Inhibition of Proliferation, Migration, and Invasion of Keloid Fibroblasts By miR-183-5p Through Downregulating EGR1 / Inhibición de la Proliferación, Migración e Invasión de Fibroblastos Queloides por miR-183-5p Mediante la Regulación Negativa de EGR1

SUMMARY: Keloid scar is a unique benign fibroproliferative tumor of the human skin. Previously, it was reported that early growth response 1 (EGR1), a transcription factor, promotes keloid fibrosis; however, the mechanism by which EGR1 modulates keloid formation was not elaborated. In this research, the specific function and the microRNA (miRNA) regulatory network of EGR1 in keloids was examined. Keloid fibroblasts (KFs) were transfected with EGR1-small interfering RNA (siEGR1), EGR1-overexpression plasmid (pcDNA3.1-EGR1), and microRNA (miR-183-5p)-mimics to regulate the expression of EGR1 and miR-183-5p. The study employed dual-luciferase reporter assays to explore the targeting regulation of miR-183-5p on EGR1. Additionally, Western blotting, flow cytometry, qRT-PCR, cell count kit-8 (CCK-8), transwell, and wound healing assays, and RNA sequencing were conducted. EGR1 was upregulated in KFs, and EGR1 silencing diminished proliferation, fibrosis, migration, invasion, and apoptosis of cells. In KFs, the expression of miR- 183-5p was reduced, leading to the inhibition of cell proliferation, migration, and invasion. Conversely, it enhanced apoptosis. By targeting EGR1, miR-183-5p partially counteracted the impact of EGR1 on migration, invasion, and fibrosis in KFs. The findings imply that miR-183-5p suppresses keloid formation by targeting EGR1. As a result, EGR1 holds promise as a potential therapeutic target for preventing and treating keloids.

La cicatriz queloide es un tumor fibroproliferativo benigno único de la piel humana. Anteriormente, se informó que la respuesta de crecimiento temprano 1 (EGR1), un factor de transcripción, promueve la fibrosis queloide; sin embargo, no se explicó el mecanismo por el cual EGR1 modula la formación de queloides. En esta investigación, se examinó la función específica y la red reguladora de microARN (miARN) de EGR1 en queloides. Se transfectaron fibroblastos queloides (KF) con ARN de interferencia pequeño de EGR1 (siEGR1), plásmido de sobreexpresión de EGR1 (pcDNA3.1-EGR1) y miméticos de microARN (miR-183-5p) para regular la expresión de EGR1 y miR-183. -5p. El estudio empleó ensayos de indicador de luciferasa dual para explorar la regulación dirigida de miR-183-5p en EGR1. Además, se realizaron pruebas de transferencia Western, citometría de flujo, qRT-PCR, kit de recuento celular-8 (CCK-8), transwell y curación de heridas, y secuenciación de ARN. EGR1 estaba regulado positivamente en KF, y el silenciamiento de EGR1 disminuyó la proliferación, fibrosis, migración, invasión y apoptosis de las células. En KF, la expresión de miR- 183-5p se redujo, lo que llevó a la inhibición de la proliferación, migración e invasión celular. Por el contrario, mejoró la apoptosis. Al apuntar a EGR1, miR-183-5p contrarrestó parcialmente el impacto de EGR1 en la migración, invasión y fibrosis en KF. Los hallazgos implican que miR-183-5p suprime la formación de queloides al apuntar a EGR1. Como resultado, EGR1 es prometedor como objetivo terapéutico potencial para prevenir y tratar los queloides.

A prospective study on the development and application verification of the quantitative evaluation software for three-dimensional morphology of pathological scars based on photo modeling technology / 中华烧伤杂志

Objective: To develop a quantitative evaluation software for three-dimensional morphology of pathological scars based on photo modeling technology, and to verify its accuracy and feasibility in clinical application. Methods: The method of prospective observational study was adopted. From April 2019 to January 2022, 59 patients with pathological scars (totally 107 scars) who met the inclusion criteria were admitted to the First Medical Center of Chinese PLA General Hospital, including 27 males and 32 females, aged 33 (26, 44) years. Based on photo modeling technology, a software for measuring three-dimensional morphological parameters of pathological scars was developed with functions of collecting patients' basic information, and scar photography, three-dimensional reconstruction, browsing the models, and generating reports. This software and the clinical routine methods (vernier calipers, color Doppler ultrasonic diagnostic equipment, and elastomeric impression water injection method measurement) were used to measure the longest length, maximum thickness, and volume of scars, respectively. For scars with successful modelling, the number, distribution of scars, number of patients, and the longest length, maximum thickness, and volume of scars measured by both the software and clinical routine methods were collected. For scars with failed modelling, the number, distribution, type of scars, and the number of patients were collected. The correlation and consistency of the software and clinical routine methods in measuring the longest length, maximum thickness, and volume of scars were analyzed by unital linear regression analysis and the Bland-Altman method, respectively, and the intraclass correlation coefficients (ICCs), mean absolute error (MAE), and mean absolute percentage error (MAPE) were calculated. Results: A total of 102 scars from 54 patients were successfully modeled, which located in the chest (43 scars), in the shoulder and back (27 scars), in the limb (12 scars), in the face and neck (9 scars), in the auricle (6 scars), and in the abdomen (5 scars). The longest length, maximum thickness, and volume measured by the software and clinical routine methods were 3.61 (2.13, 5.19) and 3.53 (2.02, 5.11) cm, 0.45 (0.28, 0.70) and 0.43 (0.24, 0.72) cm, 1.17 (0.43, 3.57) and 0.96 (0.36, 3.26) mL. The 5 hypertrophic scars and auricular keloids from 5 patients were unsuccessfully modeled. The longest length, maximum thickness, and volume measured by the software and clinical routine methods showed obvious linear correlation (with r values of 0.985, 0.917, and 0.998, P<0.05). The ICCs of the longest length, maximum thickness, and volume of scars measured by the software and clinical routine methods were 0.993, 0.958, and 0.999 (with 95% confidence intervals of 0.989-0.995, 0.938-0.971, and 0.998-0.999, respectively). The longest length, maximum thickness, and volume of scars measured by the software and clinical routine methods had good consistency. The Bland-Altman method showed that 3.92% (4/102), 7.84% (8/102), and 8.82% (9/102) of the scars with the longest length, maximum thickness, and volume respectively were outside the 95% consistency limit. Within the 95% consistency limit, 2.04% (2/98) scars had the longest length error of more than 0.5 cm, 1.06% (1/94) scars had the maximum thickness error of more than 0.2 cm, and 2.15% (2/93) scars had the volume error of more than 0.5 mL. The MAE and MAPE of the longest length, maximum thickness, and volume of scars measured by the software and clinical routine methods were 0.21 cm, 0.10 cm, 0.24 mL, and 5.75%, 21.21%, 24.80%, respectively. Conclusions: The quantitative evaluation software for three-dimensional morphology of pathological scars based on photo modeling technology can realize the three-dimensional modeling and measurement of morphological parameters of most pathological scars. Its measurement results were in good consistency with those of clinical routine methods, and the errors were acceptable in clinic. This software can be used as an auxiliary method for clinical diagnosis and treatment of pathological scars.

Principle and clinical application of keloid core excision technique / 中国修复重建外科杂志

OBJECTIVE@#To review the research progress of the principle and clinical application of keloid core excision technique.@*METHODS@#The literature on keloid core excision technique at home and abroad in recent years was extensively reviewed, and the principle, development history, indications, advantages and disadvantages of this technique were summarized, and the existing controversies were analyzed.@*RESULTS@#Keloid core excision is a technique to remove the inner fibrous core from the keloid and cover the defect with the keloidal flap. It reduces the wound tension, yields good aesthetic results in the treatment of ear keloids, and reduces the recurrence rate of keloids combining with adjuvant therapies.@*CONCLUSION@#The keloid core excision technique has specific advantages, yet its overall efficacy remains controversial. Further studies are imperative to explore the mechanisms regarding keloid recurrence and the vascular supply principles of the keloidal flap. It is also necessary to define appropriate surgical indications and safety protocols of this technique.

Keloid nomogram prediction model based on weighted gene co-expression network analysis and machine learning / 生物医学工程学杂志

Keloids are benign skin tumors resulting from the excessive proliferation of connective tissue in wound skin. Precise prediction of keloid risk in trauma patients and timely early diagnosis are of paramount importance for in-depth keloid management and control of its progression. This study analyzed four keloid datasets in the high-throughput gene expression omnibus (GEO) database, identified diagnostic markers for keloids, and established a nomogram prediction model. Initially, 37 core protein-encoding genes were selected through weighted gene co-expression network analysis (WGCNA), differential expression analysis, and the centrality algorithm of the protein-protein interaction network. Subsequently, two machine learning algorithms including the least absolute shrinkage and selection operator (LASSO) and the support vector machine-recursive feature elimination (SVM-RFE) were used to further screen out four diagnostic markers with the highest predictive power for keloids, which included hepatocyte growth factor (HGF), syndecan-4 (SDC4), ectonucleotide pyrophosphatase/phosphodiesterase 2 (ENPP2), and Rho family guanosine triphophatase 3 (RND3). Potential biological pathways involved were explored through gene set enrichment analysis (GSEA) of single-gene. Finally, univariate and multivariate logistic regression analyses of diagnostic markers were performed, and a nomogram prediction model was constructed. Internal and external validations revealed that the calibration curve of this model closely approximates the ideal curve, the decision curve is superior to other strategies, and the area under the receiver operating characteristic curve is higher than the control model (with optimal cutoff value of 0.588). This indicates that the model possesses high calibration, clinical benefit rate, and predictive power, and is promising to provide effective early means for clinical diagnosis.

Differences of water barrier function between keloid and its surrounding normal skin in patients with keloids and its related mechanism / 中华烧伤杂志

Objective: To compare the differences of water barrier function between keloids and its surrounding normal skin in patients with keloids, and to explore the primary mechanism. Methods: A cross-sectional observational study was conducted. From October 2020 to March 2021, 30 patients with keloids who met the inclusion criteria visited Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, including 18 females and 12 males, aged 20-48 years. The transepidermal water loss (TEWL) of their keloids and the surrounding normal skin of the 30 patients were measured by multi probe adapter on the reception day. The keloid tissues and normal skin of 5 patients after keloid repair surgery were processed for hematoxylin-eosin staining to measure the thickness of epidermis. Immunohistochemistry was performed on samples from 3 of those 5 patients to detect the expressions of cytokeratin-10, involucrin, and filaggrin in keloids and normal skin. Data were statistically analyzed with paired sample t test and independent sample t test. Results: On the reception day, the TEWL of keloids of 30 patients was 9.0 (6.9, 13.4) g·m-2·h-1 and the TEWL of the normal skin was 8.1 (6.4, 18.1) g·m-2·h-1, between which the difference was not statistically significant (t=0.44, P>0.05). After keloid repair surgery, the thickness of epidermis in the keloids of 5 patients was (194±44) μm, which was significantly thicker than that of the normal skin (44±11) μm, (t=6.88, P<0.01). Furthermore, increased keratinocytes, lack of normal epidermal ridge structures, and thickened stratum corneum were observed in the keloid area. After keloid repair surgery, the expression level of cytokeratin-10 in keloids was significantly lower than that in normal skin of 3 patients (t=8.50, P<0.01), but there were no statistically significant differences in the expression levels of involucrin or filaggrin between keloids and normal skin (with t values of 0.07 and 0.96, respectively, P>0.05). Conclusions: Keloid tissue from patients with keloids displays increased number of keratinocytes and thickened epidermis. But the water barrier function in keloid area is similar to the surrounding normal skin, suggesting that TEWL may not be the main mechanism lead to the persistent development of keloids.

Research advances on the characteristics of fibroblast in keloid / 中华烧伤杂志

In re-cent 20 years, the development of cell biology technology has promoted the research of keloid. Keloid fibroblasts (KFbs) are the main effector cells in keloid, which are closely related to the occurrence and development of keloid. It is significantly different in terms of biological characteristics and gene expression between KFbs and normal fibroblasts. This articles reviews the characteristics of KFbs from multiple perspectives, describing its biological character- istics in details including microstructures, metabolic character- istics, and proliferation properties, and introducing the main characteristics of heterogeneity and genomics of KFbs. The further research on KFbs will help to elucidate the pathogenesis of keloids and provide valuable strategies for the prevention and treatment of keloids.

Risk factors associated with the progression from keloids to severe keloids / 中华医学杂志(英文版)

BACKGROUND@#Keloids are benign fibrous growths that are caused by excessive tissue build-up. Severe keloids exert more significant effects on patients' quality of life than do mild keloids. We aimed to identify factors associated with the progression from mild keloids to severe keloids, as distinct from those associated with the formation of keloids.@*METHODS@#In this retrospective case-control study, 251 patients diagnosed with keloids at West China Hospital between November 2018 and April 2021 were grouped according to the severity of lesions (mild [n = 162] or severe [n = 89]). We collected their basic characteristics, living habits, incomes, comorbidities, and keloid characteristics from Electronic Medical Records in the hospital and the patients' interviews. Conditional multivariable regression was performed to identify the independent risk factors for the progression of keloids.@*RESULTS@#Eighty-nine patients (35.5%) were classified as having severe keloids. We found the distribution of severe keloids varied with sex, age, excessive scrubbing of keloids, family income, the comorbidity of rheumatism, disease duration, characteristics of the location, location in sites of high-stretch tension, the severity and frequency of pain, the severity of pruritus, and infection. Multivariable analysis revealed significant associations between severe keloids and infection (odds ratio [OR], 3.55; P = 0.005), excessive scrubbing of keloids (OR, 8.65; P = 0.001), low or middle family income (OR, 13.44; P = 0.021), comorbidity of rheumatism (OR, 18.97; P = 0.021), multiple keloids located at multiple sites (OR, 3.18; P = 0.033), and disease duration > 15 years (OR, 2.98; P = 0.046).@*CONCLUSION@#Doctors should implement more active and thorough measures to minimize the progression of mild keloids in patients who have any of the following risk factors: infection, excessive scrubbing of keloids, low or middle family income, comorbidity of rheumatism, multiple keloids located at multiple sites, and disease duration > 15 years.

Research advances on the influence of poor dietary habits on the development of keloids / 中华烧伤杂志

Long-term poor dietary habits can cause changes in the intestinal flora, resulting in the production of a large number of lipopolysaccharide, increase intestinal mucosal permeability, and activate the entrance of a large number of inflammatory factors into the portal vein. In addition, a high carbohydrate diet can increase liver metabolic burden, increase mitochondrial oxidative phosphorylation, leading to oxidative stress, generate new fat during adenosine triphosphate synthesis, and thus resulting in ectopic fat accumulation, which further activate nuclear factor-κB signaling pathway and release inflam- matory factors such as tumor necrosis factor-α, interleukin-1β (IL-1β), IL-6, and so on. This leads to obesity and insulin resis- tance, ultimately triggering systemic low-grade inflammation. This article reviews the mechanism of poor dietary habits leading to systemic low-grade inflammation, the clinical and experimental research progress of keloids and systemic low-grade inflammation, the association between dietary habits and keloid constitution, and puts forward the hypothesis that poor dietary habits may lead to the occurrence and development of keloids.

Assessment of the effect of treatment on the quality of life of adult Keloid

Background: Documentations of the effect of treatment on the quality of life of keloid patients are few. This study assessedimprovement in quality-of-lifefollowing keloid treatment. In addition, to assess which of the offered four modalities of treatment improved quality of life more.Methods:Thisquasi-experimentalstudy was conducted on 32 adults who had treatment for keloid disease in the clinic from February 2019 to January 2020. This was part of a comparative study of four different modalities of keloid treatment. The quality of life was assessed before and after treatment using the Dermatology Life Quality Index questionnaire (DLQI). Data was analyzed using SPSS version 23.0Results:Quality of life significantly improved after treatment with the mean ± SD DLQI score improving from 7.75 ± 6.15 to 4.16 ± 4.93, p=0.001. Quality of life before treatment was impaired in 93.7% and improved to 65.6%. Before treatment, 2 patients had no QOLimpairment but this improved to 11 patients after treatment. Prior to treatment, severely impaired QOLwas in recorded 28.1% of thepatient's and in 9.4% after treatment. Quality of life improved more in patients who had the combined intralesional triamcinolone acetonide and 5-flourouracil treatment. Significant improvement in the DLQI items of symptomatology, embarrassment, social activity and choice of clothing was noted.Conclusion:Treatment of keloid improves quality of life and this is dependent on the modality of treatment. The items of quality of life improved include; embarrassment, choice of clothing, interference with socialactivities, symptoms of pain and pruritus.

Histoid leprosy presenting as a large tumor

Abstract Histoid leprosy is a rare form of multibacillary leprosy, characterized by the presence of papules, plaques, or nodules whose appearance is keloid-like, skin colored, or erythematous. Fusiform cells are the main histopathological feature. Due to the fact that it can simulate other dermatological lesions, for example, dermatofibroma and neurofibroma, it constitutes a diagnostic challenge for clinicians and pathologists. It is a bacilliferous form of leprosy, and it plays an important role in disease transmission. A case of a patient with histoid leprosy living in the Northeast Region of Brazil is reported.

Lobomycosis: exuberant presentation with malignant transformation

Abstract Lobomycosis is a chronic granulomatous infection caused by the yeast Lacazia loboi, typically found in tropical and subtropical geographical areas. Transmission occurs through traumatic inoculation into the skin, especially in exposed areas, of men who work in contact with the soil. Lesions are restricted to the skin and subcutaneous tissue, with a keloid-like appearance in most cases. The occurrence of squamous cell carcinoma on skin lesions with a long evolution is well known; however, there are scarce reports of lobomycosis that developed into squamous cell carcinoma. The authors report a patient from the Brazilian Amazon region, with lobomycosis and carcinomatous degeneration, with an unfavorable outcome, due to late diagnosis.

Comparison of primary keloid fibroblast cultivation methods and the characteristics of fibroblasts cultured from keloids, keloid-surrounding tissues, and normal skin tissues / Comparación de los métodos de cultivo de fibroblastos queloides primarios y las características de los fibroblastos cultivados a partir de queloides, tejidos circundantes queloides y tejidos cutáneos normales

SUMMARY: The establishment of primary keloid fibroblast culture has always been a fundamental measure for studying mechanisms of keloid disease. The quality of the primary cell culture can directly affect the results of further experiments. This study was performed to investigate the optimal growth conditions, including the optimal storage time and collagenase treatment time, for in vitro cell culture models and the suitable methods for epidermis-dermis separation in different tissues. Keloid tissues, keloid-surrounding tissues, and normal skin tissues were collected from patients, for primary fibroblast culture. Two methods, tissue explant and collagenase digestion, were deployed and compared. Expression levels of the keloid-related genes α -SMA, Col1, and Col3 were assessed in cells cultured using both methods, to verify the qualities of the primary cells. A comparative analysis was conducted between the two methods and among the three different tissues used. Bacterial and lipid contamination was immediately minimized after the samples were processed. Different methods of epidermis removal and different durations of collagenase digestion were required in different tissues to generate optimal results. Real-time PCR results showed that the mRNA expression levels of keloid-related genes in cultured fibroblasts correlated to their in vivo expression profile, as previously reported in other studies. The results of this study have revealed several key points in the culture of primary keloid fibroblasts and demonstrated the correlation in gene expression between in vivo keloid fibroblasts and in vitro primary keloid fibroblasts.

RESUMEN: La identificación de un cultivo de fibroblastos queloides primarios, siempre ha sido una medida fundamental para estudiar los mecanismos de la enfermedad queloide. La calidad del cultivo de células primarias puede afectar directamente los resultados de otros experimentos. Este estudio se realizó para investigar las condiciones óptimas de crecimiento, incluido el tiempo óptimo de almacenamiento y el tiempo de tratamiento con colagenasa, para modelos de cultivo celular in vitro y los métodos adecuados para la separación epidermis-dermis en diferentes tejidos. Se recogieron de los pacientes tejidos queloides, tejidos circundantes queloides y tejidos cutáneos normales, para cultivo primario de fibroblastos. Se implementaron y compararon dos métodos, explante de tejido y digestión con colagenasa. Los niveles de expresión de los genes relacionados con queloides α -SMA, Col1 y Col3 se evaluaron en células cultivadas usando ambos métodos, para verificar las cualidades de las células primarias. Se realizó un análisis comparativo entre los dos métodos y entre los tres tejidos diferentes utilizados. La contaminación de bacterias y lípidos se minimizó inmediatamente después de que se procesaron las muestras. Se requirieron varios métodos de eliminación de la epidermis y diferentes tiempos de digestión con colagenasa en los tejidos para generar resultados óptimos. Los resultados de la PCR en tiempo real mostraron que los niveles de expresión de ARNm de genes relacionados con queloides en fibroblastos cultivados se correlacionaban con su perfil de expresión in vivo, como se informó en estudios anteriores. Los resultados de este studio indicaron varios puntos clave en el cultivo de fibroblastos queloides primarios y han demostrado la correlación en la expresión génica entre fibroblastos queloides in vivo y fibroblastos queloides primarios in vitro.

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.

Reintroducción de la circuncisión como una técnica quirúrgica reconstructiva / Reintroduction of Circumcision as a Technique Reconstructive Surgical

La circuncisión es una cirugía practicada frecuentemente en urología. Sin tener en cuenta los principios básicos de la cirugía reconstructiva, puede generar procesos de cicatrización anómalos, con resultados estéticos y funcionales inadecuados, fimosis secundaria, cicatrización hipertrófica, queloide o "pene enterrado." El objetivo de este video es recordar la importancia de operar con las directrices de una cirugía reconstructiva, resaltando el cuidado de los tejidos y el uso de suturas de bajo calibre, para prevenir complicaciones y resultados insatisfactorios, resaltando la preservación de las zonas postuladas por Firlit. Se sospecha que las complicaciones de este procedimiento son subestimadas por los especialistas. El manejo cuidadoso de los tejidos, el uso de suturas de bajo calibre y los puntos subcuticulares con poca tensión, son medios para optimizar el proceso de cicatrización, evitando la isquemia y las cicatrices hipertróficas, basados en el fundamento de que esta es una cirugía no solo funcional, sino reconstructiva y estética. La circuncisión es un procedimiento que debe conservar la funcionalidad y estética del pene, por lo que debe ser realizado bajo las directrices de una cirugía

Circumcision is a frequently practiced surgical procedure in urology. Without considering the basic principles of reconstructive surgery, it can result in abnormal cicatrization processes, with inadequate aesthetic or functional results, secondary phimosis, hypertrophic or keloid scarring, or even "buried penis." The objective of this video is to remind the importance of operating with the principles of reconstructive surgery, highlighting the careful handling of tissues and the use of low-caliber sutures, to prevent complications and unsatisfactory results, preserving the areas postulated by Firlit. The complications of this procedure are suspected to be underestimated by specialists. Careful tissue management, the use of low-caliber sutures and subcuticular points with no tension are means to optimize the healing process, avoiding ischemia and hypertrophic scars, based on the fact that this is a surgery that is not only functional, but reconstructive and aesthetic as well. Circumcision is a procedure that must preserve the functionality and aesthetics of the penis and it must be performed under the principles of reconstructive surgery.

Recidiva de cicatriz queloide en pacientes tratados con resección quirúrgica más radioterapia / Keloid scar recurrence in patients treated with surgical resection plus radiotherapy

INTRODUCCIÓN. El proceso de cicatrización puede derivar en anomalías, que afectan el aspecto estético y funcional de la zona afectada; la combinación de tratamientos ha permi-tido resultados favorables. OBJETIVOS. Describir los factores que se dan en las recidivas de cicatriz queloide en pacientes tratados con resección quirúrgica más radioterapia. MA-TERIALES Y MÉTODOS. Estudio observacional, descriptivo y retrospectivo. Población de 2 960 Historias Clínicas, se tomó muestra de 100. Criterios de inclusión: diagnóstico de cicatriz queloide, edad de 12 a 75 años, combinación de tratamiento quirúrgico y radiotera-pia. Criterios de exclusión: edades fuera del rango, tratamiento diferente, en la Unidad de Plástica y Reconstructiva del Hospital de Especialidades Carlos Andrade Marín durante el período enero 2013 a diciembre 2019. Los datos fueron tomados del sistema AS400, el análisis se realizó en el programa estadístico International Business Machines Statistical Package for the Social Sciences, versión 22. RESULTADOS. La localización frecuente fue en el pabellón auricular con 83% (83; 100), de estos el 57% (57; 100) fueron poste-rior a perforación; la recidiva se presentó en el 24% (24; 100) y la principal complicación en los pacientes fue Radiodermitis. DISCUSIÓN. La evidencia científica guardó relación con el estudio referente a técnica, sexo, localización del queloide, causa y complicación. CONCLUSIÓN. Se pudo describir los factores que se dieron en las recidivas de cicatriz queloide en pacientes tratados con resección quirúrgica más radioterapia.

INTRODUCTION. The healing process can lead to anomalies, which affect the aesthe-tic and functional appearance of the affected area; the combination of treatments have allowed favorable results. OBJECTIVES. Describe the factors that occur in keloid scar recurrences in patients treated with surgical resection plus radiotherapy. MATERIALS AND METHODS. Observational, descriptive and retrospective study. Population of 2 960 Clini-cal Histories, a sample of 100 was taken. Inclusion criteria: diagnosis of keloid scar, age 12 to 75 years, combination of surgical treatment and radiotherapy. Exclusion criteria: ages outside the range, different treatment, in the Plastic and Reconstructive Unit of the Carlos Andrade Marín Specialty Hospital during the period January 2013 to December 2019. The data were taken from the AS400 system, the analysis was carried out in the program Sta-tistical International Business Machines Statistical Package for the Social Sciences, ver-sion 22. RESULTS. The frequent location was in the auricle with 83% (83; 100), of these 57% (57; 100) were after perforation; recurrence occurred in 24% (24; 100) and the main complication in patients was Radiodermatitis. DISCUSSION. The scientific evidence was related to the study referring to technique, sex, location of the keloid, cause and compli-cation. CONCLUSION. It was possible to describe the factors that occurred in keloid scar recurrences in patients treated with surgical resection plus radiotherapy.

Case for diagnosis. Keloidal cord-like lesion on the leg

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.

Cicatriz queloide gigante / Giant keloid scar

Introducción: La cicatriz queloide forma parte de las cicatrices patológicas por exceso; es una afección que se caracteriza por el depósito excesivo de colágeno en la dermis y tejido celular subcutáneo. El proceso por el cual se desarrolla no es del todo conocido, es más frecuente en la raza negra y afecta en igual proporción a hombres que mujeres. Objetivo: Informar a la comunidad médica sobre experiencia en el manejo y tratamiento con dos pacientes portadores de lesiones queloides de gran tamaño. Caso clínico: Se presentan dos pacientes con cicatriz queloide gigante a partir de ambos lóbulos auriculares y cuello anterior; se expone la conducta terapéutica basada en la combinación de tres modalidades de tratamiento: cirugía; infiltración con acetónido de triamcinolona, 1 ml (40 mg) desde el día del acto quirúrgico, se repitió cada 15 días; junto a presoterapia con crema esteroidea. Conclusiones: Aunque no existe un tratamiento ideal, se debe tener en cuenta al tratar esta enfermedad si se está ante una lesión recidivante, el tiempo de aparición de la tumoración, sus características clínicas; de seleccionarse el tratamiento quirúrgico como opción terapéutica, debe acompañarse de otras modalidades de tratamiento(AU)

Introduction: The keloid scar is part of the pathological scars by excess, is a condition characterized by the excessive deposit of collagen in the dermis and subcutaneous cell tissue, the process by which it develops is not entirely known, it is more frequent in the black race, affects in equal proportion men than women. Objective: To inform the medical community of the experience in handling and treating two patients with large keloid lesions. Clinical case: Two patients with giant keloid scars are presented from both earlobes and anterior neck where therapeutic behavior based on the combination of three treatment modalities is exposed: surgery, triamcinolone acetonide 1 ml (40mg) infiltration beginning on the first day after surgery, repeated every 15 days and pressotherapy with steroid cream. Conclusions: Although there is no ideal treatment, it should be taken into account when treating this disease if we are facing a recurrent injury, the time of onset of the tumor, its clinical characteristics, surgical treatment should be selected as a therapeutic option, accompanied by other forms of treatment(AU)

Tratamento para queloides: revisão de literatura / Treatment of keloids: a literature review

Introdução: Queloides surgem de resposta excessiva à lesão da derme, resultando em proliferação de fibroblastos, produção exagerada de colágeno e comprometimento da pele sadia adjacente. O diagnóstico é clínico e muitos métodos conservadores e cirúrgicos já foram utilizados para tratamento. Porém, dados da eficácia desses tratamentos são limitados e não há consenso na literatura quanto a melhor técnica a ser empregada, permanecendo uma lacuna que necessita ser preenchida, a fim de que seus usos sejam indicados com maior confiabilidade, em um modelo de medicina baseada em evidências. Métodos: Revisão não sistemática da literatura sobre "queloides" nas bases de dados PubMed, Scielo, MEDLINE, UptoDate e livros-texto das áreas de Dermatologia e Cirurgia Dermatológica. Revisão de Literatura: Foram enumeradas e abordadas as principais informações sobre técnicas cirúrgicas e adjuvantes empregadas para essas lesões, que são: excisão, injeções intralesionais, crioterapia, laserterapia, revestimento com gel de silicone, radioterapia e pressoterapia. Torna-se relevante o levantamento dessas informações, tendo em vista que, além de poder causar dor, prurido e restrição de movimento, o principal motivo da procura de assistência médica para queloide é devido ao aspecto cosmético/estético, e as taxas de reincidência e falha terapêutica ainda são altas, sendo necessário conscientizar o paciente sobre o procedimento e seus efeitos. Conclusão: São muitos os tratamentos disponíveis para o queloide, sejam cirúrgicos ou não, todavia não há consenso sobre uma abordagem universalmente aceita. São necessários mais estudos, com a finalidade de definir a melhor conduta e atingir melhores resultados, visto a qualidade mediana das evidências apresentadas nos estudos.

Introduction: Keloids are characterized by an abnormal response to dermal trauma, resulting in fibroblast proliferation, excessive collagen production, and impairment of adjacent healthy tissue. The diagnosis is clinical, and many conservative and surgical methods can be used as treatments. However, data on the efficacy of these treatments are limited, and there is no consensus regarding the best treatment option. This gap needs to be filled by developing comprehensive evidence-based therapies. Methods: A non-systematic literature review of keloid scars was carried out using PubMed, Scielo, MEDLINE, UptoDate, and dermatology and dermatological surgery textbooks. Literature review: The search retrieved relevant information on surgical and adjuvant therapies used for keloids, including excision, intralesional injections, cryotherapy, laser therapy, silicone gel sheeting, radiation therapy, and pressure therapy. These data are crucial because, in addition to complaints of pain, itching, and restriction of movement, the main reason for seeking treatment for keloids is for cosmetic and aesthetic improvement, and the rates of recurrence and treatment failure are high, emphasizing the importance of creating awareness regarding the available procedures and their effectiveness. Conclusion: Many surgical and adjuvant therapies for keloids are available. Nonetheless, there is no consensus on a universally accepted treatment. Therefore, additional high-quality studies are needed to identify the most effective therapeutic approaches to achieve better results.

Impacto do tratamento com laser fracionado de CO2 em cicatrizes hipertróficas e queloides: uma revisão sistemática / Impact of fractional CO2 laser treatment on hypertrophic scars and keloids: a systematic review

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.

Clinical efficacy of intermittent magnetic pressure therapy for ear keloid treatment after excision

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.