSTRACT
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.
Subject(s)
Administration, Topical , Adrenal Cortex Hormones/therapeutic use , Cicatrix, Hypertrophic/diagnosis , Cryotherapy/methods , Female , Fluorouracil/therapeutic use , Follow-Up Studies , Humans , India , Injections, Intralesional , Keloid/diagnosis , Laser Therapy/methods , Male , Risk Assessment , Treatment OutcomeABSTRACT
Se hace referencia a la distinción entre cicatrización y cicatriz y la clasificación según el origen de esta última. Se pasa breve revista a los factores generales y locales que intervienen como complicación de la cicatrización. Se mencionan en forma de cuadro sinóptico las tres fases en que se divide el proceso de cicatrización y su tiempo de duración. Se dividen las cicatrices en viciosas y patológicas. Las primeras se definen como exageración del proceso normal de cicatrización y de las segundas, que son una neopatología, se hace referencia especial al queloide, diferenciándola de la cicatriz hipertrófica, que es una cicatriz viciosa. Breve referencia a un trabajo de investigación personal de 1966 sobre "Primeras etapas de la histogénesis del queloide provocado" y su conclusión. Se pasa revista a factores locales y generales que intervendrían en la formación de un queloide. Para concluir se formulan reglas elementales de la Cirugía dermatológica para lograr una buena cicatriz quirúrgica
Subject(s)
Humans , Cicatrix/classification , Wound Healing/physiology , Keloid/physiopathology , Wound Healing/physiology , Keloid/diagnosis , Keloid/etiologyABSTRACT
Se presentan 58 casos tratados con homeopatía de cicatrices hipertróficas y/o queloides. Fase primaria: la mejoría ocurrió de un 30 por ciento a un 50 por ciento del tamaño original con 12 casos a los 6 meses y 36 casos a los 12 meses; la curación en esta fase fue de 3 casos. Fase secundaria: de los 55 casos que llegaron a los 24 meses de tratamiento, se curaron 44 casos. Quedaron 10 casos con residuos de tejidos que fueron completados por cirugía plástica. Un caso de infección recidivante no curó