Hyperbaric oxygen therapy improves the effect of keloid surgery and radiotherapy by reducing the recurrence rate

Abstract

Objective: Keloids are exuberant cutaneous scars that form due to abnormal growth of fibrous tissue following an injury. The primary aim of this study was to assess the efficacy and mechanism of hyperbaric oxygen therapy (HBOT) to reduce the keloid recurrence rate after surgical excision and radiotherapy. Methods: (1) A total of 240 patients were randomly divided into two groups. Patients in the HBOT group (O group) received HBOT after surgical excision and radiotherapy. Patients in the other group were treated with only surgical excision and radiotherapy (K group). (2) Scar tissue from recurrent patients was collected after a second operation. Hematoxylin and eosin (H&E) staining was used to observe keloid morphology. Certain inflammatory factors (interleukin-6 (IL-6), hypoxia-inducible factor-1α (HIF-1α), tumor necrosis factor-α (TNF-α), nuclear factor κB (NF-κB), and vascular endothelial growth factor (VEGF)) were measured using immunohistochemical staining. Results: (1) The recurrence rate of the O group (5.97%) was significantly lower than that of the K group (14.15%), P<0.05. Moreover, patients in the O group reported greater satisfaction than those in the K group (P<0.05). (2) Compared with the recurrent scar tissue of the K group, the expression levels of the inflammatory factors were lower in the recurrent scar tissue of the O group. Conclusions: Adjunctive HBOT effectively reduces the keloid recurrence rate after surgical excision and radiotherapy by improving the oxygen level of the tissue and alleviating the inflammatory process.

Therapeutic Strategies by Regulating Interleukin Family to Suppress Inflammation in Hypertrophic Scar and Keloid

“…Some molecules may have two sides and differ strongly functions in varied pathways, which results in potentially contradictory outcomes. For example, in the treatment of keloid with HBOT, song ( Song et al, 2018 ) observed that it could reduce the formation of scar by reducing inflammatory factors such as IL-6 and IL-8, while another experiment (Y. Hao et al, 2020 ) did not observe the same changes, but the alterations in expression of IL-12p40 and IL-RA were observed.…”

“…According to the mechanism of hypoxia-induced inflammation, several clinical experiments confirmed that adjuvant hyperbaric oxygen treatment (HBOT) reduced the inflammatory reaction and recurrence rate by regulating the oxygen level. In Song’s study ( Song et al, 2018 ), 240 patients with keloid were recruited and randomly divided into two groups, Group O receiving HBOT after surgical resection and radiotherapy and Group K as control. After HBOT, both the infiltration of inflammatory cells and the expression of inflammatory factors such as IL-6, HIF-1 α, TNF-α, NF-κ B and VEGF obviously decreased.…”

Characteristics of Tumor Immune Gene and Immune Cell Infiltration during Keloid Formation

“…Among the miRNAs involved in keloid pathogenesis, miRNA-21, miRNA-141-3p, miRNA-181a, and miRNA-205 were thought to upregulate broblast proliferation and depress apoptosis of keloid-derived broblasts through the PI3K/Akt/mammalian target of rapamycin (mTOR) signaling pathway [17]. Drugs that indirectly target the biochemical microenvironments of keloids include growth factors (e.g., TGF-bs, bFGF, and VEGF), immunomodulators (e.g., tacrolimus, trehalose, IFN, and imiquimod), and anti-in ammatory drugs (e.g., IL-10 and IL-6) [18][19][20][21][22][23][24]. Based on the above research, we believe that keloid patients have abnormal gene expression compared to ordinary people.…”

Keloid Scars: An Updated Review of Combination Therapies

“…However, when dual therapy consisting of excision plus radiation was compared to excision, radiation, and another treatment (either hyperbaric oxygen or platelet-rich plasma therapy), a statistical difference was observed [ 19 ]. Hyperbaric oxygen and platelet-rich plasma therapy for keloids is not sufficiently studied, but both options have shown promise when used in combination with at least two additional treatment modalities [ 20 , 21 ].…”