The Use of Chemotherapeutics for the Treatment of Keloid Scars.
The Use of Chemotherapeutics for the Treatment of Keloid Scars.
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DOI：
10.4081/dr.2015.5880
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发表时间：
2015-05-21
影响因子：
1.1
通讯作者：
Tehrani H
中科院分区：
文献类型：
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作者：
Jones CD;Guiot L;Samy M;Gorman M;Tehrani H
瘢痕疙瘩是病理性瘢痕，其是皮肤损伤后过度的真皮组织增殖的结果，并且经常引起身体、心理和美容问题。关于瘢痕疙瘩形成存在各种理论，但确切的病理生理学事件仍不清楚。许多不同的治疗方式已经涉及到他们的管理，但目前还没有完全令人满意的方法来治疗所有的瘢痕疙瘩病变。我们回顾了一些不同的化疗药物已被提出用于治疗瘢痕疙瘩和增生性瘢痕，同时深入了解一些新的化疗药物，目前正在研究。使用预定义的PubMed检索策略，确定了评价不同化疗药物（如5-氟尿嘧啶（5-FU）、丝裂霉素C、博来霉素和类固醇注射液）单独或与其他化疗药物或替代治疗方式联合治疗瘢痕疙瘩的影响的非随机试验。27篇论文被发现。在大多数5-FU治疗的病例中发现瘢痕改善≥ 50%，丝裂霉素C、博莱霉素和类固醇注射的结果相似。与单药治疗相比，5-FU和类固醇联合病灶内注射产生了统计学显著性改善。单药治疗的复发率范围为0 - 47%（5-FU）、0 - 15%（博莱霉素）和0 - 50%（类固醇注射）。然而，手术切除和辅助5-FU或类固醇注射形式的联合治疗表现出较低的复发率，分别为19%和6%。目前，大多数文献支持使用联合治疗（通常是手术和辅助化疗）作为瘢痕疙瘩的主要治疗方法，但需要进一步研究以确定更长时间内的成功率。此外，有可能开发新的治疗方法，但需要进一步研究以阐明其真正的疗效。
Keloid scars are pathological scars, which develop as a result of exaggerated dermal tissue proliferation following cutaneous injury and often cause physical, psychological and cosmetic problems. Various theories regarding keloidogenesis exist, however the precise pathophysiological events remain unclear. Many different treatment modalities have been implicated in their management, but currently there is no entirely satisfactory method for treating all keloid lesions. We review a number of different chemotherapeutic agents which have been proposed for the treatment of keloid and hypertrophic scars while giving insight into some of the novel chemotherapeutic drugs which are currently being investigated. Non-randomized trials evaluating the influence of different chemotherapeutic agents, such as 5-fluorouracil (5-FU); mitomycin C; bleomycin and steroid injection, either alone or in combination with other chemotherapeutic agents or alternative treatment modalities, for the treatment of keloids were identified using a predefined PubMed search strategy. Twenty seven papers were identified. Scar improvement ≥50% was found in the majority of cases treated with 5-FU, with similar results found for mitomycin C, bleomycin and steroid injection. Combined intralesional 5-FU and steroid injection produced statistically significant improvements when compared to monotherapy. Monotherapy recurrence rates ranged from 0-47% for 5-FU, 0-15% for bleomycin and 0-50% for steroid injection. However, combined therapy in the form of surgical excision and adjuvant 5-FU or steroid injections demonstrated lower recurrence rates; 19% and 6% respectively. Currently, most of the literature supports the use of combination therapy (usually surgery and adjuvant chemotherapy) as the mainstay treatment of keloids, however further investigation is necessary to determine success rates over longer time frames. Furthermore, there is the potential for novel therapies, but further investigation is required to elucidate their true efficacy.