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Background Recently, pulsed dye laser (PDL) combined with triamcinolone intralesional injection (TAILI) has been introduced for surgical scar prevention. However, little is known about this procedure's effectiveness in preventing hypertrophic scar following surgical scar removal. Objectives This study aimed to evaluate the outcome of early intervention using PDL combined with TAILI after surgical removal of hypertrophic cesarean section (CS) scars. Methods The medical records of 35 patients who underwent early intervention using PDL and TAILI after removal of hypertrophic CS scars were retrospectively reviewed. The scars' average Vancouver Scar Scale (VSS) scores before scar removal and three months after the final treatment were compared. Results The patients received 4.23 treatments on average and were followed up for a mean period of 7.74 months. The mean final VSS was 3.11 ± 1.52 and was significantly lower than that of the previous VSS (9.29 ± 1.74, P = 0.000). VSS of the previous CS scar, and the presence or absence of keloid formation in other areas, were associated with treatment outcome (P = 0.003 and 0.008, respectively). Conclusions Early intervention using PDL combined with TAILI could prevent the recurrence or progression of hypertrophic CS scarring after surgical scar removal.

Keloid is a skin disease characterized by fibrous hyperplasia, which is often difficult to cure. Long non-coding RNAs (lncRNAs) have been shown to be associated with the development of many diseases. However, the role and mechanism of lncRNA H19 in keloid has been less studied. Our study found that lncRNA H19 expression was increased in keloid tissues and fibroblasts. Besides, H19 knockdown hindered the proliferation, migration, invasion, extracellular matrix (ECM) deposition, and enhanced the apoptosis of keloid fibroblasts. Further experiments showed that microRNA (miR)-769-5p could be sponged by H19, and its knockdown reversed the suppression effect of H19 knockdown on keloid formation. Eukaryotic initiation factor 3A (EIF3A) was found to be a target of miR-769-5p, and its overexpression inverted the inhibition effect of miR-769-5p overexpression on keloid formation. Moreover, the expression of EIF3A was regulated by H19 and miR-769-5p in keloid fibroblasts. Collectively, LncRNA H19 might play an active role in keloid formation, which might provide a new target for the treatment of keloid.

The wound healing process involves three continuous stages. Where, any imbalance can lead to the formation of unwanted keloids, hypertrophic scar, or tumors. Keloids are any unpleasant, non-compliant comorbidity affecting a major section of people around the globe who acquire it either genetically or by pathological means as a result of a skin injury. Angiogenesis is unavoidable in the healing process after an injury or disruption of skin to promote tissue regeneration. Uncontrolled angiogenesis during the healing process can initiate the unwanted response in the wound that facilitate keloid. Angiogenic therapy is adapted to accelerate healing after an injury. Else ways, there exists a risk of keloid formation due to excessive angiogenesis during the wound healing process. There are numerous strategies to treat keloid. Anti-angiogenic factors are provided to patients post-surgery to prevent the keloid formation; however, they come into the picture after the formation of keloid. The available strategies to treat keloids are steroidal injections, surgical excision of the keloid, radiotherapy, pressure therapy, the use of cryosurgery, and many more. The available treatments are not promising in reducing the recurrent rate of keloids as there are chances of high re-occurrences with similar/larger lesions on the removed keloid site. In this review, we are discussing the importance of controlled angiogenesis with the help of controlled drug delivery strategies enabling the wound healing process without the induction of keloid.

Background We developed an easy and minimally invasive method of transmeatal tympanoplasty using meatal areolar tissue (MAT) grafts to achieve less postoperative morbidity or surgical scarring. We compared the functional and anatomical results of the developed method with conventional endaural tympanoplasty with a temporalis fascia (TF) graft. Methods In this retrospective cohort study, 58 patients (59 ears) with simple chronic otitis media who underwent type I tympanoplasty between January 2016 and August 2018 were included. All surgeries were performed in a tertiary referral hospital and by the same senior surgeon. The tympanic membrane (TM) was repaired with either a TF or an MAT graft. Results Healing of the perforated TM and improvement in a hearing test by air-bone gap (ABG) closure were identified. Postoperative wound conditions were also evaluated. Twenty-eight ears were grafted with MAT, and 31 ears were grafted with TF. Graft success was observed in 26 patients (92.9%) in the MAT group and 28 patients (90.3%) in the TF group. Both groups showed functional improvement compared with the preoperative measurements. The postoperative pure tone audiogram (p = 0.737), ABG closure (p = 0.547), and graft success rate (p = 0.726) were not significantly different between the two groups. Neither wound dehiscence nor keloid formation was observed in our patients. Conclusion Both MAT and TF grafts revealed satisfactory surgical and functional results. Compared with the conventional endaural approach with TF grafts, the new transmeatal approach method with an MAT graft causes relatively minimal trauma and results in better wound cosmetics. This method represents an easy, minimally invasive surgery and shows comparatively good results.

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 are African American females who were recommended a treatment plan that combined surgical wide local excision and radiation therapy. All patients had aesthetically acceptable outcomes with recurrence-free results at least 13-months post procedure. Conclusions: These three cases describe the successful treatment of perineal keloids that utilize a combination of surgical excision with targeted radiotherapy. This approach can be offered to patients with recurrent keloidal masses and the presented principles can be utilized to achieve recurrence-free results. Teaching Points: 1. Readers will understand the basics of the pathophysiology of keloid formation and their effect on patients who experience them in sensitive areas such as the mons, vulva, and/or lower abdomen. 2. Readers will be able to describe and implement the described technique for management of keloids in these potentially sensitive areas.

Keloids are a type of scar, which is the result of overgrowth of dense fibrous tissue that usually develops after healing a skin injury. Keloids occur due to prolonged inflammatory phases in the wound, resulting in increased fibroblast activity and continuous extracellular matrix formation. Gotu kola (Centella asiatica) leaves are effective in the treatment of wounds because they contain Triterpene components such as asiatic acid, madecassic acid, asiaticoside and madecassoside. The purpose of this literature review is to report the latest scientific findings on the role of gotu kola leaf content in preventing keloid formation by increasing fibroblast proliferation, increasing collagen synthesis and mucopolysaccharide acids, increasing intracellular fibronectin which then significantly increases the tensile strength of newly formed skin, inhibiting the phases of the formation of skin, inflammation of the keloid scar tissue. The method used in this article is article search through the NCBI database and Google Scholar. The year of publication of library resources is from 1999 to 2018 with 20 sources of literature. The theme collected was related to the Centella asiatica leaf content towards the wound phase to prevent keloid formation. The results of the synthesis of articles that have been found are gotu kola leaves can inhibit the formation of keloids in wounds. Keywords: gotu kola leaf, keloid, wound

Background A few reports on scar and keloid formation in patients receiving systemic isotretinoin have encouraged a conservative approach in which laser procedures are delayed during and 6 to 12 months after the completion of treatment. Objective To assess the safety of laser hair removal with alexandrite, diode, and Nd:YAG lasers in patients receiving systemic isotretinoin treatment. Materials and methods Fifty-two patients who underwent laser hair removal during isotretinoin treatment were retrospectively analyzed and compared with a control group for side effects. Results There were 48 female and 4 male patients. The average isotretinoin dose was 33.7 mg/d. The average interval between the start of isotretinoin treatment and the first laser hair removal was 39.3 days. The mean number of sessions under treatment was 4.1. Three patients had temporary crusting, and 1 patient had a small area of temporary hypopigmentation. Five (9.6%) patients in the control group had crusting. The incidence of side effects was not significantly different between the 2 groups (p > .05). Neither patients in the isotretinoin group nor those in the control group experienced blistering, pigmentation, ulceration, and scar or keloid formation. Conclusion Laser hair removal is a safe procedure with alexandrite, diode, and Nd:YAG lasers in patients receiving systemic isotretinoin.

Keloids are disfiguring, hypertrophic scars with yet poorly understood pathomechanisms, which could lead to severe functional impairments. Here we analyzed the characteristics of keloidal cells by single cell sequencing and discovered the presence of an abundant population of Schwann cells that persisted in the hypertrophic scar tissue after wound healing. In contrast to normal skin, keloidal Schwann cells possess a repair-like phenotype and high cellular plasticity. Our data support the hypothesis that keloidal Schwann cells contribute to the formation of the extracellular matrix and are able to affect M2 polarization of macrophages. Indeed, we show that macrophages in keloids predominantly display a M2 polarization and produce factors that inhibit Schwann cell differentiation. Our data suggest a contribution of this cross-talk to the continuous expansion of keloids, and that targeting Schwann cells might represent an interesting novel treatment option for keloids.

Keloid scars result from excess collagen deposition in the dermis or subcutaneous tissue in response to surgery or tissue trauma. The penis is a rare site for keloid formation, even in predisposed individuals. Only few cases of penile keloids have been reported so far. In this report, we present penile keloids complicating neonatal circumcision in twin brothers. Risk of recurrence in previous reports and measures to guard against its occurrence are also discussed.

Current understanding of steroid treatments for keloids is in regards to modulation of inflammation, proliferation, and apoptosis, with no in vivo study on the latter. Using a nude mouse model, we investigated whether triamcinolone acetonide (TA) injections induce keloids regression through enhancing apoptosis.Thirty-six keloid specimens (1 × 1 cm) were harvested from 6 patients and separated into sets of 2 from the same patient: no treatment and intralesional TA injection (0.4 mg/mL/kg) at 8 weeks of postimplantation. One set was implanted in each of 18 randomly selected nude mice, which were separated into 3 groups based on time of keloid harvesting after treatment: group A, 2 weeks; group B, 8 weeks; and group C, 14 weeks. Each group had 1 set of specimen from each patient. Histological staining was performed with hematoxylin and eosin stain. Immunohistochemistry staining was performed for human-prolyl 4-hydroxylase (hPH4) and caspase 3 protein, along with terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay.All keloid specimens survived, with no noted overgrowth. Hematoxylin and eosin staining revealed dense extracellular matrix and viable fibroblasts, and hPH4 immunohistochemistry revealed strong expression, demonstrating keloid viability. Caspase 3 protein and TUNEL expressions were significantly increased in the treatment versus control groups, demonstrating that TA injections induced apoptosis.Triamcinolone acetonide intralesional injections significantly increased apoptosis in keloids, represented by increased caspase 3 protein and TUNEL expressions, supporting that steroids suppress keloids in part owing to enhancement of apoptosis.

Keloid formation involving ears is commonly encountered in medical practice. There are variable treatment options with different outcomes particularly on recurrence. With treatment, there might be complications with varying severity. One of the commonest preferred treatment is intralesional steroid injection using triamcinolone acetonide (TCA). We encountered a complication of intralesional TCA injection when a patient who had an ear keloid developed gangrenous keloid involving the pinna after receiving a TCA injection that required surgical debridement. We believe such a complication has been underreported. We reviewed the literatures to highlight the complications following TCA injection of ear keloid.

Introduction: Helical rim keloids occur commonly following ear piercings, trauma and previous surgeries and can be disfiguring. Many techniques have been developed to treated these disfiguring lesions with varying successes, however, individuals prone to developing keloids inadvertently recur despite best efforts. Objective: To determine whether helical rim advancement flap reconstruction following helical rim keloid excision can reduce recurrences. Design: Case series followed up to 2 years. Setting: Single Centre Tertiary Hospital Facial Plastics Service. Participants: All patients who consented to helical rim advancement reconstruction after keloid excision. Results: The authors report a series of 7 patients with helical rim keloids ranging from 1.2 cm to 5 cm in widest diameter treated with keloid excision and reconstruction with helical rim advancement flap technique. There were no recurrences within a mean of about 19 months post-operatively. Most patients report satisfaction with the cosmetic end-result. Discussion: From the authors’ experience, helical rim advancement reconstruction following excision of keloids about 2.5 cm in widest diameter is an excellent tension-free option to avoid recurrence of helical rim keloids. Wound tension is a key risk factor for keloid formation. We hypothesise that the reason why there was no recurrence is because in helical rim advancement flap reconstruction, the underlying helical rim takes all the tension of closure off the dermis, resulting in tension-free skin closure. Conclusion: Helical rim advancement flap reconstruction is a viable technique to avoid recurrence and minimise cosmetic deformities of the pinna for selected helical rim keloids. Keywords: Keloid, Ear, Pinna, Advancement flap, Antia-Buch

The role of genetic factors in keloid is a firmed by the fact that keloids have been shown to occur among members of the same family.. We undertook this study to determine whether there is any association between patients’ bloodgroup and HLA sub-types to keloids and keloid recurrence. This was a prospective longitudinal study of patients with keloids and a control of patients managed for other surgical conditions with no keloids. Blood was taken from each patient and analysed for blood group and HLA sub-types using the sequence specific primer geno-typing. Data captured were summarized and analysed using students T-test to compare means. Probability values significance was at 0.05. A total of 90 patients with keloids and 59 in a control group were followed up in the study. The male to female ratio of the patients was 2:1. The most common blood group for both groups was blood group O at 51.3% and 49.2%, followed by blood group A and B respectively. Patients with keloids had a significantly higher positive alleles with DQA*01, DQB1*05, DQB1*06 and DRB1*15. There was an association between blood group A and DQB1*06 and recurrence. In conclusion, this study demonstrates that there is significant difference in HLA sub-types among patients who form keloids and the non-keloid forming patients among our study cohorts. Salient differences were also noted in patients with keloid recurrence based on their blood group, a pointer to the significance of genetic factors in keloid pathogenesis and severity.

Hypertrophic scar (HS) and keloid are fibroproliferative disorders (FPDs) of the skin due to aberrant wound healing, which cause disfigured appearance, discomfort, dysfunction, psychological stress, and patient frustration. The unclear pathogenesis behind HS and keloid is partially responsible for the clinical treatment stagnancy. However, there are now increasing evidences suggesting that inflammation is the initiator of HS and keloid formation. Interleukins are known to participate in inflammatory and immune responses, and play a critical role in wound healing and scar formation. In this review, we summarize the function of related interleukins, and focus on their potentials as the therapeutic target for the treatment of HS and keloid.

Background Poor cosmesis, secondary to keloid or hypertrophic scar, following thyroid surgery may cause considerable patient distress and be a significant challenge to treat. In this case series we examined the efficacy of prophylactic external beam radiation therapy (EBRT) for prevention of keloid formation in keloid-prone patients undergoing thyroid surgery. While much has been published about documenting the efficacy in reducing keloid formation following keloid excision, very little literature exists documenting prophylactic use related to surgeries with the goal of prevent de novo keloid formation. Methods We retrospectively evaluated a series of ten patients, who underwent a prophylactic EBRT for keloid prevention after thyroid surgery between January 2013 and February 2019. Patient demographics, primary diagnosis, surgical procedure, EBRT dosage, and post-operative visit records were reviewed. Results All ten patients who received EBRT for keloid prophylaxis following a thyroid surgery were female. Half of the patients were African Americans, 40% Caucasians, and 10% Hispanic. The mean age was 46.40±15.63 years with BMI of 31.5±5.5 kg/m2. Radiation was initiated within 6 hours of the surgery with an average radiation dose per session of 5.7±1.7 Gy. The total average EBRT dose delivered was 17.4±4.2 Gy. Mean follow-up period was 13 months post-thyroidectomy, with the longest follow-up at 23 months. One patient, who underwent a lateral neck dissection in addition to thyroid surgery, developed hypertrophic scar in less than 10% of her incision length. Nine other patients (90%) showed no post-surgical keloid nor hypertrophic scar formation and patients were satisfied with postsurgical cosmesis. Conclusions We examined the efficacy of prophylactic EBRT in keloid-prone patients undergoing thyroid surgery. Prophylactic EBRT following thyroid surgery is effective in achieving a satisfactory cosmetic outcome in patients at high risk for keloid formation.

Sprengel deformity is a rare congenital anomaly of the pectoral girdle of unknown incidence. Surgical intervention is indicated in moderate to severe cases having functional and cosmetic impairment. Various surgical corrective procedures have evolved over the past decades, however the extensive magnitude of some of the surgical techniques have sometimes resulted in an unwarranted worse outcome due to associated complications like brachial plexus palsy, scapular winging, sternoclavicular joint prominence, improper scar healing and keloid formation which restrict such procedures to experienced hands at few centres. We report a case of Cavendish grade 3 Sprengel deformity in a five-year-old boy managed with a minimally aggressive modified technique of preserving the trapezius and restricting the surgery to excision of omovertebral bar and supraspinatous part of scapula by a transverse incision overlying the spine of scapula. In Sprengel deformity, the trapezius attached to the elevated scapula is underdeveloped and the technique of retraction instead of detachment of this muscle during surgery, can prevent scar adhesions and improve wound healing. In our patient, satisfactory cosmetic correction and good functional shoulder movements were achieved with minimal intervention.

Keloids are fibroproliferative dermal tumors of unknown origin that are characterized by the overabundant accumulation of extracellular matrix (ECM) components. The mechanism of keloid formation has remained unclear because of a poor understanding of its molecular basis. In this study, the dermal ECM components of keloids were identified and the pathological features of keloid formation were characterized using large-scale quantitative proteomic analyses of decellularized keloid biomatrix scaffolds. We identified a total of 267 dermal core ECM and ECM-associated proteins that were differentially expressed between patients with keloids and healthy controls. Skin mechanical properties and biological processes including protease activity, wound healing, and adhesion were disordered in keloids. The integrated network analysis of the upregulated ECM proteins revealed multiple signaling pathways involved in these processes that may lead to keloid formation. Our findings may improve the scientific basis of keloid treatment and provide new ideas for the establishment of keloid models.

Keloids are caused by an imbalance between collagen matrix decomposition and production during wound repair. Spontaneous keloids are a rare type of keloid that arise without a significant history of trauma or surgery. We herein report a case involving a 59-year-old woman with symmetric neoplasms at the bilateral labia majora that had persisted for about 3 years and a >10-year history of pruritus and pain at the bilateral labia majora with folliculitis. The bilateral labia majora gradually swelled and lost their normal physiological morphology. The patient was diagnosed with keloids. Under general anesthesia, the keloids were resected. The right incision was sutured directly and the left was closed using an inguinal flap. Adjuvant radiotherapy was administered after the surgery. No recurrence of the keloids was observed at the 1-year follow-up, and the patient was satisfied with the appearance of the vulvar region. This is the first report of spontaneous symmetrical giant keloids at the bilateral labia majora, and it emphasizes the importance of the effect of abnormal inflammation on keloid formation. Repairing genital defects using an inguinal flap has only a minor effect on the patient’s postoperative movement, and an ideal vulvar appearance can be achieved.

It is generally believed that intervention on skin while on isotretinoin or within 6 to 12 months after treatment can lead to prolonged healing and abnormal scarring. The objective of this systematic review is to evaluate the body of evidence on concomitant use of isotretinoin and lasers for adverse events as a consequence of treatment. A PRISMA-compliant systematic review (Systematic Review Registration Number: CRD42017056492) of 12 electronic databases was conducted for the terms "laser" and "isotretinoin" or associated brand names from inception until June 2020. Subsequent reference search of studies meeting predefined inclusion criteria were conducted, and all articles were evaluated for bias and assigned levels of evidence to facilitate data synthesis. The search strategy produced 29 studies. Of 871 patients included in the studies of interest, 12 experienced transient adverse effects that resolved spontaneously, and only two presented with keloid formation, both from case reports. This systematic review suggests the risk associated with concomitant isotretinoin and laser use is small to absent. Further studies are needed, but these results suggest that current contraindications may be overly cautious.

This study aimed to identify long non-coding RNAs (lncRNAs), microRNAs (miRNAs), and messenger RNAs (mRNAs) differentially expressed (DE) during keloid formation, predict DElncRNA-DEmiRNA-DEmRNA interactions, and construct a competing endogenous RNA (ceRNA) network through secondary data mining of keloid-related sequencing and microarray data in the open-source Gene Expression Omnibus (GEO) database. The GSE113621 dataset was downloaded from the GEO database, |log2FC|>1 and p 0.95 was selected as the index to predict the targeting relationships among lncRNAs, miRNAs, and mRNAs; and a network diagram was constructed using Cytoscape. The expression of 2356 lncRNAs was changed in the keloid-prone group—1306 were upregulated and 1050 were downregulated. Six lncRNAs, namely, 2 upregulated (DLEU2 and AP000317.2) and 4 downregulated (ADIRF-AS1, AC006333.2, AL137127.1 and LINC01725) lncRNAs, were expressed only in the keloid-prone group and were used to construct a ceRNA network. DLEU2 may regulate fibroblast proliferation, differentiation, and apoptosis through hsa-miR-30a-5p/hsa-miR-30b-5p. In-depth mining of GEO data indicated that lncRNAs and a ceRNA regulatory network participate in the wound healing process in keloid-prone individuals, possibly providing novel intervention targets and treatment options for keloid scars.

Keloid and hypertrophic scar formation after orthopaedic surgical closure is a complex issue. The nature and location of procedures maximize wound tension, leave foreign bodies, and diminish dermal supply, all potentiating keloid formation. There is little discussion regarding the pathophysiology and management of this recurrent problem in orthopaedic literature. Keloid formation is a fibroproliferative disorder resulting in extensive production of extracellular matrix and collagen, but prevention and treatment is poorly understood. Patient and surgical factors contributing to the development of this condition are discussed. The treatments include both medical and surgical therapies that work at a biologic level and attempt to produce a cosmetic and complication-free management strategy. Medical options that have been investigated include combinations of intralesional steroid therapy, laser therapy, and biologics. Preventive surgical closure and excision remain mainstays of treatment. Radiation therapy has also been used in refractory cases with mixed results. Despite medical therapies and surgical excision aimed at treating the resulting scar, recurrence rate is very high for all modalities that have been studied to this point. Future work is being done to better understand the pathophysiology leading to keloid and hypertrophic scar formation in an effort to find preventive methods as compared to treatment strategies.

Background: AnbarNesa smoke is used to treat skin ulcers and many inflammatory conditions in Iranian traditional medicine. Avicenna used it to treat vaginitis and uteritis and named it Anbar (smoke) Nesa (women). Objectives: The current study aimed at applying the smoke in modern medicine; since it was not soluble in water or in alcohol, it was solved in propylene glycol and the new product called ANNAS. Then the wound healing activity of ANNAS was examined on the incisional wounds created on the dorsum of male Wistar rats. Methods: By means of biopsy punch, two full-thickness incisions were made on different sides of the rats’ vertebral column and treated daily by one drop of ANNAS or propylene glycol randomly. The wounds were excised on days 14 and 21; then stained with anti-SMA antigen for myofibroblast cell detection. The myofibroblasts were counted at the surface and deep layers of the dermis as indicators of wound scar by optical microscopy. Results: The obtained results showed that the number of myofibroblasts was significantly lower in surfaces and deep layers of the dermis and, consequently, in the entire dermis of lesions treated with ANNAS compared to the ones treated with propylene glycol on days 14 (P < 0.002) and 21 (P < 0.0001). Conclusions: It seems that AnbarNesa decreases keloid formation and prevents scar creation. Besides, hair follicles, dermal appendages, and sebaceous glands were also observed on day 21 in lesions treated with ANNAS, which was a novel finding reported for the first time and could be a proof for the acceleration of wound healing by the invented drug, ANNAS.

Chapter 8 is dedicated to the topic of controlled and uncontrolled responses to trauma, that is, wound healing and polytrauma, a topic that has been experiencing a paradigm change of medical thinking during the past 15 years. At first, the DAMP-promoted wound healing process as a classical homeostatic defensive function of the innate immune system, as well as its dysregulation in the form of keloid formation and chronic, nonhealing wounds is presented. The theme is followed by a burning topic of intensive care medicine, the polytrauma that, in its modern pathogenetic interpretation, is characterized by two emerging models that are proposed and discussed in detail. The first model refers to severe trauma-induced emission of DAMPs in excess, which trigger hyperinflammatory pathways known as systemic inflammatory response syndrome (SIRS), most often associated with multiple organ dysfunction/failure. The second tentative but clinically still unproven model refers to severe trauma-induced emission of suppressing DAMPs (SAMPs) in excess, which—by operating in parallel, only slightly delayed—may trigger counterbalancing hyperinflammation-resolving/immunosuppressive pathways known as compensatory antiinflammatory response syndrome (CARS), often associated with increased susceptibility of patients to infections. The various DAMPs and putative SAMPs so far reported to be involved in these two scenarios are described in detail. Finally, the emerging field of DAMPs and SAMPs in diagnosis, prognosis, and therapy in severely traumatized, acutely critically ill patients is discussed by focusing on a theoretical framework in the future exploitation of DAMPs and SAMPs as therapeutic targets in polytrauma.

We aimed to explore potential molecular basis of keloid formation and response mechanism of keloid to hydrocortisone (HC).Transcriptional profile of GSE7890 which contained five normal scars with no HC treatment (NNHC), four normal scars treated with HC (NHC), five keloids with no HC treatment (KNHC), and five keloids treated with HC (KHC) samples was downloaded to identify differentially expressed genes (DEGs). Based on DEGs, hierarchical cluster analysis and pathway enrichment analysis were performed. Then, identification of characteristic pathway was performed, followed by calculation of pathway deviation score.Compared to NNHC group, total 1603 DEGs in NHC group, 895 DEGs in KHC group, and 832 DEGs in KNHC group were identified. Hierarchical cluster analysis revealed these four groups could be well distinguished. Total three pathways included cytokine-cytokine receptor interactions were significantly different between KNHC and NNHC groups. Besides, MAPK signaling pathway, endocytosis, and apoptosis were selected between KHC and KNHC groups. Genes of vascular endothelial growth factor C (VEGFC), tenascin C (TNC), and jun proto-oncogene (JUN) were selected as important DEGs in KHC, KNHC, and NHC groups, respectively.VEGF and TNC were, respectively, involved in KHC and KNHC in the mechanism of focal adhesion. JUN might be a potential molecular marker related to normal scar.

Although penile keloid formation can be seen after major penile surgeries, it is rarely reported after circumcision and there is no standard method for the treatment of this complication. We present a patient who was admitted with a penile keloid mass that occurred after circumcision surgery and discuss the treatment we administered in light of the current literature review. A 7-year-old white boy was admitted to our clinic with a swollen stiff mass on the foreskin six months after circumcision. The parents indicated that no complication occurred in the early postoperative period. Physical examination revealed a white-colored stiff mass measuring approximately 2×1.5 cm in size along the penile ventral surface. Intralesional injection of 0.5 ml triamcinolone acetonide was administered for 12 weeks. At 9 months after circumcision, the keloid tissue was resected. Beginning from the first postoperative week, a silicone gel sheet and topical steroid application were administered for 8 weeks. At a 1-year follow-up, the penis had a satisfactory appearance.

Isotretinoin is a first generation retinoid with pleiotropic effects on keratinocyte differentiation, proliferation, and activity of sebaceous glands. For years, there has been intense debate on whether the use of isotretinoin combined with cosmetic or surgical procedures is safe and potentially more efficient than either therapy alone. Due to delays in wound healing and keloid formation, conservative recommendations were not to combine isotretinoin with any plastic surgery or local treatment at 6 to 12 months after discontinuation of the drug. However, there is increasing evidence that a combination approach is not only safe, but may also provide excellent cosmetic outcomes in acne scars, sebaceous gland hyperplasia, and thick-skinned patients undergoing facial plastic surgery. In particular, low-dose regimens of isotretinoin may offer advantages over standard dosage treatments because of better tolerability and safety in long-term use adjunct with surgical interventions. In this article, the authors aim to summarize the current evidence on the use of isotretinoin in facial plastic surgery and to share their experience from selected patients.

Background:. Keloid formation after syndactyly division is a stressful situation for patients. In our experience, digital enlargement may be involved in keloid formation following syndactyly divisions. Therefore, we aimed to identify predictive factors and reference values for keloid formation. Methods:. In this retrospective study, 11 keloid patients (seven children, four adults) and 11 nonkeloid patients after syndactyly division (control group) with the same sex, age, webspace division site, and operation were enrolled between 2008 and 2020. Using preoperative x-ray images, we compared bony width, length, area, and protruding index relative to the great toe between keloid and control groups. Additionally, reference values for keloid formation were obtained using receiver operating characteristic curves. Statistical analysis was performed using Spearman’s correlation test. Results:. When compared with the same digit in the normal foot, distal phalanx (P3) bony base width, area, and protruding index on keloid foot were significantly different between keloid group and control group. The reference values for keloid formation after syndactyly release were 1.34 for the P3 area ratio and 1.61 for the P3 triangular area ratio (using the horizontal length of the P3 base and P3 vertical length). The reliability of reference values for the P3 area ratio and P3 triangular area ratio was excellent for all patients. Conclusions:. If digital enlargement in distal phalanx is present when compared with adjacent toe in patients who had undergone primary foot syndactyly divisions, risk of keloid development should be communicated preoperatively, and preventive strategies for keloid development and close observations are required.

The focus of the present letter to editor is on keloid formation and its management following treatment of congenital form of Boutonniere finger. Keloids and hypertrophic scars represent fibroblast-mediated hyperactive response to dermal injuries that extend beyond the wound margins, causing functional and aesthetic impairments.[1] Keloids most commonly develop on chest, ear lobe, shoulders, and upper arm.[2] [3] Lesions which extend beyond the wound borders are called keloids.[4] They usually appear in areas such as ear, chest, and deltoid regions.[2] They are usually the result of fibroblast abnormal proliferation and accumulation of excessive extracellular matrix during wound healing.[3] Herein, we describe an atypical keloid on the finger of a 3-year old patient after treatment of congenital deformity.

We report the case of a patient who developed keloid scarring associated with Mammostat-induced skin trauma during reduction mammoplasty. A 32-year-old patient consulted for breast hypertrophy and developed from the fourth postoperative month significant keloid scars on skin shears caused by dermal stretching techniques used during de-epithelialization. The Mammostat-related scars were keloid, while those found on old skin incisions were only enlarged and slightly hypertrophic. We followed up this patient for 7 years. During this time, she received the following local treatments: scar kneading, silicone dressings, intralesional injections of corticosteroids, and potent dermocorticosteroids. After balancing the benefit/risk ratio of a possible revision surgery for resection and plasty of her keloid scars, we opted for therapeutic abstention. In patients at high risk of keloids, we recommend a soft de-epithelialization causing no skin shear, performed by manual tensioning of the dermis.

Background: The reported health and socioeconomic consequences of ear piercing, especially in modern day society, underscore the need to further research into this subject. In this study, we determine the trends and complications of ear piercing among selected Nigerian population. Aim and Objectives: The aim and objective of this study was to draw attention to the trends and complications of ear piercing with a view to prevent its associated complications. Methodology: It is a descriptive cross-sectional study carried out between February and May 2015 among selected Nigerian population from two of its six geo-political zones. A self-administered semi-structured questionnaire which had been pretested was used to collect data from 458 respondents who consented using multistage sampling technique. Results: Of 480 respondents enumerated, 458 completed the questionnaires and gave their biodata. The male:female ratio was 1:6.2. Their ages ranged from 18 to 75 years with a mean of 35.56 ± 10.16. About 35.4% of the respondents were within the age group of 31–40 years. Majority of the respondents, i.e.,79.3% practiced ear piercing on their children. Most of them (86.8%) preferred single piercing. Ear piercing was performed within the 1st week of birth in 37.2% of the respondents. Large percentage (93.2%) of the respondents will not encourage ear piercing in male children. Nearly 20.5% of the respondents observed complications. Conclusion: Ear piercing remained a common practice in Nigeria, with respondents preferring it on females. Majority of the piercings are done in childhood and by untrained personnel. Keloid formation was the notable complication observed by the respondents. There is a need to increase awareness about the hazards of ear piercings and to enact laws that regulate ear piercings particularly in children which is hereby stretched.