Prevention of Earlobe Keloid Recurrence with Postoperative Corticosteroid Injections Versus Radiation Therapy A Randomized, Prospective Study and Review of the Literature

Sclafani, Anthony P.; Gordon, Lawrence H.; Chadha, Manjeet; Romo, Thomas

doi:10.1111/j.1524-4725.1996.tb00376.x

Cited by 130 publications

(93 citation statements)

References 28 publications

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“…Recurrence rates of as low as 2%, but up to 50%, have been reported following postoperative external-beam radiotherapy 21,22 . A randomized controlled trial of earlobe keloid excision followed by either intralesional steroid injection or radiotherapy has shown that radiotherapy has a lower recurrence rate than that of steroid injection, a statistically significant difference was not observed 23 .…”

Section: Discussionmentioning

confidence: 99%

“…The use of steroid injections as an adjunctive procedure after keloid excision had been reported with using various dosages, schedules and concentrations of drug. When excision was combined with postoperative intralesional triamcinolone acetonide injection, the recurrence rates were 0∼86.7% (Table 2) 8,13,23,[25][26][27][28] . Table 2 showed that the recurrence rates (0∼33.3%) for the ear keloids were lower than those for keloids other sites and our study showed a 16.6% recurrence rate.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Surgery and Perioperative Intralesional Corticosteroid Injection for Treating Earlobe Keloids: A Korean Experience

et al. 2009

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Background:The aesthetic implications of ear keloids, which affect people of all races, are serious and the treatment of earlobe keloids is known to be difficult. The high rate of recurrence following excision alone has led to investigating various types of adjuvant therapy, including intralesional corticosteroid injection. Objective: We evaluated the efficacy of excision combined with perioperative intralesional triamcinolone acetonide injection for treating earlobe keloids of Korean patients. Methods: From 1997 to 2006, eighteen keloids on the earlobes of fifteen Korean patients were treated. The patient age ranged from 15 to 32 years (mean age: 24 years). All the patients were female and the keloids occurred after ear piercing. Preoperative intralesional triamcinolone acetonide (TA) injection was administered twice at a 1-month interval. Postoperative intralesional TA injections were given every 1 month for several months, depending on the patient's clinical progress. Results: The follow-up period ranged from 4 to 42 months (mean: 18.5 months). After the surgery, TA intralesional injections were given 2 to 13 times (mean: 5.2 times). Of the treated keloids, eleven showed good results (61.1%) and three recurred (16.6%). No complications from the TA intralesional injection were observed. Conclusion: Among the various treatments for earlobe keloids, we suggest that excision with corticosteroid intralesional injection can be used as the first line therapy when considering its effect and economic advantage. (Ann Dermatol 21(3) 221∼225, 2009)

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Surgery and Perioperative Intralesional Corticosteroid Injection for Treating Earlobe Keloids: A Korean Experience

et al. 2009

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“…63,65,66 A randomized controlled trial treating 42 patients with 50 earlobe keloids using intralesional steroid injections, and comparing these patients with a group who had postoperative radiotherapy, noted no significant differences in recurrence rate. 67 A recent case report of a giant keloid scar on the buttock reported the use of radiotherapy after surgical excision. 60 This adjuvant treatment was successful in preventing recurrence within 36 months.…”

Section: Radiotherapymentioning

confidence: 99%

Strategic management of keloid disease in ethnic skin: a structured approach supported by the emerging literature

Uddin

Bayat

2013

Br J Dermatol

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SummaryKeloid disease (KD) is a common, benign, dermal fibroproliferative growth of unknown aetiology. Lesions tend to grow over time; they often recur following therapy and do not regress spontaneously. KD causes considerable discomfort due to pain, pruritus and inflammation, and a significant psychosocial impact with reduced quality of life. It is unique to humans and occurrence is higher in individuals with dark, pigmented, ethnic skin. There is a strong familial heritability, with a high ethnic predisposition in individuals of African, Asian and Hispanic descent. High recurrence rates and unknown resolution rates present a major problem for both the patient and clinician. Many treatment modalities exist; however, there is no single advocated therapy. Therefore, the aim of this review was to explore the most current literature regarding the range of treatment options for KD and to offer a structured approach in the management of KD, based on evidence and experience, to aid clinicians in their current practice. A focused history involving careful evaluation of the patient's symptoms, signs, quality of life and psychosocial well-being should direct targeted therapy, complemented with regular follow-up and re-evaluation. Many treatment modalities, such as intralesional steroid injection, silicone gel application, cryotherapy, lasers, 5-fluorouracil and, relatively recently, photodynamic therapy, are currently being used in clinical practice for the management of KD. Combination therapies have also been shown to be beneficial. However, there is a lack of robust, randomized, level-one, evidence-controlled trials evaluating these treatment options. Management of KD in ethnic pigmented skin remains a clinical challenge. Thus, a strategic approach with structured assessment, targeted therapy and focus on prevention of recurrence is highly recommended. Quality evidence is essential in order to tailor treatment effectively for the ethnic patient presenting with KD.What's already known about this topic?• Keloid disease (KD) is a common, benign, fibroproliferative tumour of unknown origin.• With high recurrence rates, treatment of KD remains a challenge for both the patient and clinician.• With lack of level-one evidence, there is no single advocated therapy.What does this study add?• A structured strategic approach for management of KD by utilizing a focused history, targeted therapy and regular follow-up of the patient.• Patients' symptoms, signs, quality of life and psychosocial well-being should be carefully evaluated and managed.

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“…PDT is effective in the treatment of psoriasis and arthritis, 26 whereas ␥-RT inhibits keloid formation. 27 Therefore, it is not surprising that these modalities are being studied to inhibit the occurrence of restenosis as a fibroproliferative response to arterial injury. However, most of the mechanisms by which ␥-RT inhibits restenosis remain unclear.…”

Section: Discussionmentioning

confidence: 99%

Different Effects of Photodynamic Therapy and γ-Irradiation on Vascular Smooth Muscle Cells and Matrix

Heckenkamp

Leszczyński

Schiereck

et al. 1999

ATVB

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Abstract-␥-Irradiation (␥-RT) and photodynamic therapy (PDT) are known to inhibit intimal hyperplasia. The common mechanism is that both modalities produce free radicals, but unlike ␥-RT, PDT generates them through the absorption of light by photosensitizers. The purpose of this in vitro study was to assess the differences that PDT and ␥-RT have on the fibroproliferative response after vascular injury by comparing their effects on vascular smooth muscle cells (SMCs) and on the extracellular matrix (ECM). Mitochondrial activity (tetrazolium salt), proliferation ([ 3 H]thymidine incorporation), and the mechanisms of cell death (terminal deoxynucleotidyl transferase-mediated dUTP biotin nick end labeling [TUNEL] staining) were used to assess differences between PDT (100 J/cm 2 ) and ␥-RT (10 or 20 Gy) on SMC injury. The different effects on bioregulatory molecules were investigated by quantitating the proliferation of SMCs cultured with conditioned medium and on treated ECM. PDT of SMCs reduced proliferation and mitochondrial activity (0.5Ϯ0.75% and 1.7Ϯ4.25%, respectively, PϽ0.0001), whereas ␥-RT of SMCs decreased cell proliferation but did not affect metabolic activity. Stimulation with calf serum of ␥-RT-treated SMCs did not affect proliferation but increased mitochondrial enzyme activity (160Ϯ11%, PϽ0.0005). The conditioned medium, derived from PDT-but not ␥-RT-treated SMCs, did not stimulate effector SMC proliferation compared with ␥-RT-treated SMCs (16Ϯ4.1% versus 80Ϯ16.8%, PϽ0.0001). Apoptosis was the principle cytotoxic mechanism after PDT, whereas ␥-RT cells were growth arrested but viable. PDT of the ECM reduced effector SMC proliferation compared with controls and ␥-RT cells (18Ϯ6.5% versus 100Ϯ17.7% and 84Ϯ8.9%, respectively, PϽ0.0001). These data suggest that ␥-RT and PDT may inhibit restenosis but by different mechanisms. The effects of PDT are more diverse and may result in improved outcome while avoiding the teratogenic exposure due to ionizing irradiation. (Arterioscler Thromb Vasc Biol.

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Prevention of Earlobe Keloid Recurrence with Postoperative Corticosteroid Injections Versus Radiation Therapy A Randomized, Prospective Study and Review of the Literature

Cited by 130 publications

References 28 publications

Surgery and Perioperative Intralesional Corticosteroid Injection for Treating Earlobe Keloids: A Korean Experience

Surgery and Perioperative Intralesional Corticosteroid Injection for Treating Earlobe Keloids: A Korean Experience

Strategic management of keloid disease in ethnic skin: a structured approach supported by the emerging literature

Different Effects of Photodynamic Therapy and γ-Irradiation on Vascular Smooth Muscle Cells and Matrix

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