Keloid treatments: an evidence-based systematic review of recent advances

Laura A. Walsh1,2, Ellen Wu1 , David Pontes1 , Kevin R. Kwan1 , Sneha Poondru2 , Corinne H. Miller1 and Roopal V. Kundu1,2*

*Correspondence:

Roopal V. Kundu 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。

1 Northwestern University Feinberg School of Medicine, Chicago, IL, USA

2 Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA

Abstract

Background Keloids are pathologic scars that pose a significant functional and cosmetic burden. They are challenging to treat, despite the multitude of treatment modalities currently available.

Objective The aim of this study was to conduct an evidence-based review of all prospective data regarding keloid treatments published between 2010 and 2020.

Methods A systematic literature search of PubMed (National Library of Medicine), Embase (Elsevier), and Cochrane Library (Wiley) was performed in November of 2020. Search strategies with the keywords “keloid” and “treatment” were performed by a medical librarian. The search was limited to prospective studies that were peer-reviewed, reported on clinical outcomes of keloid therapies, and were published in the English language between January 1, 2010, and November 24, 2020.

Results A total of 3462 unique citations were identified, of which 108 studies met inclusion criteria. Current literature supports silicone gel or sheeting with corticosteroid injections as first-line therapy for keloids. Adjuvant intralesional 5-fuorouracil (5-FU), bleomycin, or verapamil can be considered, although mixed results have been reported with each. Laser therapy can be used in combination with intralesional corticosteroids or topical steroids with occlusion to improve drug penetration. Excision of keloids with immediate post-excision radiation therapy is an effective option for recalcitrant lesions. Finally, silicone sheeting and pressure therapy have evidence for reducing keloid recurrence.

Conclusions This review was limited by heterogeneity of subject characteristics and study outcome measures, small sample sizes, and inconsistent study designs. Larger and more robust controlled studies are necessary to further understand the variety of existing and emerging keloid treatments, including corticosteroids, cryotherapy, intralesional injections, lasers, photodynamic therapy, excision and radiation, pressure dressings, and others.

Severe skin and soft tissue infection in the left upper limb caused by Aeromonas veronii: a case report

Linhui Li1†, Jie Huang1†, Long Xu1 , Guangyi Wang1 , Shichu Xiao1 , Zhaofan Xia1 , Qin Qin2 , Yazhou Li2 and Shizhao Ji1* iD

† Linhui Li and Jie Huang contributed equally to this work.

*Correspondence:

Shizhao Ji

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1 Department of Burns, Burn Institute of PLA, The First Affiliated Hospital of Naval Medical University, No. 168 Changhai Road, Yangpu District, Shanghai 200433, China

2 Department of Laboratory Diagnosis, The First Affiliated Hospital of Naval Medical University, No. 168 Changhai Road, Yangpu District,

Shanghai 200433, China

Abstract

Introduction Skin and soft tissue infections are common because of exposure to aquatic environment, while severe infections caused by Aeromonas veronii are rare.

Case presentation We report a case of severe skin and soft tissue infection of the left upper limb caused by Aeromonas veronii. A 50-year-old Chinese woman, who had a history of cardiac disease and type 2 diabetes mellitus, accidentally injured her left thumb while cutting a fish. Early antibiotic therapy and surgical debridement was performed before the result of bacterial culture came back. Whole-genome sequencing was further performed to confirm the pathogen and reveal the drug resistance and virulence genes. The wound was gradually repaired after 1 month of treatment, and the left hand recovered well in appearance and function after 3 months of rehabilitation.

Conclusion Early diagnosis, surgical intervention, and administration of appropriate antibiotics are crucial for patients who are suspected of having skin and soft tissue infection, or septicemia caused by Aeromonas veronii.

Keywords Aeromonas veronii, Wound infection, Antibiotic therapy, Whole-genome sequencing, Case report

Role of vitamin D and calcium signaling in epidermal wound healing

D. Bikle1

Received: 19 April 2022 / Accepted: 31 July 2022 / Published online: 13 August 2022

© The Author(s), under exclusive licence to Italian Society of Endocrinology (SIE) 2022

D. D. Bikle

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1 Department of Medicine and Dermatology, University of California San Francisco, San Francisco VA Medical Center, San Francisco, USA

Abstract

Purpose This review will discuss the role of vitamin D and calcium signaling in the epidermal wound response with particular focus on the stem cells of the epidermis and hair follicle that contribute to the wounding response.

Methods Selected publications relevant to the mechanisms of wound healing in general and the roles of calcium and vitamin D in wound healing in particular were reviewed.

Results Following wounding the stem cells of the hair follicle and interfollicular epidermis are activated to proliferate and migrate to the wound where they take on an epidermal fate to re-epithelialize the wound and regenerate the epidermis. The vitamin D and calcium sensing receptors (VDR and CaSR, respectively) are expressed in the stem cells of the hair follicle and epidermis where they play a critical role in enabling the stem cells to respond to wounding. Deletion of Vdr and/or Casr from these cells delays wound healing. The VDR is regulated by co-regulators such as the Med 1 complex and other transcription factors such as Ctnnb (beta-catenin) and p63. The formation of the Cdh1/Ctnn (E-cadherin/catenin) complex jointly stimulated by vitamin D and calcium plays a critical role in the activation, migration, and re-epithelialization processes.

Conclusion Vitamin D and calcium signaling are critical for the ability of epidermal and hair follicle stem cells to respond to wounding. Vitamin D deficiency with the accompanying decrease in calcium signaling can result in delayed and/or chronic wounds, a major cause of morbidity, loss of productivity, and medical expense.

Keywords Vitamin D · Calcium · Keratinocytes · Wounding · p63 · Stem cells

Patients’ perception of changes and consequences after tumor resection

A qualitative study in Austrian patients with musculoskeletal malignancies

Carmen Trost iD Stephan Heisinger · Philipp T. Funovics · Reinhard Windhager · Gerhard M. Hobusch · Tanja Stamm  iD

Received: 16 May 2022 / Accepted: 24 November 2022 © The Author(s) 2023

Summary

      Objective The aim of this study was to investigate the effects and consequences of surgical treatment of patients with musculoskeletal malignancies on everyday Methods A modified form of grounded theory was

used for data collection and analysis. Data collection was systematic and analyzed simultaneously and 16 interviews were conducted: 2 narrative, 11 guided and 3 expert interviews (surgeon, physical therapist, support group). Data collection and analysis alternated until no new codes could be found. Once theoretical saturation was achieved, the main category was formed and described using the literature.

Results The main category results from the combination of all categories and leads to the core category. In the center is the affected person and in the immediate environment are the patient’s relatives/partners. In the next instance the primary care physician is necessary to establish a sense of normalcy. This depends on the individuality of the person and the restored possibilities of movement.

Conclusion Based on the results, the necessity of implementing psychosocial care involving the social environment is shown. The importance of relatives/ partners for recovery is emphasized. Furthermore, the communication between the specialists and family physicians should be simplified.

Availability of data and material The data were pseudonymized/anonymized and stored according to the guidelines of the Medical University of Vienna. The authors have full control of all primary data and agree to allow the journal to review their data if requested.

Code availability The commercial qualitative Software Atlas.ti 1.6.0 (484) (ATLAS.ti Scientific Software Development GmbH [ATLAS.ti 20 Mac] (2020). Retrieved from https:// atlasti.com) has been used for this study. No code is available.

Supplementary Information The online version of this article (https://doi.org/10.1007/s00508-022-02136-6) contains supplementary material, which is available to authorized users.

Dr.scient.med. C. Trost, BA MA ( ) · S. Heisinger · P. T. Funovics · R. Windhager · G. M. Hobusch

Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18–20, 1090 Vienna, Austria

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Keywords Qualitative research · Health-professional patient communication · Patients’ perception · General practitioners · Musculoskeletal malignancies · Patients’ needs

Outcome of burn injury and associated factor among patient visited at Addis Ababa burn, emergency and trauma hospital: a two years hospital-based cross-sectional study

Damena Mulatu1 , Ayalew Zewdie2 , Biruktawit Zemede2 , Bewuketu Terefe3 and Bikis Liyew4*

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4 Department of Emergency and Critical Care Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, P.O.BOX 196, Gondar, Ethiopia Full list of author information is available at the end of the article

© The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativeco mmons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Abstract

Background: Burn is one of the critical health problems worldwide. Developing countries with sub-Saharan and Asian populations are affected more. Its mortality and non-fatal complications depend on several factors including age, sex, residency, cause, the extent of the burn, and time and level of care given.

Objective: The purpose of this study was to assess the outcome of burn injury and its associated factor among patients who visited Addis Ababa burn emergency and trauma hospital.

Methods: The institutional-based, retrospective cross-sectional study design was conducted from April 1, 2019, to March 30, 2021. After checking the data for its consistency the data were entered and analyzed by using SPSS version 25. A total of 241 patients who had visited Addis Ababa burn, emergency and trauma Hospitals after sustained burn injury were recruited through convenience sampling method for final analysis. Model goodness-of-ft was checked by Hosmer and Lemeshow test (0.272). After checking multi-collinearity both the bi-variable and multivariable logistic regression model was fitted and variables having a p-value less than or equal to 0.05 at 95% CI in the multivariable analysis were considered statistically significant.

Result: Adults (age 15 to 60 years) are the most affected groups accounting for 55.2% followed by pediatric age groups (age <15 years) (43.6%) and the elderly (age > 60 years) (1.2%). Scald burn was the major cause accounting for 39 % followed by Flame burn (33.6%), Electrical burn (26.6%), and chemical burn (0.8%). The mean TBSA% was 15.49%, ranging from1% to 64%. Adult males are more affected by electrical burns while adult females and the elderly encounter fame burn. 78.4% of patients were discharged without complications, 14.9% were discharged with complications and 6.6% died. The commonest long-term complication is the amputation of the extremity (19, 7.9%). Age greater than 60 years and TBSA% greater than 30% is a strong predictors of mortality with odds of 2.2 at 95% CI of [1.32, 3.69] and 8.7 at 95% CI of [1.33, 57.32] respectively.

Conclusion and recommendation: The mortality rate show decrement from previous studies. Overall scald burn is common in all age groups but electrical burns and fame burns affected more adult and elderly age groups. Extremities were by far, the commonest affected body parts. The extent of burn injury and the age of the patient independently predict mortality. Early intervention will reduce mortality and complications.

Keywords: Burn injuries, Magnitude, Outcome, Total body surface area percentage, Addis Ababa burn, Emergency and trauma hospital

Compression Therapy in Dermatology

Marco Romanelli1  iD  Flavia Manzo Margiotta1  · Alessandra Michelucci1  · Giammarco Granieri1  · Agata Janowska1  · Valentina Dini1

Marco Romanelli

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1 Dermatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56122 Pisa, Italy Accepted: 8 March 2023 © The Author(s) 2023

Abstract

Purpose of Review The compression therapy provides valuable support during management of vascular and inflammatory lower leg skin disorders. The review outlines the mechanism of action and the treatment options available with indications for use in wound management and general dermatology.

Recent Findings Atypical wounds such as pyoderma gangrenosum, cutaneous vasculitis and other inflammatory skin diseases may benefit from the use of compression therapy. Adherence to treatment is always a challenging aspects for

patients and caregiver, but modern technologies and specific materials have improved the compliance during treatment.

Summary Compression therapy is a main option in vascular ulcer management. The technology provided by different

devices together with new methods of bandaging application have increased the outcomes and acceptability from patients.

Physicians should be aware of the advantages provided by compression therapy in skin diseases.

Keywords Compression therapy · Bandaging system · Chronic wounds · Wound management