Effect of the combination of photobiomodulation therapy and the intralesional administration of corticoid in the preoperative and postoperative periods of keloid surgery: A randomized, controlled, double-blind trial protocol study.

Keloid scars are characterized by the excessive proliferation of fibroblasts and an imbalance between the production and degradation of collagen, leading to its buildup in the dermis. There is no "gold standard" treatment for this condition, and the recurrence is frequent after surgical procedures removal. In vitro studies have demonstrated that photobiomodulation (PBM) using the blue wavelength reduces the proliferation speed and the number of fibroblasts as well as the expression of TGF-ß. There are no protocols studied and established for the treatment of keloids with blue LED. Therefore, the purpose of this study is to determine the effects of the combination of PBM with blue light and the intralesional administration of the corticoid triamcinolone hexacetonide on the quality of the remaining scar by Vancouver Scar Scale in the postoperative period of keloid surgery. A randomized, controlled, double-blind, clinical trial will be conducted involving two groups: 1) Sham (n = 29): intralesional administration of corticoid (IAC) and sham PBM in the preoperative and postoperative periods of keloid removal surgery; and 2) active PBM combined with IAC (n = 29) in the preoperative and postoperative periods of keloid removal surgery. Transcutaneous PBM will be performed on the keloid region in the preoperative period and on the remaining scar in the postoperative period using blue LED (470 nm, 400 mW, 4J per point on 10 linear points). The patients will answer two questionnaires: one for the assessment of quality of life (Qualifibro-UNIFESP) and one for the assessment of satisfaction with the scar (PSAQ). The team of five plastic surgeons will answer the Vancouver Scar Scale (VSS). All questionnaires will be administered one, three, six, and twelve months postoperatively. The keloids will be molded in silicone prior to the onset of treatment and prior to excision to assess pre-treatment and post-treatment size. The same will be performed for the remaining scar at one, three, six, and twelve months postoperatively. The removed keloid will be submitted to histopathological analysis for the determination of the quantity of fibroblasts, the organization and distribution of collagen (picrosirius staining), and the genic expression of TGF-ß (qPCR). All data will be submitted to statistical analysis. Trial registration: This study is registered in ClinicalTrials.gov (ID: NCT04824612).

Keloid negatively affects body image.

BACKGROUND/OBJECTIVES: Keloid is a healing disorder that occurs exclusively in humans. This pathology is considered a benign cicatricial neoplasm, whose physiopathogenesis has not yet completely clarified. Its disfiguring appearance often could potentially cause a disturbance in the patient regarding his/her body image. The objective is to evaluate the impact of keloid on body image. METHODS: 61 patients with keloid in socially exposed regions of the body were included. The participants were submitted to clinical evaluation, composed of anamnesis and physical examination, and answered two questionnaires: the Body Dysmorphic Symptoms Scale (BDSS) questionnaire and the Rosenberg Self-Esteem Scale - Unifesp/EPM. RESULTS: Forty percent of the patients had negative aspects of body image (BDSS score≥6). The scores of these patients on the Rosenberg Scale reached an average of 10.5 (p<0.03). CONCLUSIONS: The presence of a keloid negatively affects body image.

Psychological stress as a risk factor for postoperative keloid recurrence.

OBJECTIVE: To investigate psychological stress on the prognosis of the postoperative recurrence of keloids. METHODS: Patients with keloids (n=25), candidates for surgical resection and postoperative radiotherapy, had their psychological stress evaluated on the day before the surgical procedure. The parameters evaluated were pain and itching (Visual Numerical Scale), quality of life (Questionnaire QualiFibro/Cirurgia Plástica-UNIFESP), perceived stress (Perceived Stress Scale), depression and anxiety (Hospital Depression and Anxiety Scale), salivary cortisol and minimum and maximum galvanic skin responses (GSR) at rest and under stress (i.e., while the questionnaires were being filled out). Patients were evaluated during the 3rd, 6th, 9th and 12th months of postoperative care. During each return visit, two experts classified the lesions as non-recurrent and recurrent. RESULTS: The recurrence group presented the greatest values in GSR during a stressful situation. The chance of recurrence increased by 34% at each increase of 1000 arbitrary units in maximum GSR during stress. CONCLUSION: Psychological stress influenced the recurrence of keloids.

What factors affect the quality of life of patients with keloids?

OBJECTIVE: To evaluate factors that affect the quality of life (QoL) of patients with keloids. METHODS: A study was conducted on 102 patients of both genders between 15 and 70 years old. During initial evaluation, clinical factors, such as keloid visibility, duration and evolution of the disease, previous treatments, types of treatments and recurrence were recorded. Later, patients responded to the QualiFibro questionnaire, which is specific for evaluation of the QoL of patients with keloids and comprises the physical and psychological domains, and six visual numeric scales (VNS), of which three are related to psychological factors (satisfaction with appearance, shame of the disease, and suffering experienced), and the other three are related to physical factors (pruritus, pain and movement restriction). RESULTS: Patients with keloids on non-visible areas of the body (p<0.01) and more than 10 years of disease (p<0.049) reported higher scores on the physical domain of the QualiFibro questionnaire, indicating increased severity compared with patients with keloids on visible areas of the body and disease duration of less than 10 years. There was a positive correlation between psychological (satisfaction with appearance, feelings of embarrassment about the disease and suffering experienced) and physical factors (pruritus, pain and movement restriction) evaluated using the VNSs, and both domains of the QualiFibro questionnaire. CONCLUSION: Results indicate that the physical domain of the QualiFibro questionnaire was the most affected in patients with keloids on non-visible areas and in those with keloids for more than 10 years. Psychological and physical factors associated with keloids as assessed with the VNS affected both psychological and physical domains of QoL.

What factors affect the quality of life of patients with keloids? / Quais fatores realmente afetam a qualidade de vida dos portadores de queloide?

OBJECTIVE: To evaluate factors that affect the quality of life (QoL) of patients with keloids. METHODS: A study was conducted on 102 patients of both genders between 15 and 70 years old. During initial evaluation, clinical factors, such as keloid visibility, duration and evolution of the disease, previous treatments, types of treatments and recurrence were recorded. Later, patients responded to the QualiFibro questionnaire, which is specific for evaluation of the QoL of patients with keloids and comprises the physical and psychological domains, and six visual numeric scales (VNS), of which three are related to psychological factors (satisfaction with appearance, shame of the disease, and suffering experienced), and the other three are related to physical factors (pruritus, pain and movement restriction). RESULTS: Patients with keloids on non-visible areas of the body (p<0.01) and more than 10 years of disease (p<0,049) reported higher scores on the physical domain of the QualiFibro questionnaire, indicating increased severity compared with patients with keloids on visible areas of the body and disease duration of less than 10 years. There was a positive correlation between psychological (satisfaction with appearance, feelings of embarrassment about the disease and suffering experienced) and physical factors (pruritus, pain and movement restriction) evaluated using the VNSs, and both domains of the QualiFibro questionnaire. CONCLUSION: Results indicate that the physical domain of the QualiFibro questionnaire was the most affected in patients with keloids on non-visible areas and in those with keloids for more than 10 years. Psychological and physical factors associated with keloids as assessed with the VNS affected both psychological and physical domains of QoL.

OBJETIVO: Avaliar quais fatores influenciam a qualidade da vida (QV) dos portadores de quelóide. MÉTODOS: Estudo envolvendo 102 pacientes, de ambos os gêneros, com idade entre 15 e 70 anos. Na avaliação inicial, os fatores clínicos referentes à visibilidade do queloide, tempo de evolução da doença, tratamento prévio, tipos de tratamento e recidiva foram catalogados. Posteriormente, os pacientes responderam ao questionário QualiFibro, composto pelos domínios físico e psicológico, específico para avaliar a QV dos portadores de quelóide, e a seis escalas visuais numéricas (EVN), sendo três escalas em relação a fatores psicológico (satisfação com a aparência, vergonha da doença e sofrimento vivenciado), e três escalas em relação a fatores físicos (prurido, dor e restrição de movimentos). RESULTADOS: A pontuação do domínio físico do questionário QualiFibro foi maior para os portadores de queloide em região não-visível (p<0,01) e com tempo de evolução maior que 10 anos (p<0,049), refletindo piora em relação aos portadores com queloide em região visível e com tempo de evolução de doença menor que 10 anos. Houve correlação positiva entre os fatores psicológico (satisfação com a aparência, vergonha da doença e sofrimento vivenciado) e físicos (prurido, dor e restrição de movimentos) avaliados pelas EVN's e ambos os domínios do questionário QualiFibro (p<0,01). CONCLUSÃO: O domínio físico do questionário QualiFibro foi pior nos portadores de quelóide não-visível e naqueles com duração maior que 10 anos. Os fatores psicológicos e físicos das EVN's, implicados ao queloide, afetaram tanto o domínio físico quanto o domínio psicológico da QV.

Crippling giant keloid

Keloids occur commonly in dark-skinned races on the face, the neck and the front thorax. One such patient, a Negro man aged 50, in whom an unusually large tumour-like keloid caused disability, disfigurement and social seclusion, was seen at University Hospital of the West Indies. He was wheeled into the surgical clinic supporting in his lap a large mass wrapped in dressing, hanging from his chin. He was unable to move his head sideways because of the heavy object dragging on his neck (AU)