Psychological stress as a risk factor for postoperative keloid recurrence

Furtado, Fabianne; Hochman, Bernardo; Farber, Paulo Luiz; Müller, Marisa Campio; Hayashi, Lilian Fukusima; Ferreira, Lydia Masako

doi:10.1016/j.jpsychores.2011.12.010

Cited by 17 publications

(12 citation statements)

References 59 publications

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“…Multivariate analysis showed that the maximum GSR under stress associated significantly with recurrence (Odds Ratio = 1.34; 95% confidence intervals = 1.01-1.77; P = .040) and that the risk of recurrence rose by 34% for every 1000 AU increase in GSR. 111 In contrast, a cross-sectional study 112 of 18-year-old males found that acne scarring did not associate with socio-economic status, which can be linked to psychological stress and physical health. 113 However, the authors speculated that this could reflect the homogeneity of the population sample (all had the same age and gender).…”

Section: Effect Of Psychological Stressmentioning

confidence: 91%

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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Section: Effect Of Psychological Stressmentioning

confidence: 91%

Systemic factors that shape cutaneous pathological scarring

Huang

Ogawa

2020

FASEB j.

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“…This result might be explained with the minor psychological and social relevan ce of hypertrophic scarring. As this type of pathologic scar shows a milder phenotype and better prognosis 19 because of its self-limiting tendency and spontaneous regression, most patients do not seek the help of specialized health services such as outpatient clinics 20 . On the other hand, it was observed that mixed scars were the most frequent in this study.…”

Section: Discussionmentioning

confidence: 99%

Distribuição de queloide e cicatriz hipertrófica segundo fototipos de pele de Fitzpatrick

Hochman¹,

Farkas²,

Isoldi³

et al. 2012

Rev. Bras. Cir. Plást.

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Background: Keloid and hypertrophic scars have a common physiopathogenic origin and are defined as fibroproliferative scars. Fibroproliferative scars are frequent in indivi duals with darker skin. However, mixing of "races" renders it difficult to group patients with different skin tones according to morphological and static classifications (white for Caucasians; brown for individuals of Spanish descent (Hispanic/Latino); yellow for indi viduals of East Asian descent; and black for individuals of African descent) according to their response to sun exposure. It is known that when individuals whose ethnic origin is in colder countries move to tropical countries, they show a higher incidence of these types of scars, which mainly affect parts of the body that are more exposed to the sun. A correlation between fibroproliferative scars and Fitzpatrick phototype, a dynamic classification based on the skin's response to sun exposure, would contribute to an understanding of the patho physiology of these scars. The aim of this study is to investigate the distribution of fibro proliferative scars according to Fitzpatrick phototypes. Methods: We classified patients' fibroproliferative scars according to the Muir classification as Long-Term Evolution (keloid scars), Short-Term Evolution (hypertrophic scars), and Intermediate Group (mixed scars), while their skin types were grouped according to the Fitzpatrick classification. Results: Fitzpatrick phototype III and mixed scars were predominant among the patients analyzed (p = 0.001). A correlation (p = 0.025) was observed between fibroproliferative scars and Fitzpatrick phototypes; the higher the phototype, the higher the tendency to develop keloid and mixed scar tissue. Conclusions: Fitzpatrick skin phototypes proved to be an efficient method to study keloid and hypertrophic scars.Keywords: Keloid. Cicatrix, hypertrophic. Skin pigmentation. Melanocytes. Ultraviolet rays. RESUMO Introdução:Queloide e cicatriz hipertrófica são cicatrizes patológicas com natureza fi siopatogênica comum, denominadas, em conjunto, cicatrizes fibroproliferativas. São mais frequentes em indivíduos de pele mais escura. Contudo, a atual miscigenação dificulta o enquadramento dos pacientes com variadas tonalidades de pele em classificações morfo lógicas e estáticas (branco ou caucasoide, mulato, pardo, hispânico ou latino, amarelo ou oriental ou mongoloide e negro ou negroide), e diferentes quanto à exposição solar. Sabe -se que pessoas oriundas de países de clima temperado ou frio quando residem em países

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“…Furtado et al 83 were the first to show a direct correlation between stress and keloid. Patients with fibroproliferative scars who were candidates for surgical resection and postoperative radiotherapy underwent evaluation of psychological stress on the day before the surgery.…”

Section: Psychoneuroimmune–endocrine System and Keloidmentioning

confidence: 99%

New approach to the understanding of keloid: psychoneuroimmune–endocrine aspects

Hochman

Isoldi

Furtado

et al. 2015

CCID

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The skin is a dynamic and complex organ that relies on the interrelation among different cell types, macromolecules, and signaling pathways. Further, the skin has interactions with its own appendages and other organs such as the sebaceous glands and hair follicles, the kidney, and adrenal glands; systems such as the central nervous system; and axes such as the hypothalamic–pituitary–adrenal axis. These continuous connections give the skin its versatility, and when an injury is caused, some triggers start a cascade of events designed to restore its integrity. Nowadays, it is known that this psychoneuroimmune–endocrine intercommunication modulates both the homeostatic condition and the healing process. In this sense, the skin conditions before a trauma, whether of endogenous (acne) or exogenous origin (injury or surgical incision), could regulate the process of tissue repair. Most skin diseases such as psoriasis and atopic dermatitis, among others, have in their pathophysiology a psychogenic component that triggers integrated actions in the nervous, immune, and endocrine systems. However, fibroproliferative disorders of wound healing, such as hypertrophic scar and keloid, are not yet included in this listing, despite showing correlation with stress, especially with the psychosocial character. This review, by understanding the “brain–skin connection”, presents evidence that allows us to understand the keloid as a psychomediated disease.

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Psychological stress as a risk factor for postoperative keloid recurrence

Cited by 17 publications

References 59 publications

Systemic factors that shape cutaneous pathological scarring

Systemic factors that shape cutaneous pathological scarring

Distribuição de queloide e cicatriz hipertrófica segundo fototipos de pele de Fitzpatrick

New approach to the understanding of keloid: psychoneuroimmune–endocrine aspects

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Psychological stress as a risk factor for postoperative keloid recurrence

Cited by 17 publications

References 59 publications

Systemic factors that shape cutaneous pathological scarring

Systemic factors that shape cutaneous pathological scarring

Distribuição de queloide e cicatriz hipertrófica segundo fototipos de pele de Fitzpatrick

New approach to the understanding of keloid: psychoneuroimmune&ndash;endocrine aspects

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New approach to the understanding of keloid: psychoneuroimmune–endocrine aspects