Keloids and Hypertrophic Scars: Pathophysiology, Classification, and Treatment
Keloids and Hypertrophic Scars: Pathophysiology, Classification, and Treatment
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DOI：
10.1097/dss.0000000000000819
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发表时间：
2017-01-01
影响因子：
2.4
通讯作者：
Raphael, Brian
中科院分区：
文献类型：
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作者：
Berman, Brian;Maderal, Andrea;Raphael, Brian
瘢痕疙瘩和增生性瘢痕代表了对伤口愈合过程的异常反应。这些瘢痕的特征在于生长失调和过度的胶原蛋白形成，并且可能对患者造成美容和功能破坏。目的：描述瘢痕疙瘩和增生性瘢痕的病理生理学，并比较其与正常伤口愈合过程的差异。瘢痕疙瘩和增生性瘢痕的分类进行了讨论。最后，详细描述了各种治疗选择，包括预防、常规治疗、手术治疗和辅助治疗。材料和方法进行文献回顾，识别有关瘢痕疙瘩和增生性瘢痕的病理生理学、分类和治疗的相关出版物。包括白细胞介素（IL）-6、IL-8和IL-10，以及各种生长因子，包括转化生长因子-β和血小板衍生生长因子。对于瘢痕疙瘩和增生性瘢痕，已经研究了许多治疗方法，包括常规治疗如封闭敷料、压迫疗法和类固醇;手术治疗如切除和冷冻手术;以及辅助和新兴疗法，包括放射疗法、干扰素、5-氟尿嘧啶、咪喹莫特、他克莫司、西罗莫司、博来霉素、多柔比星、转化生长因子-β、表皮生长因子、维拉帕米、视黄酸，他莫昔芬，肉毒杆菌毒素A，洋葱提取物，硅基伪装，水凝胶支架，和皮肤张力卸载device.Conclusion瘢痕疙瘩和增生性瘢痕仍然是一个具有挑战性的条件，与潜在的美容和功能的后果，患者。存在通过不同机制起作用的几种疗法。对该病发病机制的深入了解将有助于开发新的、更有针对性的治疗方法。
BACKGROUND Keloid and hypertrophic scars represent an aberrant response to the wound healing process. These scars are characterized by dysregulated growth with excessive collagen formation, and can be cosmetically and functionally disruptive to patients. OBJECTIVE Objectives are to describe the pathophysiology of keloid and hypertrophic scar, and to compare differences with the normal wound healing process. The classification of keloids and hypertrophic scars are then discussed. Finally, various treatment options including prevention, conventional therapies, surgical therapies, and adjuvant therapies are described in detail.MATERIALS AND METHODS Literature review was performed identifying relevant publications pertaining to the pathophysiology, classification, and treatment of keloid and hypertrophic scars.RESULTS Though the pathophysiology of keloid and hypertrophic scars is not completely known, various cytokines have been implicated, including interleukin (IL)-6, IL-8, and IL-10, as well as various growth factors including transforming growth factor-beta and platelet-derived growth factor. Numerous treatments have been studied for keloid and hypertrophic scars, which include conventional therapies such as occlusive dressings, compression therapy, and steroids; surgical therapies such as excision and cryosurgery; and adjuvant and emerging therapies including radiation therapy, interferon, 5-fluorouracil, imiquimod, tacrolimus, sirolimus, bleomycin, doxorubicin, transforming growth factor-beta, epidermal growth factor, verapamil, retinoic acid, tamoxifen, botulinum toxin A, onion extract, silicone-based camouflage, hydrogel scaffold, and skin tension offloading device.CONCLUSION Keloid and hypertrophic scars remain a challenging condition, with potential cosmetic and functional consequences to patients. Several therapies exist which function through different mechanisms. Better understanding into the pathogenesis will allow for development of newer andmore targeted therapies in the future.