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Chirurgie 1. April 2012

An overview of the pathogenesis, prevention and treatment of keloids

BACKGROUND: Keloids are pathological scars that arise from a fibroproliferative disorder of the skin, which causes injured skin to undergo abnormal wound healing. Recent studies suggest that keloid scarring may be a "multifactorial disorder" that is driven by various genetic factors along with local mechanophysiological skin factors. Thus, it appears that keloid scarring is a hyperplastic disorder of the skin that is determined by local factors rather than being a neoplasm like benign skin tumors, which can occur all over the body. This paper presents a review of previous papers and proposes new strategies for the prevention and treatment of keloids. METHODS: Review. RESULTS: To prevent the development of keloids, it is important to remove four primary factors that hamper proper wound healing, namely an inadequately moist environment, strong mechanical forces on the wound, foreign body reactions and allergies, and infections. If these factors are allowed to influence a wound, they can cause strong and continuous inflammation that can produce noticeable and/or growing keloids. Keloids can be treated by surgical methods, including tension-reduction sutures, z-plasties, core incision methods, and flap surgery. Adjuvant therapies of surgical or non-surgical therapies include corticosteroid injection, laser therapy (dye or Nd:YAG lasers), cryotherapy, radiotherapy, antitumor/immunosuppressive agents, stabilization/compression therapy, and make-up therapy. CONCLUSIONS: Over the last decade, many high quality studies that address keloid management and treatment have been performed. There is now sufficient evidence-based information for keloid treatment. This is likely to improve significantly as our knowledge of scar biology progresses and new agents to treat keloids are developed.

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