A Case of Keloids Complicated by Castleman’s Disease: Interleukin-6 as a Keloid Risk Factor

Quong, Whitney L.; Kozai, Yasuji; Ogawa, Rei

doi:10.1097/gox.0000000000001336

Cited by 21 publications

(14 citation statements)

References 11 publications

(13 reference statements)

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“…This chronic inflammation is largely driven by mechanical tension on the wound/scar edges, although it can also be worsened by systemic factors such as hypertension, 16 pregnancy (sex hormones), 17 and conditions that associate with high circulating levels of inflammatory cytokines such as interleukin-6. 18 In particular, the cyclical skin stretching that occurs during daily bodily movements is a strong keloidogenic factor. 2,3 The anterior chest skin is especially prone to such mechanical stresses given its constant motion due to arm movements.…”

Section: Discussionmentioning

confidence: 99%

Z-plasty and Postoperative Radiotherapy for Anterior Chest Wall Keloids: An Analysis of 141 Patients

Arima

Dohi

Kuribayashi

et al. 2019

Plastic and Reconstructive Surgery - Global Open

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Background: The therapies for anterior chest wall keloids include surgical excision, postoperative radiotherapy, silicone taping stabilization, and steroid plaster. However, to date, there is no universally accepted combination treatment strategy for anterior chest wall keloids. Methods: All consecutive patients with single or multiple anterior chest wall keloids who underwent keloid excision, tension-reducing suturing, z-plasty, and postoperative radiotherapy in 2013–2016 in Nippon Medical School were included in this case series study. Only keloids that arose from small injuries such as folliculitis or acne were selected. The surgery was followed by tension-reducing self-management of the wounds with silicone tape and steroid plaster. The postsurgical radiotherapy modality was 18 Gy administered in 3 fractions over 3 days. The primary study outcome was keloid recurrence during the 24-month follow-up period. Recurrence was defined as the development of stiff and red lesions in even a small part of the scar that did not respond to 6 months of steroid plaster therapy. Results: In total, 141 patients with 141 lesions were enrolled. Of the 141 lesions, 15 (10.6%) recurred. All recurrences were successfully treated by steroid plaster and steroid injection. The recurrence patients did not differ from the nonrecurrence patients in terms of the size of the original keloid or gender distribution. Conclusions: Anterior chest wall keloids can be successfully treated by customized plans that involve appropriate surgical modalities (including z-plasty) followed by postoperative radiotherapy (18 Gy in 3 fractions over 3 days) and scar self-management with silicone tape and steroid plaster.

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Section: Discussionmentioning

confidence: 99%

Z-plasty and Postoperative Radiotherapy for Anterior Chest Wall Keloids: An Analysis of 141 Patients

Arima

Dohi

Kuribayashi

et al. 2019

Plastic and Reconstructive Surgery - Global Open

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“…Systemic factors can influence keloid and hypertrophic scar progression: both lesion forms are known to worsen in pregnant women [7, 8] and in patients with hypertension [9]. The lesions are also exacerbated by conditions that increase the levels of inflammatory cytokines, including IL-6 in the blood [10]. Conversely, empirical observations have shown that keloids and hypertrophic scars improve when pseudomenopausal therapy for such as uterine fibrosis and endometoriosis is instituted.Local stretching that places the skin under tension exacerbates keloids and hypertrophic scars [11].…”

Section: Main Contextmentioning

confidence: 99%

Diagnosis and Treatment of Keloids and Hypertrophic Scars—Japan Scar Workshop Consensus Document 2018

et al. 2019

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There has been a long-standing need for guidelines on the diagnosis and treatment of keloids and hypertrophic scars that are based on an understanding of the pathomechanisms that underlie these skin fibrotic diseases. This is particularly true for clinicians who deal with Asian and African patients because these ethnicities are highly prone to these diseases. By contrast, Caucasians are less likely to develop keloids and hypertrophic scars, and if they do, the scars tend not to be severe. This ethnic disparity also means that countries vary in terms of their differential diagnostic algorithms. The lack of clear treatment guidelines also means that primary care physicians are currently applying a hotchpotch of treatments, with uneven outcomes. To overcome these issues, the Japan Scar Workshop (JSW) has created a tool that allows clinicians to objectively diagnose and distinguish between keloids, hypertrophic scars, and mature scars. This tool is called the JSW Scar Scale (JSS) and it involves scoring the risk factors of the individual patients and the affected areas. The tool is simple and easy to use. As a result, even physicians who are not accustomed to keloids and hypertrophic scars can easily diagnose them and judge their severity. The JSW has also established a committee that, in cooperation with outside experts in various fields, has prepared a Consensus Document on keloid and hypertrophic scar treatment guidelines. These guidelines are simple and will allow even inexperienced clinicians to choose the most appropriate treatment strategy. The Consensus Document is provided in this article. It describes (1) the diagnostic algorithm for pathological scars and how to differentiate them from clinically similar benign and malignant tumors, (2) the general treatment algorithms for keloids and hypertrophic scars at different medical facilities, (3) the rationale behind each treatment for keloids and hypertrophic scars, and (4) the body site-specific treatment protocols for these scars. We believe that this Consensus Document will be helpful for physicians from all over the world who treat keloids and hypertrophic scars.

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“…24 In addition, we observed a case where the modest auricular keloid of a Japanese woman became severely exacerbated 11 years after its onset when she developed the rare lymphoproliferative disorder called angiofollicular lymph node dysplasia (also called Castleman's disease), which is characterized by significantly elevated circulating IL-6 levels. 25…”

Section: Il-6mentioning

confidence: 99%

Systemic factors that shape cutaneous pathological scarring

Huang

Ogawa

2020

FASEB j.

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Cutaneous pathological scars are fibrotic lesions that grow continuously, invade the adjacent skin, and are erythematous, itchy, and painful. Their etiology remains unclear but may involve genetic, local mechanical, and systemic factors. Here, we will summarize the main systemic factors that shape cutaneous pathological scarring, especially keloid formation and aggravation. They include circulating cytokines, chemokines, growth factors, particular cell types, sex hormones, the systemic renin‐angiotensin system, and vitamin D, all of which directly shape the angiogenesis, inflammation, fibrosis, and remodeling in pathological scars. There are also several environmental factors that more indirectly influence pathological scar formation or progression, namely diet, smoking, psychological stress, and exercise. Notably, much of the evidence on these systemic factors focus on their effects on one pathological scar characteristic, namely their fibrosis. However, systemic factors probably also shape other pathological scar characteristics. We describe two new avenues of keloid research that may greatly improve our understanding of pathological scarring and the systemic factors that affect it. One is the multiple similarities between keloids and tumors; the other is the different stem‐cell populations in keloids. We expect this research will greatly aid the development of diagnostic biomarkers for cutaneous pathological scars and drugs/techniques/regimens that prevent, improve, or cure these scars.

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A Case of Keloids Complicated by Castleman’s Disease: Interleukin-6 as a Keloid Risk Factor

Cited by 21 publications

References 11 publications

Z-plasty and Postoperative Radiotherapy for Anterior Chest Wall Keloids: An Analysis of 141 Patients

Z-plasty and Postoperative Radiotherapy for Anterior Chest Wall Keloids: An Analysis of 141 Patients

Diagnosis and Treatment of Keloids and Hypertrophic Scars—Japan Scar Workshop Consensus Document 2018

Systemic factors that shape cutaneous pathological scarring

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