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a, b Preoperative findings of a handle-shaped keloid of the right helix, c, d postoperative result after 7 days, e postoperative result after 3 months wearing the pressure device, f postoperative result after 6 months
Source publication
Keloids are benign cutaneous lesions, arising from proliferating fibroblasts. Keloids of the ear may occur after trauma, surgery or helix piercings and are difficult to treat, since they tend to form recurrences. Guidelines suggest multimodal therapy; however, recurrence rates remain high and distinct algorithms for the combination of different mod...
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Background: Perineal keloids can have an overwhelming impact on patients’ lives including pain, skin breakdown, infection, and interference with intercourse. There is a paucity of literature addressing the effective treatment techniques. Cases: Three case of perineal keloid treatment, with at least 13-month follow up, are presented. All patients ar...
Citations
... Surgical excision should be performed on these patients. Preoperative, intraoperative and postoperative combined treatments can be applied with surgical excision [2][3][4]. ...
Purpose
Ear keloids lead to psychological problems in the patient by causing complaints, such as itching and swelling. It is highly resistant to treatment, and recurrences are frequent. In the present study, the purpose was to investigate the treatment success of the intralesional steroid and PRP combination in addition to surgical excision in ear keloids. The 5-year recurrence rates and adverse effects of both treatments were also compared in this respect.
Materials and methods
In this study, 60 patients between the ages of 16 and 65 who were followed up between 2015 and 2020 due to ear keloids were evaluated retrospectively. Patients were divided into 3 different groups (n = 20) as (A-B-C). There were patients who had only intralesional steroid injections due to ear keloids in Group A, patients who had intraoperative/postoperative steroid injections combined with surgical excision were in Group B, and patients who had intraoperative/postoperative steroid+intraoperative Platelet-Rich Plasma (PRP) injections combined with surgical excision were in Group C.
Results
It was found that the 5-year recurrence rate was the lowest in Group C (Surgical Excision+PRP + TAC). The 5-year recurrence rate of Group C was significantly lower when compared with other groups (p < 0.05). When the 5-year recurrence rate of Group A (TAC) and B (Surgical Excision+TAC) was compared, the recurrence rate of Group B was significantly lower (p < 0.05). When the adverse effects were compared, no significant differences were detected between two Groups (A-B) in terms of Skin Atrophy and Telangiectasia. Significant differences were detected between patients in Group C and other groups (p < 0.05). No significant differences were detected between Group B and C (p = 0.832).
Conclusion
The combination of surgical excision with Intralesional TAC and PRP treatment in patients with ear keloids should be considered as a highly successful multimodal treatment in terms of low recurrence and adverse effects.
... Surgical excision followed by other combination therapy is recommended at the least. However, the recurrence rate is still not low, ranging from 0% to 57% for ear keloids during follow-up of up to 48 months [22][23][24][25]. In this study, we demonstrated that the rate of recurrence of ear keloids was lower than that of other keloids and that the recurrence-free interval was longer than that of keloids at other sites during long-term follow-up. ...
Background
Recurrence rates of keloids have generally been reported at one time point. However, the longer the duration after treatment, the greater the likelihood that such lesions will recur. In this study, we analysed the time to recurrence during long-term follow-up.
Material and methods
We retrospectively reviewed recurrence-free interval in 52 patients with keloid (age 8–79 years) who had been treated between June 2006 and January 2011 using a standardised protocol developed by our group.
Results
Mean duration of follow-up was 37.5 (range, 7–120) months in patients with keloid. Kaplan-Meier survival curves revealed a statistically significant difference in recurrence-free interval between ear keloids and keloids excluding ear keloids. Recurrence rate for keloids was high in the first 2 years after treatment.
Conclusions
Kaplan-Meier analysis was useful for understanding the tendency of recurrence of keloids after treatment using a standardised protocol.
... Due to incomplete knowledge of the factors that stimulate and trigger the formation of abnormal scars, there are in the literature treatment methods, none of them being ideal for keloid management. They include intralesional injections of corticosteroids (IC), 5-fluorouracil, interferon alfa/gamma, bleomycin or verapamil, use of topical clobetasol, gel or silicone band, immunomodulators, retinoids and onion extract, cryotherapy, radiotherapy, use of earrings pressure, ligation of sessile keloids and pulsed light laser among others [6][7][8][9]. ...
Keloid scars are a particularly challenging fibroproliferative wound healing disorder with a variety of proposed management approaches including concurrent surgery and intralesional steroid injection. We aimed to identify the optimum time for triamcinolone injection of keloids, by comparing the recurrence and complication occurrence in patients who received pre-, intra- or post-operative injection. Studies reporting on the rate of recurrence and complication occurrence following treatment of keloid scarring with concurrent surgical excision and intralesional steroid injection were identified from the PubMed, Web of science and Embase databases. The I-squared (I2) statistic was used to quantify the variability in study estimates due to heterogeneity and to determine whether the fixed or random effect models will be employed. Publication bias was visualized through funnel plots and tested with the Egger’s test. We found that the recurrence rate was significantly lower with post-operative injection compared to intra-operative injection (p < 0.001) and pre-operative injection (p = 0.009). A significant difference between intra-operative and pre-operative injection was not found (p = 0.46). In conclusion, post-operative steroid injection after surgical excision results in lower keloid recurrence compared to pre- and intra-operative injection.
Level of Evidence IV “This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.”
Keloids belong to the group of fibroproliferative diseases and clinically often present with functional and cosmetic impairment of the patient, as well as with pruritus and pain. The pathogenesis of keloids has not been definitively clarified and treatment is often protracted and less than satisfactory. A variety of therapeutic options are available for treatment of keloids; however, the evidence base is small due to studies with low case numbers. Use of multimodal treatment concepts seems to be promising and has shown good results, especially in the treatment of auricular keloids.
Keloids belong to the group of fibroproliferative diseases and clinically often present with functional and cosmetic impairment of the patient, as well as with pruritus and pain. The pathogenesis of keloids has not been definitively clarified and treatment is often protracted and less than satisfactory. A variety of therapeutic options are available for treatment of keloids; however, the evidence base is small due to studies with low case numbers. Use of multimodal treatment concepts seems to be promising and has shown good results, especially in the treatment of auricular keloids.
Background:
Keloid formation occurs with increased incidence in African Americans and Afro-Caribbeans when compared with other ethnic populations. Although surgical management and nonsurgical management of keloids are mainstays of treatment, there are significant variations within studies comparing the efficacy of intraoperative steroid injection, postoperative radiotherapy, or a combination of both modalities. The purpose of our study is to evaluate the efficacy of different treatment modalities used for treatment of keloids and to determine their recurrence in a select Afro-Caribbean population.
Methods:
A retrospective review of the plastic surgery case list from January 2015 to October 2019 was conducted, with identification of 46 Afro-Caribbean and African American patients with 56 keloids. Each patient was contacted to determine whether they had experienced recurrence of their keloid(s). Eighteen patients were lost to follow-up, resulting in 28 patients with 35 keloids included in our study. The treatment protocol involved surgical excision for all keloids, with selective additional triamcinolone 40 mg/mL injection intraoperatively, immediate postoperative radiotherapy, or intraoperative triamcinolone injection with postoperative radiotherapy. Recurrence rates between the different treatment groups were calculated, and statistical analyses were performed using IBM SPSS Statistics, with a value of P < 0.05 deeming statistical significance.
Results:
Our study demonstrates that postoperative recurrence rates of primary and secondary keloids were 43% and 58%, respectively. Results of recurrence rate varied by specific treatment modality; keloid excision yielded a rate of only 54%, keloid excision with postoperative radiation yielded a rate of 83%, keloid excision with intraoperative triamcinolone injection yielded a rate of 33%, and keloid excision with a combination of intraoperative triamcinolone injection and postoperative radiation yielded a rate of 33%.
Conclusion:
Patients of Afro-Caribbean and African American ethnicity are more heavily affected by the formation of keloids compared with other population groups. Results of varying modalities for keloid management demonstrate that patients who received a combination of excision with intraoperative triamcinolone injection, with or without postoperative radiation, had the lowest recurrence rates compared with other treatment protocols including excision alone and excision with postoperative radiation only.
Background:
Research evaluating the efficacy of multimodal therapy for the treatment of keloids has reported combination regimens are most effective.
Objective:
To compare recurrence rates for keloids treated with surgery plus one adjuvant intervention (dual therapy) versus surgery plus 2 or more adjuvant interventions (triple therapy).
Materials and methods:
Systematic literature review and meta-analysis of combination treatment for keloids.
Results:
After full-text review, we included 60 articles representing 5,547 keloids: 5,243 received dual therapy, 259 received triple therapy, and 45 received quadruple therapy (the latter 2 groups were combined for analysis). The difference in recurrence rates between dual (19%) and triple therapy (11.2%) was not significant (p = .343). However, the difference in recurrence rates between dual therapy using surgery and radiation (18.7%) and triple therapy using surgery, radiation, and a third intervention (7.7%) was significant (p = .002). The differences for surgery and intralesional triamcinolone (TAC) showed trends toward significance, because keloids treated with dual therapy (21.7%) had a higher recurrence rate than those treated with triple therapy comprised of surgery, TAC, and another intervention (13.7%; p = .099).
Conclusion:
Triple therapy using surgery plus radiation and/or TAC as one of the adjuvant treatment modalities may achieve the lowest recurrence rates for keloids.
