Hyperbaric oxygen treatment on keloid tumor immune gene expression / 中华医学杂志(英文版)

BACKGROUND@#Hyperbaric oxygen treatment (HBOT) has been demonstrated to influence the keloid recurrence rate after surgery and to relieve keloid symptoms and other pathological processes in keloids. To explore the mechanism of the effect of HBOT on keloids, tumor immune gene expression and immune cell infiltration were studied in this work.@*METHODS@#From February 2021 to April 2021, HBOT was carried out on keloid patients four times before surgery. Keloid tissue samples were collected and divided into an HBOT group (keloid with HBOT before surgery [HK] group, n = 6) and a non-HBOT group (K group, n = 6). Tumor gene expression was analyzed with an Oncomine Immune Response Research Assay kit. Data were mined with R package. The differentially expressed genes between the groups were compared. Hub genes between the groups were determined and verified with Quantitative Real-time PCR. Immune cell infiltration was analyzed based on CIBERSORT deconvolution algorithm analysis of gene expression and verified with immunohistochemistry (IHC).@*RESULTS@#Inflammatory cell infiltration was reduced in the HK group. There were 178 upregulated genes and 217 downregulated genes. Ten hub genes were identified, including Integrin Subunit Alpha M (ITGAM), interleukin (IL)-4, IL-6, IL-2, Protein Tyrosine Phosphatase Receptor Type C (PTPRC), CD86, transforming growth factor (TGF), CD80, CTLA4, and IL-10. CD80, ITGAM, IL-4, and PTPRC with significantly downregulated expression were identified. IL-10 and IL-2 were upregulated in the HK group but without a significant difference. Infiltration differences of CD8 lymphocyte T cells, CD4 lymphocyte T-activated memory cells, and dendritic resting cells were identified with gene CIBERSORT deconvolution algorithm analysis. Infiltration levels of CD4 lymphocyte T cell in the HK group were significantly higher than those of the K group in IHC verification.@*CONCLUSION@#HBOT affected tumor gene expression and immune cell infiltration in keloids. CD4 lymphocyte T cell, especially activated memory CD4+T, might be the key regulatory immune cell, and its related gene expression needs further study.

Dermatofibrossarcoma protuberante diagnosticado erroneamente como queloide e tratado com acetonido de triancinolona / Dermatofibrosarcoma protuberans misdiagnosed as keloid and treated with triamcinolone acetonide

INTRODUÇÃO: Dermatofibrossarcoma protuberante é um tumor de pele raro e de malignidade intermediária, com baixo potencial metastático, mas altas taxas de recorrência após tratamento cirúrgico. Por apresentar eventual semelhança clínica com cicatrizes hipertróficas e queloides, o diagnóstico correto mostra-se fundamental para o sucesso do tratamento. O objetivo do presente trabalho é fazer um alerta e relatar quatro casos de dermatofibrossarcoma protuberante erroneamente diagnosticados como queloide e tratados alhures com infiltração de acetonido de triancinolona. MÉTODO: Entre novembro de 1983 e janeiro de 2008, foram atendidos quatro pacientes com dermatofibrossarcoma protuberante que tinham sido submetidos alhures a infiltrações intralesionais de acetonido de triancinolona, em virtude de diagnóstico errôneo de queloide. Nos quatro casos, foram realizadas excisões cirúrgicas radicais, com remoção de 3 cm de tecido sadio nas margens laterais, incluindo-se, na margem profunda, uma estrutura anatômica não infiltrada pelo tumor. Os pacientes receberam avaliação médica periódica em longo prazo. RESULTADOS: Os pacientes foram acompanhados por uma média de 159 meses. Três pacientes (75%) permaneceram vivos, sem sinais de doença em atividade. Um paciente (25%) faleceu devido à doença, após tentativa de remover o avançado tumor recorrente, por meio de extensa cirurgia craniofacial. A recidiva ocorreu sete anos após a operação radical. CONCLUSÃO: Dermatofibrossarcoma protuberante deve ser considerado no diagnóstico diferencial dos queloides. A infiltração intralesional de acetonido de triancinolona só deverá ser realizada após diagnóstico de certeza, que pode demandar exame anatomopatológico prévio. Um exame clínico cuidadoso e o conhecimento da lesão favorecem um diagnóstico preciso e, portanto, um tratamento adequado.

INTRODUCTION: Dermatofibrosarcoma protuberans is a rare skin tumor with intermediate malignancy, low metastatic potential, and high recurrence rates after surgical treatment. Owing to a possible clinical resemblance with hypertrophic scars and keloids, the correct diagnosis is fundamental for treatment success. The objective of the present work is to report on four cases of dermatofibrosarcoma protuberans misdiagnosed as keloid and treated elsewhere with infiltration of triamcinolone acetonide. METHOD: Between November 1983 and January 2008, four patients with dermatofibrosarcoma protuberans who had undergone intralesional infiltration with triamcinolone acetonide elsewhere were treated because of an erroneous diagnosis of keloid. Radical surgical excision was performed, and 3 cm of healthy tissue was removed from the side margins, including the deep margin, an anatomical structure not infiltrated by the tumor. The patients underwent long-term periodic medical evaluations. RESULTS: The patients were followed-up for an average of 159 months. Three patients (75%) are still alive without signs of disease at the time of this report. One patient (25%) died of the disease after an attempt to remove the advanced recurrent tumor using extensive craniofacial surgery. Recurrence occurred 7 years after the radical operation. CONCLUSION: Dermatofibrosarcoma protuberans must be considered in the differential diagnosis of keloids. Intralesional infiltration with triamcinolone acetonide should only be performed after diagnostic confirmation , which may require pathological examination. A careful clinical examination and knowledge of the lesion favor a precise diagnosis and an appropriate treatment.

Verapamilo en conjunto con las prendas de compresión en el tratamiento de la cicatriz patológica causada por quemadura / Verapamil in conjunction with pressure therapy in the treatment of pathologic scar due burn injury

Abstract Introduction: Keloids and hypertrophic scars are dermal fibro-proliferative disorders unique to humans. Their treatment is a true challenge with multiple options, but not all the time with good results. Unfortunatelythis problem is not uncommon in patients with history of burn injury. Aim: To evaluate use of verapamil andpressure garments in patients with hypertrophic or keloid scar caused by burn injury. methods: We includedpatients with a hypertrophic or keloid scar caused by burn injury that report non-response to treatment withpressure garment. The pathologic scars were evaluated by serial photographic records, Vancouver and Posasscales. The scales of Vancouver and Posas were compared with t Student. Results: We included 13 scars in11 patients. Four scars were located in the legs, 4 in the arms, 4 in the face-neck and 1 in the abdomen. Thedose of verapamil was calculated 0.03 mg per kg. Injections were scheduled every 7 to 10 days until complete 6 sessions. Taking in count Posas scale, patients referred improvement in pigmentation (0.01), thickness(0.005), pliability (0.01), pruritus (0.003) and irregular surface (0.004). In the Vancouver scale the observers mentioned improvement in elevation (0.008), pigmentation (0.014), vascularity (0.022) and flexibility (0.014).No adverse effects were found in verapamil injection. Conclusion: Verapamil was useful in conjunction withpressure garment to improve the condition of the keloid and hypertrophic scar caused by burn.

Resumen Introducción: La cicatriz queloide o la cicatriz hipertrófica son desórdenes fibro-proliferativos únicos de los humanos, cuyo tratamiento representa un reto en donde existen pocas opciones con buenos resultados.Objetivo: Evaluar el uso de verapamilo y las prendas de compresión en pacientes con cicatrización patológicacomo consecuencia de quemadura. material y método: Incluimos pacientes con cicatrización patológica,ya sea queloide o hipertrófica, causada por quemadura que mencionaron no haber tenido beneficio con el usode prendas de compresión. La cicatriz fue evaluada con fotografías seriadas, escala de Vancouver y Posas.Los resultados fueron comparados con la prueba de t de Student. Resultados: Incluimos 13 cicatrices en 11pacientes. La localización de las cicatrices fue en brazos 4, piernas 4, cara y cuello 1, y abdomen 1. La dosisde verapamilo se calculó a 0,03 mg por kg. Las inyecciones se aplicaron intralesionales y se administraroncada 7 a 10 días hasta completar 6 sesiones. Encontramos mejoría en los siguientes parámetros de la escalade Posas: pigmentación (0,01), pliabilidad (0,01), endurecimiento o grosor (0,005), prurito (0,003) e irregular (0,004). En la escala de Vancouver elevación (0,008), pigmentación (0,014), vascularidad (0,022) yflexibilidad (0,014). No encontramos efectos adversos con la administración de verapamilo. Conclusión: Elverapamilo fue útil en conjunto con las prendas de compresión para mejorar las condiciones de la cicatrizqueloide e hipertrófica causadas por lesiones por quemadura.

Keloids: A Review

The management of keloids remains a difficult clinical problem. This article is a review of the current methods available for the treatment of keloids. Online search was made on review articles and other publications on keloids mainly from PubMed (search results from National Center for Biotechnology Information at the US National Library of Medicine [NLM]) and African Journals Online. A review of the selected articles was carried out. The various methods of treatment available suggest that there is still no one method that is completely satisfactory. Currently; combination therapy using surgical excision followed by intralesional steroid or other adjuvant therapy appears to yield the best results for keloidal management

Tratamento de sequelas de queimadura: estudo de caso / Treatment of sequelae of burn: a case study

Introdução: As queimaduras apresentam alta incidência e altas taxas de mortalidade no Brasil e no mundo, as quais a tornam um grande problema de saúde pública. Após o trauma, as sequelas de queimaduras, decorrentes de um processo de reorganização tecidual, caracterizadas pela síntese excessiva e descontrolada de colágeno, resultam em uma cicatriz hipertrófica ou queloideana. Os recursos de termoterapia como a radiofrequência e fototerapia como a Luz Intensa Pulsada e laser de baixa potência reorganizam as fibras colágenas e remodelam o tecido. Objetivo: Este trabalho tem o objetivo de investigar os recursos de termoterapia, radiofrequência e fototerapia Luz Intensa Pulsada na sequela de queimadura. Relato do Caso: É relatado o caso de paciente de 21 anos, que sofreu acidente de queimadura por chama, agente causal álcool, em face e membros superiores, com evolução para sequelas do tipo cicatrizes hipertrófica queloideana, no qual foram realizadas sessões semanais de radiofrequência associada à Luz Intensa Pulsada e ao Laser de Baixa Potência na sequela de queimadura. Estudo de caso avaliado com inspeção e palpação, questionário de Rosenberg (EAR) Escala de Autoestima, Avaliador Cego e Fotometria.

Introduction: Burns have high incidence and high mortality rates in Brazil and the world, which to make a big public health problem. After the trauma, the sequelae of burns resulting from a process of tissue reorganization, characterized by excessive and uncontrolled collagen synthesis, resulting in a hypertrophic or keloid scar. Resources such as radiofrequency thermotherapy and phototherapy as Intense Pulsed Light and Low Power Laser reorganize collagen fibers and reshape the skin fabric. Objective: This work aims to investigate the features of Radio Frequency Thermotherapy and phototherapy Intense Pulsed Light in the sequel to burn. Case report: The case of patient 21 years-old, who suffered accident burning flame, alcohol causal agent in the face and upper limbs, progressing to sequelae of hypertrophic scars type is reported, in which weekly sessions were held Radio Frequency related to Intense Pulsed Light and low power laser in the sequel to burn. Case study assessed by inspection and palpation, Rosenberg questionnaire (EAR) Self-Esteem Scale, Reviewer Blind and photometry.

Update on hypertrophic scar treatment

Scar formation is a consequence of the wound healing process that occurs when body tissues are damaged by a physical injury. Hypertrophic scars and keloids are pathological scars resulting from abnormal responses to trauma and can be itchy and painful, causing serious functional and cosmetic disability. The current review will focus on the definition of hypertrophic scars, distinguishing them from keloids and on the various methods for treating hypertrophic scarring that have been described in the literature, including treatments with clearly proven efficiency and therapies with doubtful benefits. Numerous methods have been described for the treatment of abnormal scars, but to date, the optimal treatment method has not been established. This review will explore the differences between different types of nonsurgical management of hypertrophic scars, focusing on the indications, uses, mechanisms of action, associations and efficacies of the following therapies: silicone, pressure garments, onion extract, intralesional corticoid injections and bleomycin. .

Tratamento de queloide retroauricular: Revisão dos casos tratados no serviço de otorrinolaringologia do HC/UFPR / Treatment of retroauricular keloids: Revision of cases treated at the ENT service of HC/UFPR

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...

Comparison of different modalities of treatment of hypertrophic scars and keloids

Hypertrophic scars and keloids are extreme overgrowth of scar tissue. To improve the cosmesis and symptomatology, to compare the results of different treatment modalities and to find out the most workable treatment option. Prospective randomized clinical trial. This study was conducted at the Allied Hospital, Faisalabad from April 2009 to September 2011. In this study 72 patients were studied. Most of them were treated on outdoor basis while others in wards. Detailed history and physical examination were carried out and applied different treatment options and followed them up. In our study of patients of hypertrophic scars and keloids, 29 were males and 43 were females. There was 20% recurrence rate in intralesional injections of steroid, 255 in silicone gel sheeting, 25% in surgery and postoperative intralesional injection, 50% in case of surgery and postoperative irradiation and 20% in surgery alone. In case of intralesional injections of triamcinolone acetonide 62.5% patients had excellent results. In both combined surgery with radiotherapy 1 patient improved while the other got recurrence. After surgical excision of hypertrophic scars 40% patients had excellent results. Intralesional injections of triamcinolone acetonide had good results. In early lesions silicone gel sheeting was useful option while recurrent scars can be treated by combined modalities of treatment

Queloide auricular: manejo quirúrgico / Hanset keloid: a surgical management

Se presenta el caso de una paciente de sexo femenino, de 17 años edad, de raza blanca, que presenta una lesión queloide nodular, en pabellón auricular derecho, con un tiempo de evolución de un año, como consecuencia de haber usado un arete de plata, que le produjo una Infección, el arete fue retirado, y la infección tratada. Dos meses más tarde, aparece en la zona infectada, un pequeño nódulo cicatrizal, la misma que se desarrolla y va creciendo lentamente, hasta adquirir al año un tamaño de 1,3 x 1,4 x 1.3 cm. A partir del décimo mes, debido al aumento de tamaño, la paciente refiere dolor a la presión, en especial al momento de dormir. El diagnóstico se efectuó básicamente por las manifestaciones clínicas, el antecedente del uso del arete, y la infección. El tratamiento consistió en la extirpación quirúrgica del queloide y posteriormente se asoció con infiltraciones de triamcinolona, con un resultado muy bueno, sin recurrencia hasta el año de control. Se presenta este caso, para incrementar la casuística en esta localización, señalar los rasgos característicos de la enfermedad y el manejo quirúrgico efectuado.

A case of a female patient, 17 years old, white, presenting a nodular keloid in the right ear, with a duration of one year as a result of having used a silver earring that caused an infection, the earring was removed, the infection treated. Two months later, appears in the infected area, a small nodule scar, the same as it develops and grows slowly, to acquire a year a size of 1.3 x 1.3 x 1.4 cm. From the tenth month, due to increased size,the patient complained of pain to pressure, especially at bed time. The diagnosis was made mainly on clinical, previous use of the earring, and infection.Treatment consisted of surgical removal of the keloid and later was associated with infiltration of triamcinolone, with a very good, with no recurrence until control. We present this case to increase the case mix in this location, identify the characteristics of the disease and surgical management.

Queloides na adolescência: a busca pelo melhor tratamento / Keloids in adolescence: searching for the best treatment

Queloides são lesões benignas que resultam de uma proliferação fibroblástica excessiva da derme após o trauma de pele. As lesões são espessas, ultrapassam os limites da lesão inicial e invadem a pele normal. Existem diversas teorias que procuram explicar os mecanismos de formação desse tipo de lesão, mas a real patogênese ainda não foi elucidada, o que explica a multiplicidade de tratamentos disponíveis, não havendo consenso na literatura sobre a melhor abordagem terapêutica. No presente artigo, descrevemos o caso de uma adolescente que desenvolveu queloide em abdome após lesão por arma de fogo e abordamos os diversos aspectos do tratamento. Nessa faixa etária, deve-se atentar para a seguran- ça dos métodos terapêuticos empregados. Entre as opções existentes, a combinação de excisão cirúrgica com aplicação de triancinolona representa uma opção segura e eficaz (AU)

Keloids are benign lesions resulting from excessive fibroblastic proliferation of the dermis after skin injury. The lesions are thick, surpass the edges of the initial injury and invade the normal skin. There is a number of theories explaining the mechanisms of formation of this type of lesion, but the real pathogenesis is not yet elucidated, with no consensus on the best therapeutic approach, which accounts for the many available treatments. In this article, we report the case of a teenager who developed an abdominal keloid after fire gun injury and discuss several aspects of treatment. In this age group, the safety of the therapeutic methods used must be heeded. Among the existing options, the combination of surgical resection and triamcinolone administration stands as an effective, safe choice (AU)

Eficacia y seguridad en el tratamiento conservador de cicatrices hipertróficas y queloides con heparina, Extracto Cepae y Alantoína / Efficacy and safety in the conservative treatment of hypertrophic scars and keloids with Heparin, Extract Cepae and Allantoin

Con el objetivo de evaluar la eficacia clínica de un producto compuesto por heparina sódica 50 UI, Allium cepae 10 %, alantoína 1 % en la evolución de cicatrices patológicas, se realizó un ensayo abierto en un solo centro de la Ciudad de Buenos Aires. La muestra incluyó a 50 pacientes que presentaban cicatrices no fisiológicas (hipertróficas y queloides) producto de cirugías estéticas o reconstructivas. Luego de un período de seis meses de tratamiento se controló su resultado mediante el análisis morfológico de la cicatriz y la intensidad de los síntomas acompañantes. Al completar la terapia de tres aplicaciones diarias del compuesto, se evidenció una reducción promedio del 33,3 % del ancho y 42,7 % de la altura de la lesión.

Queloides y cicatrices hipertróficas: problema frecuente de manejo complejo / Keloids and hypertrophic scars: frequent problem of complex management

Keloids and hypertrophic scars are frequent observed. These two conditions are considered part of the abnormal wound-healing spectrum. The main difference between keloids and hypertrophic scars is the scar extension in relation to the original incision, where former extends beyond the original incision while the latter respects it. The main issue with both conditions is that treatment modalities used today offer unacceptable high recurrence rates, between 50 to 70 percent, when they are applied as monotherapy. With combined treatment modalities recurrence rates have improved partially depending mainly in the chosen combination and so, this strategy is likely the optimal choice for the management of these lesions. The objective of this review was to highlight the pathophysiology, clinical features, and management of keloids with mono or combined therapy, focusing mainly in the surgical and radiotherapy/brachytherapy modalities.

Meatoplasty with intraoperative topical mitomycin C application: technique and outcome

The present study was designed to evaluate the outcome of meatoplasty using Z-shaped incision with application of mitomycin C as trial to enlarge the external auditory meatus of patients undergoing modified radical mastoidectomy in comparison to classic meatoplasty with application of mitomycin C. The study included 40 patients; 25 males and 15 females with mean age of 38.7 +/- 8.4 years. All patients underwent Jull history taking, complete otorhinolaryngological examination and CT scanning and then were randomly allocated into two equal groups [n=20] according to the procedure assigned: Classic meatoplasty [C group] and Z-shaped meatoplasty [Z group] using Z-shaped skin incision made along the posterior and inferior conchal borders and extended along the posterior ear canal meatus. In both groups, mitomycin C, 0.4 mg/ml solution was applied on a sponge to the edge of the remnants of conchal cartilage for 5 minutes. Patients were examined bi-weekly till the ear was fully healed. Meatoplasty was assessed as regards the feasibility of easy examination and debridement with the use of simple otologic tools and an operating microscope. Both groups were compared as regards age, sex, operative time and amount of intraoperative bleeding. All cases passed smooth intraoperative course with non-significantly longer operative time and non-significantly more bleeding during Z-meatoplasty compared to classic meatoplasty. All Z flaps healed completely with good take without sloughing or change in color and the meatus was so enlarged to allow inspection of mastoid cavity and easy debridement with simple tools and allowed frequent otoscopic examination for cavity inspection. Only one ear, in Z group, developed hypertrophic scar that did not impose significant narrowing of the meatus. On contrary; 3 ears had classic meatoplasty developed keloid formation and significant narrowing of the meatus that hampered cavity examination and debridement. Another ear, in C group, developed postoperative perichondritis that resolved with local care and oral antibiotics, but unfortunately developed meatal stenosis. Thus, Z-meatoplasty showed a success rate of 95% which is significantly higher compared to classic meatoplasty [80%]. It could be concluded that application of mitomycin C in conjunction with Z-meatoplasty is an effective modality for reduction of possibility for hypertrophic meatal scar with its subsequent problems. Also, classic meatoplasty with mitomycin C application provided acceptable frequency of hypertrophic meatal scar and is recommended wherever Z-meatoplasty was technically difficult

Tratamiento combinado de cicatrices de larga evolución: Resultado estético y reparador en una adolescente / Combined treatment of old scars: Aesthetic and reparative results in an adolescent

Las cicatrices extensas son lesiones que condicionan la vida de los pacientes que las padecen, produciendo retracción social o como en este caso condicionando la vestimenta de una joven adolescente de 15 años. Se realiza el tratamiento de cicatrices postquemadura que padece desde los 2 meses de edad, combinando diversos métodos como peeling, mesoterapia, dermoabrasión y ultrasonido, obteniendo como resultado la mejoría clínica, estética y psicológica, brindándole una calidad de vida superior.

Extensive scars modify the patient's life. Significant scarring causes functional and cosmetic deformities, discomfort and psychological stress. We report a teenager, who suffered from burning when she was two months old. She has been under scar treatment combining several methods such as peeling, mesotherapy, manual dermoabrasion and ultrasound. Up to now, we improved the patient's life quality, obtaining a clinical improvement, such as aesthetic and psychological one.

Queloides: modalidades terapéuticas / Keloids: different therapeutic interventions

Los queloides son formas de cicatrización anormal de etiología desconocida. Aunque se han publicado muchos artículos sobre el manejo de estas cicatrices, no existen protocolos de manejo definitivos. Presentamos una revisión de las distintas modalidades terapéuticas.

Quelóide e cicatriz hipertrófica: fisiopatologia e conduta terapêutica / Keloid and hypertrophic cicatrix

Os autores apresentam uma revisão sobre a etiologia do quelóide e da cicatriz hipertrófica, bem como sobre as atuais alternativas de tratamento. Essas cicatrizes são resultado de um processo cicatricial alterado e apresentam-se frequentemente na prática clínica. Não existe atualmente um consenso sobre a etiologia e o melhor tratamento. Entre as terapêuticas propostas, a cirurgia, aplicação intralesional de corticóides, pressoterapia, crioterapia podem ser utilizados isoladamente ou associadas

Cellular signaling in tissue regeneration

With recent progress in stem cell-based research, there has been tremendous interest in stem cell-based tissue regeneration. Stem cells can be differentiated into specialized cells/tissues by growth factors and cytokines. These small molecules are thought to play an important role in both wound healing and tissue regeneration. However, their biological activity and signal transduction during tissue regeneration are poorly understood. With recent advances in signal transduction by growth factors, the receptor kinases and G protein-coupled receptors, an understanding in the underlying mechanism of how these factors regulate tissue regeneration beginning to take place. In this review, the potential underlying mechanisms of growth factor signaling in normal tissue regeneration and chronic wound healing is discussed. Thus, it is an aim to provide a basis for designing more specific therapies for tissue regeneration in the near future.

Dermatología cosmética: tratamiento de queloides / Cosmetic dermatology: queloides treatment

Este artículo hace un resumen sobre la patogenia de los queloides a fin de acercarnos a su manejo racional. Los próximos avances en la terapia de los queloides apuntan más hacia un manejo inmunológico que la excisión o terapia intralesionar que hoy practicamos. El tiempo nos dirá si el interferón o algún agente similar harán realidad la expectativa que nuestros pacientes esperan. Los queloides constituyen todo un desafío que tienen 4 características igualmente importantes: molestia, tamaño, color y disfunción. Debemos abordar todos estos aspectos con el paciente antes de iniciar un plan terapéutico, para asegurar que el tratamiento que nosotros consideramos como óptimo, es considerado así también por el paciente. Dado que la terapia aún está lejos de ser perfecta y sin complicaciones, el paciente debe estar preparado para afrontar un tratamiento que ha de ser largo.

Tratamiento de los queloides con infiltración intralesional de bleomicina / Treatment of the keloids

Se presenta 22 casos de pacientes con cicatrices queloides, a quienes se les administró bleomicina intralesional, obteniendo respuesta aceptable en la mayoría de las lesiones, constituyendo así una terapia útil y accesible