Search

Copyright of Revista Médica Clínica Las Condes is the property of Editorial Sanchez y Barcelo and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background and objective. Keloid is a pathology of the human being which mainly affects the black race, it is common in the young population, especially the female sex, and it affects the auricle considerably; however, it is not the most affected region and it has a high capacity for recurrence, causing serious aesthetic and psychological sequelae. Even though multiple therapeutic options have been proposed, there is no evidence of a treatment that has obtained an efficacy greater than 80% and that maintains result over time. For this reason, we present a study that proposes the relationship between sclerotherapy and the management of keloids of the auricle as an effective and novel outpatient strategy in the treatment of auricular keloids. Methods. Case series study at the Plastic Surgery Center of the Neiva University Hospital, Huila (Colombia) between 2013 and 2019 on patients with auricular keloids treated by intralesional infiltration of sclerosant or combined therapy that consisted of surgical resection plus infiltration with sclerosant. We evaluated demographic and clinical data, history of previous frustrated procedures, number of keloids, and recurrence. The information on the characteristics of the patients and the keloids treated were entered into the Stata software®. Results. We studied 24 patients with a total of 34 auricular keloids. In all of them we performed the procedure without inconvenience and with good tolerance; 88% of the keloids did not present recurrence after 3 years of follow-up. Conclusions. In our experience, treatment with sclerosing therapy is a management alternative with favorable results for ear keloids, which can be used as monotherapy or as adjunctive therapy to surgical resection in patients with or without a history of previous frustrated medical management. [ABSTRACT FROM AUTHOR]

Objectives. The treatment of keloid scars is based on multiple lines of therapy, with varying levels of efficacy(1), and there is currently no single treatment that guarantees cure and prevents recurrence. In the pediatric population, the treatments used are not standardized, and there is insufficient evidence to support efficacy and complications. The objective of this study was to analyze the patients who required brachytherapy as an adjuvant to surgical resection in recurrent keloid scars. Materials and methods. A retrospective analysis of patients diagnosed with keloids and undergoing adjuvant brachytherapy in our institution was carried out, while assessing efficacy and implementation in our treatment protocol for keloid scarring. Results. After various therapeutic lines, 4 patients aged 9-17 years old with recurrent keloid scars around the ear and eligible for adjuvant brachytherapy -- administered after surgical resection, in two sessions -- were studied and followed up for up to 18-21 months. Conclusions. Despite our limited experience in the use of adjuvant brachytherapy, the results obtained to date support its efficacy, as reported in the literature. We therefore consider its inclusion in the treatment of keloid scars that have recurred after other treatments to be appropriate. [ABSTRACT FROM AUTHOR]

Resumen Introducción y objetivo. El proceso de cicatrización, cuando se ve perturbado o interrumpido, puede conllevar una reparación cutánea descontrolada como la observada en los queloides. Son reconocidos como tumores fibroproliferativos únicos en humanos, lesiones difíciles de tratar debido a que la mayoría de los enfoques terapéuticos siguen siendo clínicamente insatisfactorios. Sin embargo, estudios recientes sugieren que la toxina botulínica tipo A (TBA) influye en la apoptosis y proliferación celular, razón por lo cual nos planteamos demostrar si la TBA intralesional produce mejoría no solo clínica, sino también histológica en el queloide. Material y método. Seleccionamos 11 queloides y realizamos biopsias de los mismos, además de medición previa y en 3 controles posteriores a la aplicaciónn de TBA. Hacemos descripción histopatológica de los cambios observados a los 3 meses mediante el Sofware Image Pro Plus, versión 5.0 (Olympus®) y tinciones con hematoxilina-eosina (H/E) y tricrómico de Masson. Aplicamos tratamiento estadístico mediante análisis de las características demográficas y clínicas. A las variables nominales se le determinaron frecuencia y porcentajes, por lo que elaboramos tablas descriptivas. Con las variables cuantitativas trabajamos con medidas de tendencia central (media). Para la comparación y el análisis de las variables utilizamos medidas de tendencia central (media), coeficiente de relación de Pearson y desviación estándar. Resultados. La edad promedio fue de 31 años, el sexo predominante fue el femenino (63%), la etiología más frecuente fue postraumática (35%), predominó el tipo de piel IV (50%), clínicamente hubo mejoría significativa de altura y anchura del queloide confirmada mediante coeficiente de relación de Pearson con un -0.91 y -0.88 respectivamente, así como del dolor, prurito, coloración y consistencia; también reducción del diámetro de la epidermis verificado por desviación estándar y cambios en la dermis en cuanto a distribución del colágeno, vascularización, infiltrado inflamatorio y unión dermoepidermica se refiere. Conclusiones. Dados los resultados obtenidos en nuestro estudio desde el punto de vista clínico e histopatológico, planteamos la TBA como una nueva opción terapéutica para el tratamiento del queloide.

Lobomycosis is a rare subcutaneous mycosis, prevalent in the tropical and subtropical regions of Central and South America, with a predominance in the Amazon forest. It is caused by the traumatic implantation of the Lacazia loboi fungus in the skin and subcutaneous tissue. Its clinical manifestations are solitary or multiple keloid-type dermal nodules that converge to form slow-growing, painless plaques. Diagnosis is made by histopathological identification of the fungus. For treatment, surgical removal of the lesions is the choice, associated with itraconazole and clofazimine when there are disseminated lesions, but the results are not highly effective as reported in the literature. We present a case of Lobomycosis in a male professional soldier of the National Army from Choco, who initially presented a papule with subsequent progression to a nodule on the left leg of 15 years of evolution. In this article we highlight the clinical and diagnostic characteristics of the disease. [ABSTRACT FROM AUTHOR]

A infecção genital pelo papilomavírus humano ocorre em 65% das vezes após contato com pele e mucosa contaminadas. A maioria das pessoas elimina o vírus através do sistema imune. Fatores individuais, como tabagismo, idade, multiparidade, uso prolongado de contraceptivos hormonais, comportamento sexual e infecção por outras doenças sexualmente transmissíveis, ocasionam perpetuação viral e lesões genitais, em sua maior parte, assintomáticas. As regiões mais afetadas são anogenitais. O tratamento deve ser individualizado. O tratamento agressivo pode ocasionar distúrbios cicatriciais. Relatamos um caso de múltiplos tratamentos para retirada de condiloma genital com consequente formação de extenso queloide vulvar.

Resumen Introducción y objetivo. La cicatriz queloide es uno de los problemas clínicos más frustrantes en la curación de heridas y un gran desafío para los médicos. Los diversos tratamientos (escisión parcial o total), inyección de drogas intralesionales, radioterapia, láser, silicona, prendas de lycra, entre otros, tienen un alto riesgo de recurrencia (10-45%). Los desafíos que enfrenta la comunidad dedicada a la rehabilitación incluyen la investigación del proceso de curación, los efectos de los diferentes factores involucrados en la cicatrización de heridas y el desarrollo de cicatrices, y la mejor combinación de intervenciones quirúrgicas, farmacológicas y terapéuticas para maximizar el resultado. La cirugía se puede realizar para tratar los queloides de dos maneras: primero, resección radical de los queloides y, en segundo lugar, reducción de la masa queloide. El objetivo que proponemos es mejorar las cicatrices hipertróficas y queloides mediante múltiples zetaplastias o con resección parcial más múltiples zetaplastias. Material y método. Realizamos un estudio prospectivo sobre un total de 335 cicatrices clasificadas según la escala de Vancouver entre febrero de 2013 y julio de 2018. Se intervinieron cicatrices lineales con zetaplastia múltiple teniendo en cuenta las líneas de menor tensión, tanto en cicatrices hipertróficas como en queloides extensos; si el tejido vecino lo permitía, la cicatriz se resecó parcialmente y se hizo zetaplastia múltiple; si el tejido vecino no permitía la resección, se seleccionaron algunas áreas para realizar la primera sesión de zetaplastia y en intervenciones posteriores se realizaron otras para poder intervenir en toda el área en función de las fuerzas de tensión. Resultados. Revisamos un total de 335 cicatrices, 188 (56.1%) hipertróficas y 147 (43.9%) queloides, en pacientes entre 1 y 56 años, durante un promedio de 13 años. Cara y cuello 123 (37%), extremidades superiores 85 (25,3%), extremidades inferiores 63 (18,8%), tórax 53 (15,8%) y oreja 11 (3,3%) fueron las principales áreas tratadas. De las 123 fotografías intraopoeratorias revisadas, 4 (3%) tenían solo 1 zetaplastia, 3 (2.4%) tenían 2, 27 (21.9%) tenían 3 y 89 (72.3%) más de 4 zetaplastias múltiples (promedio de 6). Con los buenos resultados obtenidos, la cirugía también se realizó en cicatrices durante el proceso de maduración, 3 o 4 meses después de la quemadura. Setenta y ocho pacientes (23.2%) con seguimiento de 5 años no presentan recurrencia, ni 35 (10.4%) a los 4 años. Conclusiones. La zetaplastia múltiple, con o sin resección parcial de cicatriz hipertófica o queloidea, puede realizarse en cicatrices activas inmaduras, rompiendo el paradigma de esperar hasta que la cicatriz esté madura o incluso cuando los tratamientos terapéuticos hayan fallado. La sutura continua con monofilamento es una contribución técnica que permite reducir el tiempo quirúrgico y facilita la extracción de los puntos.

Introdução: Placas de silicone e injeções de triancinolona melhoram o tamanho dos queloides e das cicatrizes hipertróficas, além do eritema, da elasticidade e de sintomas como dor e prurido. Esses tratamentos nao sao invasivos, têm um bom custo-beneficio e são amplamente utilizados como terapia inicial para queloides e cicatrizes hipertróficas; entretanto, faltam estudos comparativos dos dois tratamentos. Objetivo: Comparar o uso de placas de silicone, triancinolona intralesional, e a combinação de ambas as modalidades terapêuticas, no tratamento de cicatrizes hipertróficas na mesma área anatômica e causadas pelo mesmo mecanismo de lesão. Métodos e Materiais: Em um estudo prospectivo, 12 pacientes com cicatrizes de esternotomia mediana foram randomizados em 3 grupos (4 pacientes em cada grupo): Grupo 1. injeções mensais de triancinolona; Grupo 2. uma combinação de placas de silicone e injeções de triancinolona e Grupo 3. placas de silicone. Os pacientes foram avaliados em consultas clínicas mensais com o uso da Escala de Vancouver e durômetro. Foram realizadas imunohistoquímica e microscopia confocal para os colágenos de tipos I e VI em amostras de cicatriz. Os grupos foram comparados com os testes de Kruskall-Wallis e Friedman com significância de p< 0.05. Resultados: Os três tratamentos mostraram-se eficazes na melhora das cicatrizes, conforme demonstrado pela redução nos parâmetros da Escala de Vancouver. Foi observada uma diferença entre os três grupos no tempo 2, quando a triancinolona mostrou-se menos eficaz. O grupo 2 apresentou melhora na pigmentação (p = 0,042). Os colágenos de tipos I e VI apresentaram aumento de fluorescência em toda a derme superficial e profunda nas lesões não-tratadas, que diminuiu após do tratamento. Apesar do número pequeno de pacientes, este foi o primeiro estudo prospectivo que comparou estas modalidades de tratamento de cicatrizes, evitando vieses frequentemente vistos em publicações sobre tratamentos de cicatrizes.

O tratamento isolado do queloide apresenta resultado variável e, muitas vezes, insatisfatório. A combinação de terapêuticas tem se mostrado uma alternativa eficaz, principalmente para os casos recalcitrantes. A excisão cirúrgica e a irradiação no pós-operatório imediato com feixe de elétrons é uma alternativa efetiva na cicatrização e redução da taxa de recidiva dessas lesões. Os autores descrevem um paciente que apresentava queloide volumoso recalcitrante que obteve bom resultado terapêutico.

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.

Objective: To assess the effectiveness and safety of a topical silicone gel (BE + Gel reductor y reparador de cicatrices) and a polyurethane dressing (BE + Apósito reductor y reparador de cicatrices) on the evolution of scars of patients who were previously recruited in the emergency care unit while seeking wound care., Method: A single center, stratified observational, open label study was performed in the emergency care unit of Donostia Universitary Hospital (recruitment) and in the Biodonostia Health Research Institute (intervention). Scars located in unexposed body areas with the dressing, and scars located in exposed areas with either the gel or the dressing. Investigators assessed interventions at day 1 and on weeks 4, 8 and 12. Vancouver Scar Scale (VSS) and a photographical assessment were used to determine the scars evolution, and the subjective perception of the scar was evaluated by means of a questionnaire administered to the patients., Results: Patients whose scars were treated with the silicone gel had an average initial VSS score of 5.4 ± 2.08. This value was reduced to 0.86 ± 1.17 after 90 days of treatment. Patients treated with the polyurethane dressing had an average initial VSS score of 5.8 ± 2.29. After 90 days of treatment, this average score was reduced to 0.33 ± 0.66. Positive evolution of scars was also supported by photographs and by a patient questionnaire., Conclusions: Both treatments appear to be safe and effective, objectively, and subjectively, in the context of scar evolution., (Copyright © 2024 Elsevier España, S.L.U. All rights reserved.)

Background and objective. When the healing process is disturbed or interrupted, uncontrolled skin repair can occur, such as that observed in keloid. These are recognized as unique fibroproliferative tumors in humans, always representing difficult-to-treat lesions because most therapeutic approaches remain clinically unsatisfactory. However, recent studies have suggested that botulinum toxin type A (BTA) influences apoptosis and cell proliferation. This is why we set out to demonstrate whether intralesional BTA produces improvement not only clinically but also histologically in the keloid. Methods. Eleven keloids were selected and biopsies were performed as well as previous measurements and 3 controls after the application of BTA. Histopathological description of the changes observed 3 months after therapy using the Software Image Pro Plus, version 5.0 (Olympus®) and stains with hematoxylin-eosin (H/E) and Masson's trichomic. Statistical treatment was applied through analysis of demographic and clinical characteristics. The frequency and percentages were determined for the nominal variables, so descriptive tables were made. With the quantitative variables we worked with measures of central tendency (average). For the comparison and analysis of the variables, measures of central tendency (mean), coefficient of Pearson relation and standard deviation were used. Results. The average age was 31 years, the predominant sex was female (63%), the most frequent etiology was posttraumatic (35%), the skin type IV predominated (50%). Clinically there was significant improvement in height and width of the keloid confirmed by Pearson's coefficient of relationship with -0.91 and -0.88 respectively and improvement of pain, pruritus, coloration and consistency, as well as reduction of the diameter of the epidermis verified by standard deviation and changes on the dermis in terms of collagen distribution, vascularization, inflammatory infiltrate and dermo-epidermal junction. Conclusions. Due to the results obtained in our study from the clinical and histopathological point of view, BTA could be considered as a new therapeutic option for the treatment of keloid. [ABSTRACT FROM AUTHOR]

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 a-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. [ABSTRACT FROM AUTHOR]

Introducción: recientemente, el uso de piercings faciales y bucales se ha incrementado en forma notable en todo el mundo muchas veces sin conocer la capacidad de ocasionar diferentes complicaciones sobre todo la población más joven.Objetivo: identificar las principales complicaciones y efectos negativos asociadas al uso de piercings de la región maxilofacial en el municipio de Artemisa.Método: se realizó un estudio descriptivo de corte transversal en 113 pacientes que necesitaron atención en el servicio de cirugía maxilofacial del Hospital General Docente «Ciro Redondo» durante los años 2006 y 2015 (10 años). Para la obtención de la información se utilizó la observación, como método tradicional y la entrevista; para el análisis e interpretación de los resultados se emplearon el análisis porcentual.Resultados: el sexo femenino fue al más afectado con 58.5%, La localización más frecuente fue el pabellón auricular, y en la cavidad bucal la lengua y los labios. Las complicaciones más frecuentes fueron los queloides, siguiéndole en orden las infecciones, incrustación en la piel y la recesión gingival.Conclusiones: la utilización de los piercings es un problema de salud y entraña riesgos y complicaciones. Se recomienda desestimular, mediante una adecuada labor de promoción la utilización de los mismos. De ser utilizados se debe tener gran cuidado en la selección de los materiales y extremar las normas de esterilización y desinfección al momento de ser colocados.

Background and objective. The keloid scar is one of the most frustrating clinical problems in wound healing and a great challenge for doctors. The various treatments (partial or total excision), intralesional drug injection, radiotherapy, laser, silicone, lycra garments, among others, have a high risk of recurrence (10-45%). The challenges facing the rehabilitation community include the investigation of the healing process, the effects of the different factors involved in wound healing and the development of scars, and the best combination of surgical, pharmacological and therapeutic interventions to maximize the result. Surgery can be performed to treat keloids in two ways: first, radical resection of keloids and, secondly, reduction of keloid mass. Our general objective is to improve hypertrophic and keloid scars with multiple zetaplasties or with partial resection plus multiple zetaplasties. Methods. A prospective study was conducted on 335 scars classified based on the Vancouver scale between February 2013 and July 2018. Linear scars were intervened with multiple zetaplasty taking into account the lines of least tension; in hypertrophic scars or extensive keoids, if the neighboring tissue allowed it, the scar was partially resected, and perform multiple zetaplasty; if the neighboring tissue did not allow resection, some areas were selected to perform the first zetaplasty session and in subsequent interventions the others were performed to be able to intervene the entire area based on the tension forces. Results. A total of 335 scars, 188 (56.1%) hypetrophic and 147 (43.9%) keloyds, were treated in patients between 1 and 56 years, for an average of 13 years. Face and neck 123 (37%), upper extremities 85 (25.3%), lower extremities 63 (18.8%), thorax 53 (15.8%) and ear 11 (3.3%) were the main areas treated. Of 123 intraopoeratory photographs reviewed, 4 (3%) had only one zetaplasty, 3 (2.4%) had 2 zetaplasties, 27 (21.9%) had 3 zetaplasties and 89 (72.3%) had more than 4 multiple zetaplasties (with one average of 6). With the good results obtained, surgery was also performed on patients with scars during the maturation process as soon as 3 or 4 months post burn. Seventy eight patients (23.2%) who have 5-year follow-up do not present recurrence nor 35 (10.4%) at 4 years. Conclusions. Multiple zetaplasty, with or without partial resection of hypertorphic scar o keloyd, can be performed on immature active scars, breaking the paradigm of waiting until the scar is mature or even when therapeutic treatments have failed. The continuous suture with monofilament is a technical contribution that allows to reduce surgical time and facilitates the removal of the stitches. [ABSTRACT FROM AUTHOR]

As queimaduras ainda são responsáveis por grande parte dos ferimentos e óbitos decorrentes de causas externas no Brasil, bem como por grande número de afastamento do trabalho e sequelas funcionais e estéticas, principalmente na população masculina. A avaliação das queimaduras deve levar em consideração o grau de profundidade, localização, acometimento de vias aéreas e agente causal. Nos casos com indicação de tratamento ambulatorial, o antimicrobiano tópico de escolha ainda é a sulfadiazina de prata a 1%, após lavagem adequada das lesões, além da profilaxia do tétano. A prevenção de cicatrizes hipertróficas e queloides é muito importante para evitar limitações de movimento e de convívio social.

O sarcoma de Kaposi é neoplasia multicêntrica rara originária de células endoteliais com manifestação cutânea e extracutânea. Descreve-se o caso de variante clínica queloidiana de SK, incomum, em paciente do sexo masculino, de 32 anos, portador da síndrome da imunodeficiência adquirida (Aids), com regressão ao tratamento combinado de terapia antirretroviral e radioterapia.

Introdução: A terapia por ondas acústicas estimula os processos de regeneração e recuperação dos tecidos. Nesse sentido, espera-se que esse equipamento possa atuar em cicatrizes. Objetivo: Avaliar a eficácia e segurança da terapia por ondas acústicas na melhora de queloides. Métodos: Estudo aberto, prospectivo, unicêntrico que incluiu 20 participantes com diagnóstico clínico de queloide. Foram realizadas oito sessões de terapia por ondas acústicas, uma por semana, durante oito semanas. Os participantes foram avaliados no momento basal e uma e 12 semanas após o término do tratamento. Medidas de elasticidade e avaliação clínica pela Escala de Cicatrizes de Vancouver foram realizadas. Ao final do tratamento foi observada a satisfação dos participantes com o tratamento. Resultados: Após o tratamento, a percentagem de participantes com espessura do queloide entre dois e 5mm caiu de 71% para 47%, aumentando a percentagem de participantes com espessura menor do queloide na amostra total (

As cicatrizes hipertróficas e quelóides representam distúrbios cicatriciais hiperproliferativos que podem ter um impacto significativo na vida dos doentes. Os autores apresentam o caso de um doente de 53 anos, com uma cicatriz quelóide na região esternal após exérese de quisto sebáceo e múltiplas sessões de infiltração de corticóide, com um agravamento marcado da lesão. O doente foi submetido a exérese do quelóide e reconstrução do defeito com retalho livre fasciocutâneo anterolateral da coxa (anterolateral thigh flap – ALT). O pós-operatório imediato e tardio decorreu sem intercorrências, sem sinais de recidiva. O tratamento de quelóides esternais passa, inevitavelmente, por diminuir a tensão na região operada, de forma a evitar a recidiva e eventual agravamento da lesão. O tratamento deste tipo de cicatrizes é complexo, tornando-se um verdadeiro desafio para o cirurgião plástico. No caso clínico apresentado, dadas as dimensões e localização da cicatriz, a sua excisão provocou um defeito extenso, sendo necessária a transferência microcirúrgica de tecidos para cobertura completa, minimizando a tensão na região esternal.

OBJECTIVE: To evaluate the combined treatment of ear lobe keloids. METHODS: We studied 46 consecutive patients with 81 ear lobe keloids. Patients underwent local infiltration of triamcinolone acetonide (TCN) at concentrations of 40mg/ml (Group 1), 20 mg/ml (Group 2) and 10mg/ml (Group 3). The volume of TCN infiltrate varied according to the size of the lesion. Treatment consisted of three monthly injections before surgery, excision of keloid in the fourth month and perioperative infiltration, followed by two more leaks TCN within two months. Patients used earrings pressure on the scar after operation for four months. The pressure exerted by earrings in the ear lobe was measured electronically. Post-treatment follow-up of patients was 24 months. RESULTS: TCN at concentrations of 20mg/ml and 40mg/ml were effective for the treatment of keloids, no difference between the groups (p = 0.58). However, patients in which TCN was infiltrated the 10mg/ml had poor involution of keloid and the study of this group was stopped. CONCLUSION: the combination of infiltration TCN month to 20 mg/mL (1.2mg to 2.0mg per mm3 TCN injury), surgical excision and pressure application device is effective for treatment of keloid ear lobe.

Background and Objective. Cicatricial hyperplasia, denomination which gathers the hypertrophic scar and keloid, represents a big challenge in surgical practice. These pathologies rushing only on human beings have been associated by different works, in particular the keloid, with black and yellow races, confirmed fact in the state of Bahia - Brazil, where large number of reduction mammoplasty, they are accompanied by hyperplasic scars and where the afro-descendant genetic is very significant. These anomalies generate great insatisfaction in patients and surgeons. Our objective is to demonstrate than we can prevent this type of scars before the skin incision, and before the firing of the cascade of repair, molding the early stages of healing using an specific corticoid. Methods. We conduct a prospective study of longitudinal prevalence and self-controlled, on 60 breast from 30 women with diagnostic of gigantomasty, all subject to reduction mammoplasty with T inverted and graft-mammillary areola plate (Thorek-Pitanguy), and comparing between 2 groups: the first one with 30 right breast infiltrated with a solution of corticoid anti-chemoattractant in the dermis and subcutaneous, under the surgical predial design ink and before incisions (intervention group); and the second one with 30 left breast whithout infiltration (control group), to statistically determine, after a period of monitoring, the prophylactic efficacy of dexamethasone acetate in preventing the hyperplasic scar. Patients were accompanied between 6-15 months, and their kind of healing was classified by the scale of Vancouver with photographic documentation. Statistical studies were made by the Chi-square test and the Kruskal-Wallis test for experimental analysis. Results. It is shown a significant reduction, statistically, in hyperplasic scar when compared the 2 breasts (p=0.02): the right breast infiltrated with corticoid had minor incidence (p=0.06). Data confirmed by the statistical experimental test. Conclusions. Prophylactic therapeutic intervention, intra-local, with dexamethasone acetate in the transoperative is highly effective, reducing significantly the presence of the hyperplasic scar. [ABSTRACT FROM AUTHOR]

The objective of this note is to describe a case of exuberant scarring formation, with keloid characteristics and pseudo-tumoral configuration in a male Black caiman (Melanosuchus niger), with an estimated age of 60 years, belonging to the Zoobotanical Park at the Emílio Goeldi Museum, located in Belém, Pará, Brazil. The alteration appeared on the right posterior limb involving two distal phalanges of the lateral digit and measured 12.4cm at the greatest width. The keloid tissue was surgically removed and samples were processed and analyzed histopathologically, revealing growth made up of fibrous connective tissue with the habitual morphology, which was structurally mature in the more central areas.

While treatment of keloids and hypertrophic scars normally shows modest results, we found that treatment with bleomycin was more promising. The present study was divided into two parts. In the first part the aim was to show the results using a combination of bleomycin and triamcinolone acetonide per cm2 (BTA). In the second part the objective was to determine the response to both drugs in large keloids that were divided into 1 cm2 squares, treating each square with the dose previously used. In the first part of the study, the clinical response of 37 keloids ranging from 0.3 to 1.8 cm2 treated with BTA were followed up over a period of 1- 2 years. 0.375 IU bleomycin and 4 mg triamcinolone acetonide were injected every 3 months. In the second part of the study we reviewed the clinical response in six patients with large keloids. The monthly dose administered never exceeded 3 IU of bleomycin. The first study showed 36 keloids (97.29%) softening after the first dose. In the second study, 5 showed different responses (the response was complete in the four smaller keloids). The largest keloid needed 9 doses to achieve an improvement of 70%. In conclusion, combined treatment with 0.375 IU of bleomycin and 4mg of triamcinolone acetonide to 1 cm2 was considered to be an acceptable procedure for the treatment of keloids. The best results were obtained in keloids over 1 cm2 or when divided into 1 cm2 square areas. Larger series need to be performed in order to confirm these results..Enquanto normalmente o tratamento de queloides e cicatrizes hipertróficas mostra resultados moderados, o tratamento com bleomicina revelou resultados mais promissores. Este estudo foi dividido em duas partes. Na primeira parte, o objetivo foi mostrar os resultados da utilização de uma combinação de bleomicina e acetonido de triancinolona por cm2 (BAT). Na segunda parte, o objetivo foi determinar a resposta aos dois medicamentos em queloides grandes, que foram divididos em quadrados de 1 cm2, tratando cada quadrado com a dose utilizada anteriormente. Na primeira parte do estudo, a resposta clínica de 37 queloides de 0,3 to 1,8 cm2 tratados com BAT foi monitorada por um período de 1 a 2 anos. Injeções de 0,375 UI de bleomicina e 4 mg de acetonido de triancinolona foram aplicadas a cada 3 meses. Na segunda parte do estudo, revisamos a resposta clínica em 6 pacientes com queloides grandes. A dose mensal administrada nunca excedeu 3 UI de bleomicina. O primeiro estudo mostrou que 36 queloides (97,29%) amoleceram após a primeira dose. No segundo estudo, 5 mostraram diferentes respostas (a resposta foi completa nos quatro queloides menores). O queloide maior necessitou de 9 doses para apresentar melhora de 70%. Concluindo, o tratamento combinado com 0,375 UI de bleomicina e 4 mg de acetonido de triancinolona por cm2foi considerado um procedimento aceitável para o tratamento de queloides. Os melhores resultados foram obtidos em queloides com mais de 1 cm2 ou divididos em áreas de 1cm2. Estudos mais amplos deveriam ser realizados, para confirmar esses resultados.

Cutaneous endometriosis is a rare manifestation of endometriosis, representing 0.5% to 1% of all endometriosis cases. It can be divided into primary and secondary, when appearing spontaneously or after a surgical procedure, when it is mostly found on surgical scar tissue. Some etiologies were proposed, but none of them could entirely explain the appearance of the tumor. Differential diagnosis includes melanoma, metastatic nodule, keloid and pyogenic granuloma. Dermoscopic features are not yet well established, but there are some characteristics that suggest the diagnosis. Treatment is surgical in larger sized lesions. Malignization can occur. The screening for endometriosis is mandatory by means of gynecologic, imaging and marked-tumor evaluation. We report a case of primary umbilical endometriosis and discuss its dermoscopic aspects.A endometriose cutânea é forma rara de endometriose, representando de 0,5% a 1% de todos os casos da doença. Pode ser dividida em forma primária, de surgimento espontâneo, ou secundária, após procedimentos cirúrgicos aonde geralmente encontra-se sobre a cicatriz cirúrgica. Diversas etiologias foram propostas, porém, nenhuma capaz de explicar inteiramente seu aparecimento. Diagnósticos diferenciais incluem melanoma, nódulos metastáticos, quelóide e granuloma piogênico. A dermatoscopia da lesão ainda não foi bem estabelecida, mas existem alguns achados que podem sugerir o diagnóstico. O tratamento é cirúrgico nos casos de lesões maiores e o screening para endometriose é mandatório através de avaliação ginecológica, de imagem e marcador tumoral. Relatamos um caso de endometriose cutânea primária e discutimos seus aspectos dermatoscópicos.

INTRODUÇÃO: Queloide e cicatriz hipertrófica são cicatrizes patológicas com natureza fisiopatogênica comum, denominadas, em conjunto, cicatrizes fibroproliferativas. São mais frequentes em indivíduos de pele mais escura. Contudo, a atual miscigenação dificulta o enquadramento dos pacientes com variadas tonalidades de pele em classificações morfológicas e estáticas (branco ou caucasoide, mulato, pardo, hispânico ou latino, amarelo ou oriental ou mongoloide e negro ou negroide), e diferentes quanto à exposição solar. Sabe-se que pessoas oriundas de países de clima temperado ou frio quando residem em países tropicais aumentam a incidência dessas cicatrizes, principalmente nas áreas de maior exposição solar. Uma relação entre as cicatrizes fibroproliferativas e os fototipos de Fitzpatrick, classificação dinâmica baseada no relato do paciente quanto a sua resposta cutânea após a exposição solar, poderia contribuir para a compreensão da fisiopatologia dessas cicatrizes. Este estudo teve como objetivo investigar a distribuição das cicatrizes fibroproliferativas segundo os fototipos de Fitzpatrick. MÉTODO: Foram avaliados 146 pacientes provenientes do Ambulatório da Disciplina de Cirurgia Plástica da Universidade Federal de São Paulo (Unifesp, São Paulo, SP, Brasil), portadores de qualquer tipo de cicatriz fibroproliferativa, em um ou mais locais do corpo. As cicatrizes fibroproliferativas dos pacientes foram classificadas de acordo com os critérios de Muir em cicatriz tipo queloide (Long-term Evolution, LTE), cicatriz tipo hipertrófica (Short-term Evolution, STE) e cicatriz tipo mista (Intermediate Group, IG), e os tipos de pele foram classificados segundo os fototipos de Fitzpatrick. RESULTADOS: O fototipo Fitzpatrick III e a cicatriz mista foram mais frequentes entre os pacientes avaliados (P = 0,001). Houve associação (P = 0,025) entre as cicatrizes fibroproliferativas e os fototipos de Fitzpatrick, ou seja, quanto maior o fototipo maior a tendência de desenvolvimento de cicatrizes dos tipos queloide e mista. CONCLUSÕES: Os fototipos de pele segundo Fitzpatrick mostraram-se válidos como critério a ser utilizado em estudos de queloide e cicatriz hipertrófica.BACKGROUND: Keloid and hypertrophic scars have a common physiopathogenic origin and are defined as fibroproliferative scars. Fibroproliferative scars are frequent in individuals with darker skin. However, mixing of "races" renders it difficult to group patients with different skin tones according to morphological and static classifications (white for Caucasians; brown for individuals of Spanish descent (Hispanic/Latino); yellow for individuals of East Asian descent; and black for individuals of African descent) according to their response to sun exposure. It is known that when individuals whose ethnic origin is in colder countries move to tropical countries, they show a higher incidence of these types of scars, which mainly affect parts of the body that are more exposed to the sun. A correlation between fibroproliferative scars and Fitzpatrick phototype, a dynamic classification based on the skin's response to sun exposure, would contribute to an understanding of the pathophysiology of these scars. The aim of this study is to investigate the distribution of fibroproliferative scars according to Fitzpatrick phototypes. METHODS: We classified patients' fibroproliferative scars according to the Muir classification as Long-Term Evolution (keloid scars), Short-Term Evolution (hypertrophic scars), and Intermediate Group (mixed scars), while their skin types were grouped according to the Fitzpatrick classification. RESULTS: Fitzpatrick phototype III and mixed scars were predominant among the patients analyzed (p = 0.001). A correlation (p = 0.025) was observed between fibroproliferative scars and Fitzpatrick phototypes; the higher the phototype, the higher the tendency to develop keloid and mixed scar tissue. CONCLUSIONS: Fitzpatrick skin phototypes proved to be an efficient method to study keloid and hypertrophic scars.

Purpose: To quantify keloid fibroblasts after irradiation with 470nm blue LED, in vitro. Methods: Fibroblasts from keloid and adjacent skin have been obtained from 6 patients. Cells have been cultivated and maintained in DMEM culture medium. In Petri dishes, they were irradiated with energy doses of 6J, 12J and 18J. After 24 h, counting was done by the average of the triplicates for each sample. Results: There were no significant differences in the number of irradiated keloid fibroblasts at the studied doses (p=0.261). In adjacent skin fibroblasts, differences were observed (p=0.025) concerning the doses of 18 J and 6 J (p=0.03). Conclusions: There was a reduction in the number of adjacent skin fibroblasts irradiated with 470nm blue LED at the energy dose of 18 J compared to the ones irradiated at the energy dose of 6 J. There were no changes in keloid fibroblasts counting at any of the doses applied, 24 h after irradiation.Objetivo: Quantificar fibroblastos de quelóide após irradiação com LED azul de 470nm, in vitro. Métodos: Foram obtidos fibroblastos de quelóide e pele adjacente, de seis pacientes. As células foram cultivadas e mantidas em meio de cultura DMEM. Em placas de Petri, receberam irradiação com doses de energia de 6J, 12J e 18J. Após 24 horas a contagem foi feita pela média da triplicata para cada amostra. Resultados: Não houve diferença na quantidade de fibroblastos de quelóide irradiados nas doses estudadas (p=0,261). Observou-se diferença nos fibroblastos de pele adjacente (p=0,025), com relação às doses de 18 J e 6 J (p=0,03). Conclusões: Houve redução dos fibroblastos de pele adjacente irradiados com LED azul de 470 nm na dose de energia de 18 J em relação à dose de 6 J. Não houve alteração na quantidade de fibroblastos de quelóide nas doses aplicadas após 24 horas da irradiação.

Background: There are many mestizos and black inhabitants in the Cuban population who from an economic stand-point, have a highly important percentage. Many of them feel the need to improve their faces aesthetically by means of the operative correction of their nose deformities known as rhinoplasty. Objective: To assess the results of rhinoplasties in mestizos and black patients. Methods: prospective study carried out in 52 mestizos and black patients who attended the Maxillo-Facial Surgery Outpatient of the University Hospital “Dr. Gustavo Aldereguía Lima” from 2006 to 2009. All mestizos were treated with an open technique in which three types of V incisions, inverted V and transversal V incisions were used. In the transoperative process 2cc of Triamsinolone were infiltrated, with the aim to avoid keloid formation and other techniques were combined with it. Digital photos were also used during the preparation of the cases either at the pre and post surgical stages as a way of evidencing the results. Results: 42 patients were mestizos, 20 of them were females and 22 males; 10 patients were black, 7 of them females and 3 males. All the patients were highly satisfied with the result of their surgery. There were no complications in these patients Conclusions: The use of the V technique for the surgical treatment of the mestizos and black noses is effective and the use of Triamsinolone avoids keloid formation.

Presentamos nuestra experiencia en el tratamiento de los queloides mediante resección quirúrgica y radioterapia inmediata posterior. La radioterapia transforma el queloide en un tejido hipocelular, hipovascular e hipóxico, impidiendo la excesiva migración de fibroblastos. Si se administra la dosis adecuada de radiación, se consigue un equilibrio entre la formación de cicatriz y la proliferación excesiva de tejido, evitando la formación de queloide, sin impedir la cicatrización normal. Nuestro protocolo se divide en dos fases: la primera consiste en la exéresis del queloide mediante una incisión que sigue el trayecto del mismo, con un cuidadoso cierre en dos planos siendo siempre el superficial una sutura intradérmica. La segunda fase será la radioterapia, con dos modalidades posibles de tratamiento: 1- Braquiterapia (tratamiento a corta distancia), requiere la colocación de un catéter bajo la sutura, a través del cual se introduce una fuente radiactiva, normalmente Ir192. Se emplea especialmente en heridas longitudinales. 2- Radioterapia externa con electrones de baja energía. Se emplea en heridas complejas o extensas. Generalmente, dosis de 20 Gy. en 4 fracciones de 500 cGy, ofrecen excelentes resultados con mínimas secuelas o efectos secundarios. El volumen blanco debe incluir la herida quirúrgica más un margen de 4 mm. alrededor de ella. Con este procedimiento, hemos observado unos excelentes resultados, con un índice de recidivas inferior al 4%, y una mejora en los síntomas clínicos en el 100% de los casos. Como efectos secundarios observamos telangiectasias (15,4 %) o cambios en la pigmentación cutánea (5,9%).We present our experience in treatment of keloid scars with surgical resection and immediately postoperative radiotherapy. Radiotherapy changes keloid into an hypocellular, hypovascular and hypotoxic tissue, avoiding the excessive migration of fibroblasts. If the suitable dose of radiation is delivered, balance between the formation of the scar and the excessive proliferation of the tissue is achieved avoiding the formation of the keloid but keeping normal scarring. Our protocol is divided in two phases: the first one is the surgical treatment. The exeresis of the keloid is carried out through an incision that follows its own line and a careful closure in two planes; superficial one is always an intradermic suture. The second part will be radiotherapy, with two possible treatments: 1) Brachitherapy (treatment at a short distance), placing a catheter under the suture, through which a radioactive source is introduced, usually Ir192. It is used, specially in longitudinal wounds. 2) External radiotherapy with electrons of low energy. It is used in complex or large wounds. A dose of 20 Gy., in 4 fractions of 500 cGy, usually offers excellent results with minimum sequelae or side effects. The area to be irradiated should include the surgical wound, and a margin of 4 mm. around it. With this procedure, we have observed excellent results with a recidive rate lower tan 4% and an improvement in the clinical symptoms in 100% of cases. As a side effect, we have observed telangiectasies (15,4%) or changes in the cutaneous pigmentation (5,9%).

La cicatriz es el estado final y definitivo de la reparación que el organismo efectúa en una herida accidental, quirúrgica o producida por alguna afección. La cicatrización queloide es un desorden en la estructura normal de la colágena, que conduce a un crecimiento anormal y desproporcionado de las fases normales de la cicatrización, siendo esta un efecto indeseable para todo cirujano. Fue descrita por primera vez en 1.700 a. de J.C. en el papiro de Edwin Smith; sin embargo, no fue hasta en 1802 cuando Alibert usó el término queloide (cheloid=tenaza de cangrejo), por la forma de la lesión. En este artículo se realiza una actualización de esta enfermedad cicatrizal dermoepidérmica, neoplásica.

La cicatriz es el estado final y definitivo de la reparación que el organismo efectúa en una herida accidental, quirúrgica o producida por alguna afección. La cicatrización queloide es un desorden en la estructura normal de la colágena, que conduce a un crecimiento anormal y desproporcionado de las fases normales de la cicatrización, siendo esta un efecto indeseable para todo cirujano. Fue descrita por primera vez en 1.700 a. de J.C. en el papiro de Edwin Smith; sin embargo, no fue hasta en 1802 cuando Alibert usó el término queloide (cheloid=tenaza de cangrejo), por la forma de la lesión. En este artículo se realiza una actualización de esta enfermedad cicatrizal dermoepidérmica, neoplásica.The scarring process is the final and definitive repair of accidental, surgical and other types of wounds. This is a current complete and review of keloid scarring as a dermal - epidermis and neoplasic disease. The physiopathology of keloid scar formation is based on an abnormal collagen structure and alteration of healing phases. Keloid scar is a cosmetic complication undesirable for all surgeons, but it is more important in plastic and reconstructive surgery. On this article we will talk about general aspects, physiopathology and treatment of keloid scars.

Lacaziose ou doença de Jorge Lobo é micose crônica, granulomatosa, causada por implantação traumática do fungo Lacazia loboi - patógeno não cultivável até o presente - nos tecidos cutâneo e subcutâneo, manifestando-se clinicamente por lesões nodulares queloidianas predominantes, envolvendo sobretudo pavilhões auriculares, face, membros superiores e inferiores, e não comprometendo as mucosas. A maioria dos casos humanos está registrada em países da América do Sul. Entretanto, a enfermidade apresenta aspectos epidemiológicos destacados, como o aparecimento em tribo Caiabi, no Brasil Central e em mamíferos não humanos, golfinhos de duas espécies (Tursiops truncatus e Sotalia guianensis) capturados na costa da Flórida (EUA), na foz do rio Suriname, na costa de Santa Catarina (Brasil), no golfo de Gasconha (baía de Biscaia-Europa), com manifestações cutâneas e achados histopatológicos muito similares às encontradas no homem. O artigo objetiva abordar características do fungo e sua taxonomia, e aspectos históricos, ecoepidemiológicos, clínicos, imuno-histoquímicos, histopatológicos, ultra-estruturais e terapêuticos.Lacaziosis, also known as Jorge Lobo’s disease, lobomycosis and keloidal blastomycosis, is a chronic cutaneous and subcutaneous fungal granulomatous disease, caused by Lacazia loboi - an uncultivated fungal pathogen - characterized by the development of nodular keloidal lesions, particularly on the pinnae, face, upper and lower limbs, and with no involvement of mucous membranes. Most cases in humans were reported in South America, including the Caiabi Indians, in Central Brazil. The disease was described in non-human mammals, such as two species of dolphins (Tursiops truncatus and Sotalia guianensis) inhabiting the coasts of Florida (USA), South America (Suriname River estuary, Santa Catarina-Brazil coast) and Gulf of Gascony (Biscaya Bay, in Europe). The histopathological findings in dolphins were very similar to those observed in humans. The aspects related to the history, etiology, epidemiology and ecology, clinical manifestations, differential diagnosis, immunohistochemistry, pathology, ultrastructural, laboratory diagnosis and therapy of lacaziosis, are presented.

Introduction: Keloids and hypertrophic scars are dermal fibro-proliferative disorders unique to humans. Their treatment is a true challenge with multiple options, but not all the time with good results. Unfortunately this problem is not uncommon in patients with history of burn injury. Aim: To evaluate use of verapamil and pressure garments in patients with hypertrophic or keloid scar caused by burn injury. Methods: We included patients with a hypertrophic or keloid scar caused by burn injury that report non-response to treatment with pressure garment. The pathologic scars were evaluated by serial photographic records, Vancouver and Posas scales. The scales of Vancouver and Posas were compared with t Student. Results: We included 13 scars in 11 patients. Four scars were located in the legs, 4 in the arms, 4 in the face-neck and 1 in the abdomen. The dose of verapamil was calculated 0.03 mg per kg. Injections were scheduled every 7 to 10 days until complete 6 sessions. Taking in count Posas scale, patients referred improvement in pigmentation (0.01), thickness (0.005), pliability (0.01), pruritus (0.003) and irregular surface (0.004). In the Vancouver scale the observers mentioned improvement in elevation (0.008), pigmentation (0.014), vascularity (0.022) and flexibility (0.014). No adverse effects were found in verapamil injection. Conclusion: Verapamil was useful in conjunction with pressure garment to improve the condition of the keloid and hypertrophic scar caused by burn. [ABSTRACT FROM AUTHOR]

PURPOSE: To study the integration of keloid heterograft in hamster (Mesocricetus auratus) cheek pouch. METHODS: The sample is formed by 18 male hamsters, heterogenic ones, aged between 10 and 14 weeks. Keloid fragments were obtained from keloid scars of the breast region of adult female mulatto patient. Each hamster received keloid fragments into both of its pouches, in a total of 36 grafted fragments. Animals were distributed into 6 groups for having their grafts assessed in the days 5, 12, 21, 42, 84, and 168. A macroscopic assessment is performed by comparing the pouch containing the grafted fragment, at each time point, with the same pouch in the immediate post surgical moment through a comparison of standardized photographs. Under microscope, the presence of blood vases is considered within the conjunctive tissue of the grafted fragment, as a criterion of its integration. Other events, as keratin secretion, the presence of cellular infiltrated, epithelium and keloid collagen fibers aspects are also analyzed. RESULTS: Macroscopy reveals intensive vascularization of the pouch up to 12 days from the transplantation and the presence of constant dark brown pigmentation on the grafted keloid fragments. In microscopy, the integration of keloid fragments is considered by the presence of blood capillary vases within conjunctive tissue. The presence of intensive cellular inflammatory type infiltrated up to 12 days is also observed, as well as the remaining of keloid epithelium up to 21 days, and the appearing of melanocytes from the day 42. CONCLUSION: Hamster cheek pouch represents, a priori, an experimental model for the investigation of keloid.OBJETIVO: Investigar a integração do transplante heterólogo de quelóide na bolsa jugal do hamster (Mesocricetus auratus). MÉTODOS: A amostragem consiste de 18 hamsters machos, heterogênicos, com 10 a 14 semanas de idade. Fragmentos de quelóide foram obtidos de cicatrizes queloidianas da região mamária de paciente adulta parda. Cada hamster foi enxertado em ambas as bolsas com fragmentos de quelóide, totalizando 36 fragmentos enxertados. Os animais foram distribuídos em 6 grupos para exame dos fragmentos enxertados, com 5, 12, 21, 42, 84 e 168 dias. Uma avaliação macroscópica é realizada comparando a bolsa contendo o fragmento enxertado em cada período com a mesma bolsa no pós-operatório imediato, mediante a comparação de fotografias padronizadas. À microscopia, considera-se a presença de vasos sangüíneos no tecido conjuntivo do fragmento enxertado como critério de integração do mesmo. Outros eventos, como secreção de queratina, presença de infiltrados celulares e aspecto do epitélio e das fibras colágenas do quelóide, também são observados. RESULTADOS: A macroscopia revela intensa vascularização na bolsa até 12 dias de enxertia, e a presença constante de pigmentação castanho-escura nos fragmentos de quelóide enxertados. Na microscopia constata-se a integração dos fragmentos de quelóide pela presença de capilares sangüíneos no tecido conjuntivo. Observa-se, também, a presença de intenso infiltrado celular do tipo inflamatório até 12 dias, a permanência do epitélio do quelóide até 21 dias, e o aparecimento de melanócitos a partir de 42 dias. CONCLUSÃO: A bolsa jugal do hamster representa, a priori, modelo experimental para investigação do quelóide.

To describe the integration process of grafts of total human skin and keloid in hamster (Mesocricetus auratus) cheek pouch, whose sub-epithelium is naturally an "Immunologically Privileged Site". Fragments of human normal skin and keloid from the breast region of mulatto female patients were transplanted into the cheek pouch subepithelium in situ. Surgical procedure and grafted pouches for microscopic exam at several time points of the transplantation were standardized. The integration of grafted fragments of human skin and keloid was seen in late periods (84 days) since the microscopic assessment showed the presence of blood vases within the conjunctive tissue of grafted fragments. It was also possible to see among the grafted fragments the epithelium, the appearing of early cellular infiltrated, epithelial secretion of keratin, the presence of melanocytes, and delayed changes on the aspect of collagen fibers of conjunctive tissue. Pooled results allow to define hamster cheek pouch sub-epithelium as an experimental model to investigating heterologous graft physiology of human total skin and keloid with epithelium.Descrever a integração dos enxertos de pele total humana e quelóide na bolsa jugal do hamster (Mesocricetus auratus), cujo subepitélio é, naturalmente, um "Local de Privilégio Imunológico". Foram transplantados fragmentos, de pele humana normal e de quelóide, obtidos da região mamária de pacientes pardas, no subepitélio da bolsa jugal in situ. O procedimento operatório, e de preparo das bolsas enxertadas para exame microscópico em vários períodos de transplante, foi padronizado. Verificou-se a integração dos fragmentos enxertados de pele humana e de quelóide em períodos tardios (84 dias), uma vez que a avaliação microscópica revelou a presença de vasos sangüíneos no tecido conjuntivo dos fragmentos enxertados. Foi também possível observar, nos fragmentos enxertados, o epitélio, o aparecimento de infiltrado celular incipiente, secreção epitelial de queratina, presença de melanócitos e alterações tardias no aspecto das fibras colágenas do tecido conjuntivo. Os resultados, em conjunto, permitem estabelecer o subepitélio da bolsa jugal do hamster como modelo experimental para investigação da fisiologia de tranplantes heterólogos de pele total humana e quelóide com epitélio.

Syrian golden hamster (Mesocricetus auratus) has in its cheek pouches sub-epithelium an "Immunologically Privileged Site" which allows the integration of homo- and heterologous graft. This paper describes some anatomical and histological characteristics of that site, as well as analyzes aspects related with its immune properties. It also focuses the advantages of this experimental model over other models which are natural or induced carriers of immunodeficiency. Based on both these advantages and literature, this study aims to establish this model, through the performance of heterologous graft, as another option for the investigation of scar disturbances, as keloids and other diseases which may interest Plastic Surgery, as benign cutaneous lesions, and malignant neoplasias such as skin carcinomas and melanomas. The work also addresses perspectives for using this model, which still is a source scarcely known by Brazilian medical class.O hamster sírio dourado (Mesocricetus auratus) possui no subepitélio de suas bolsas jugais um "Local de Privilégio Imunológico", permitindo a integração de homo e heteroenxertos. Este artigo descreve as características anatômicas e histológicas desse local, assim como os aspectos relativos as suas propriedades imunológicas. Cita, também, as vantagens desse modelo experimental sobre outros modelos portadores, naturais ou induzidos, de imunodeficiência. Com base nessas vantagens, e também baseado na literatura, tem o intuito de estabelecer esse modelo, mediante a realização de heteroenxertos, como uma outra opção para investigar distúrbios cicatriciais, como o quelóide, e doenças de interesse em Cirurgia Plástica, como lesões cutâneas benignas e neoplasias malignas como carcinomas e melanoma cutâneo. Tece, ainda, considerações sobre perspectivas de aplicações desse modelo, ainda bastante desconhecido entre a classe médica brasileira.

OBJETIVO: Descrever a integração do transplante heterólogo de quelóide no subepitélio da bolsa jugal do hamster (Mesocricetus auratus). MÉTODOS: A amostragem consiste de 18 hamsters machos, não isogênicos, com 10 a 14 semanas de idade. Fragmentos de quelóide foram obtidos de cicatrizes queloideanas da região mamária de paciente adulta parda. Cada hamster foi enxertado em ambas as bolsas com fragmentos de quelóide, totalizando 36 fragmentos enxertados. Os animais foram distribuídos, em 6 grupos, para exame dos fragmentos enxertados com 5, 12, 21, 42, 84 e 168 dias. Uma avaliação macroscópica é realizada comparando a bolsa contendo o fragmento enxertado em cada período com a mesma bolsa no pós-operatório imediato, mediante a comparação de fotografias padronizadas. À microscopia, considera-se a presença de vasos sangüíneos no tecido conjuntivo do fragmento enxertado como critério de integração do mesmo. Outros eventos, como secreção de queratina, presença de infiltrados celulares e aspecto do epitélio e das fibras colágenas do quelóide, também são observados. RESULTADOS: A macroscopia revela intensa vascularização na bolsa até 12 dias de enxertia, e a presença constante de pigmentação castanho-escura nos fragmentos de quelóide enxertados. Na microscopia constata-se a integração dos fragmentos de quelóide pela presença de capilares sangüíneos no tecido conjuntivo. Observa-se, também, a presença de intenso infiltrado celular do tipo inflamatório até 12 dias, a permanência do epitélio do quelóide até 21 dias, e o aparecimento de melanócitos a partir de 42 dias. CONCLUSÃO: A bolsa jugal do hamster representa, a priori, modelo experimental para investigação do quelóide.

Se realizó un estudio con 80 pacientes en edades comprendidas entre 15 y 25 años, de cualquier raza y sexo que presentan queloides en cualquier parte del cuerpo, dividiéndose en 2 grupos, según tabla aleatoria confeccionada para este fin. Se le aplicó a un grupo un producto denominado quelbén, elaborado a base de lodo termal, y al otro grupo una crema esteroidea al 2 % en un período de 6 meses de tratamiento. La respuesta clínica al tratamiento se midió a través de 3 parámetros: el tamaño de la lesión y el grosor, la consistencia de la lesión, así como los síntomas subjetivos (prurito, dolor, hiperestesias y tirantez) acompañantes de la lesión. La respuesta al tratamiento con el quelbén fue favorable ya sea en pacientes limpios (11) o respondedores (21), lo que representa un 91,43 % en lo referente al grupo A, con una ostensible superioridad en cuanto a la eficacia del tratamiento en comparación con el grupo B (68,57 %), en el que se utilizó la crema esteroidea al 2 %.A study was conducted on 80 patients aged 15-25 years of any race and sex, who presented with keloids located in any part of their bodies. They were divided into two groups according to a random table designed for this end. One group was treated with a thermal mud-based product called quelbén and the other group was applied a 2% steroid cream for a period of 6 months. The clinical response to the treatment was evaluated on the basis of three parameters: size and thickness of lesion, consistency of lesion and accompanying subjective symptoms (rush, pain, hyperesthesia and tightness. The response to treatment with quelbén was positive either in clean patients (11) or responders to the treatment (21), which represented 91.3% in group A, a remarkably higher effectiveness of this treatment over the 2% steroidal cream used in group B (68.57%)

Leprosy is an infectious disease that can be disabling if not treated early, but it also is curable if treated correctly, in almost all of cases. About 20 to 50% of all patients with leprosy develop a reactionary state during the course of the disease, more often after the start of polychemotherapy for leprosy, however this may occur before or after the treatment. Maybe leprosy would not have such a great impact if such reactionary states did not occur. Type 1 reactions or reversal reactions take place mainly in pa-tients with tuberculoid leprosy, borderline leprosy, and borderline lepromatous leprosy. We present a case of a 52 years old male patient who came for an outpatient consultation at the ASA-FIOCRUZ Leprosy Service with skin lesions associated to myalgia and paresthesia. After the clinical and paraclinical evaluation it was identified that the keloid-like lesions were an atypical presentation of lepromatous reverse reaction. [ABSTRACT FROM AUTHOR]