Cicatrices Queloides; revisión y experiencia en un tratamiento integral / Keloid Scars; review and experience in a comprehensive treatment

Alicia Maria Tamayo Carbón, Daniel Alfredo Posada Ruiz, Manuel Alejandro Orozco Jaramillo, José Nemesio Cairos Baez, Sebastian Florido Sarria

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Resumen

Objetivo: aportar conocimiento actualizado sobre la fisiopatología
y el tratamiento integral de las cicatrices queloideas.

Desarrollo: se construyeron descriptores en ciencias de salud
DeCS - MESH y se hizo una búsqueda en Medline y EBSCO a
través de cicatriz patológica, cicatriz queloide, cicatriz y tejido de
granulación, mediante un conector booleano AND, encontrado
24 citas relacionadas con exactitud del tema y revisadas con sus
respectivas referencias. Se utilizaron un total de 45 referencias
bibliográficas pertinentes para el desarrollo de esta investigación.
Los queloides son neoplasias benignas del tejido conectivo
compuestas de masas densas de colágeno. Su etiología es variable
y los tratamientos se direccionan a la exéresis del tejido afectado
y control de la respuesta fibroproliferativa. Los tratamientos
aceptados varían desde el manejo médico hasta la resección
quirúrgica y la combinación de ambos.

Conclusiones: el tratamiento de los queloides es un reto para los
cirujanos dada su alta recurrencia. Si bien los diferentes tratamientos
se conocen de manera amplia y están bien documentados, se hace
necesario emplear conjunta y sucesivamente múltiples técnicas
terapéuticas combinadas como la cirugía, infiltración de fármacos,
presoterapia, entre otras para aseguran un mejor resultado.

Palabras clave: cicatriz patológica; cicatriz queloide; cicatriz;
tejido de granulación.

ABSTRACT

Objetive: to provide updated knowledge of the pathophysiology
and comprehensive treatment of large keloid scars.

Development: health science descriptors DeCS - MESH
were constructed, searching in MEDLINE and EBSCO through
Pathological scar, Keloid Scar, Cicatrix, Granulation tissue using
AND boolean connector finding 24 articles accurately related to the
subject that were revised with their respective references using a total of 45 bibliographic references for the development. Keloids
are benign connective tissue neoplasms composed of dense
collagen masses. Its etiology is variable and the treatments are
directed to the removal of the affected tissue and control of the
fibroproliferative response. The accepted treatments vary from
medical management to surgical resection and the combination
of both.

Conclusions: treating keloid scars is a challenge for surgeons
given its high recurrence. Although therapeutic treatments are well
documented and widely known, it is necessary to use jointly and
successively multiple therapies such as surgery, drugs infiltration,
pressotherapy, among others to guarantee a better result.

Keywords: pathological scar; keloid scar, cicatrix, granulation
tissue.

Palabras clave

Cicatriz patológica; Cicatriz queloide; Cicatriz; Tejido de granulación

Referencias

(1) Barrera JA, Maan ZN, Gurtner GC. Adipose tissue in wound healing. En: Coleman SR, Marzola RF, Pu LLQ. Fat Inyection From Filling to Regeneration. 2 ed. New York: Thieme; 2018. p 179.

(2) Lee Hj, Jang YJ. Recent understandings of Biology, Prophylaxis and treatment Strategies for Hypertrophic Scars and Keloids. International Journal of Molecular Sciences [Internet]. 2018 Mar [cited 2020 Apr 4]; 19(3):711. Available from: http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=128667861〈=es&site=ehost-live

(3) Coiffman F. Cicatrices hipertrofias y queloides. En: Coiffman F, Vazques G. Cirugía Plástica. Reconstructiva y Estética. Tomo 1. 3ra ed. Colombia: AMOLCA; 2008. p. 315-319

(4) Beato Canfux AI, Valdés Mesa S, Machado Fernández ML, Palacios Alfonso IR. Cicatriz queloide gigante. Rev Cubana Med Militar [Internet]. 2020 [citado 2 Mar 2020]; 49(1):192-198. Disponible en: http://search.ebscohost.com/login.aspx?direct=true&db=lth&AN=141693662〈=es&site=ehost-live

(5) Coiffman F. Cicatrices hipertrofias y queloides. En: Coiffman F, Vazques G. Cirugía Plástica. Reconstructiva y Estética. Tomo 1. 4ta ed. Colombia: AMOLCA; 2015. 15: 115-121.

(6) Bijlard E, Kouwenberg CA, Timman R, Hovius SE, Busschbach JJ, Mureau MA. Burden of Keloid Disease: A Cross-sectional Health-related Quality of Life Assessment. Acta Derm Venereol. 2017 Feb;97(2):225-229. doi: 10.2340/00015555-2498.

(7) He Y, Deng Z, Alghamdi M, Lu L, Fear MW, He L. From genetics to epigenetics: new insights into keloid scarring.Cell Prolif. 2017 Abr ;50(2). doi: 10.1111/cpr.12326.

(8) Zhao B, Guan H, Liu JQ, Zheng Z, Zhou Q, Zhang J, Su LL, Hu DH. Hypoxia drives the transition of human dermal fibroblasts to a myofibroblast-like phenotype via the TGF-B1/Smad3 pathway. Int. J. Mol. Med. 2017; 39: 153-159. 10.3892/ijmm.2016.2816. 27909731

(9) Ma X, Chen J, Xu B, Long X, Qin H, Zhao RC, et al. Keloid-derived keratinocytes acquire a fibroblast-like appearance and an enhanced invasive capacity in a hypoxic microenvironment in vitro. Int J Mol Med. 2015 May;35(5):1246-56. doi: 10.3892/ijmm.2015.2135.

(10) da Silva IR, Tiveron LC, da Silva MV, Peixoto AB, Carneiro CAX, Dos Reis MA, et al. In Situ Cytokine Expression and Morphometric Evaluation of Total Collagen and Collagens Type I and Type III in Keloid Scars. Mediators Inflamm. 2017; 2017: 6573802. doi: 10.1155/2017/6573802.

(11) Zhou HM, Wang J, Elliot C, Wen W, Hamilton DW, Conway SJ. Spatiotemporal expression of preiostin during skin development and incisional wound healing: Lessons for human fibrotic scar formation. J Cell Commun. Signal. 2010; 4: 99-107. 10.1007/s12079-010-0090-2. 20521985

(12) Burgos IG. Queloides. Desde la fisiopatogenia a la terapéutica. Act Terap Dermatol. 2006; 29: p.156-164.

(13) Wang P, Jiang LZ, Xue B. Recombinant human endostatin reduces hypertrophic scar formation in rabbit ear model through down-regulation of VEGF and TIMP-1. Afr. Health Sci. 2016; 16: 542-553. 10.4314/ahs.v16i2.23. 27605970

(14) Tredget EE, Nedelec B, Scott PG, Ghahary A. Hypertrophic scars, keloids, and contractures. The cellular and molecular basis of therapy. Surg. Clin. N. Am. 1997; 77: 701-730. 10.1016/S0039-6109(05)70576-4

(15) Tuan TL, Nichter LS. The molecular basis of keloid and hypertrophic scar formation. Mol. Med. Today. 1998; 4: 19-24. 10.1016/S1357-4310(97)80541-2

(16) Chua SC, Gidaszewski B, Khajehei M. Efficacy of surgical excision and sub-dermal injection of triamcinolone acetonide for treatment of keloid scars after caesarean section: a single blind randomised controlled trial protocol. Trials. 2019 Jun;20 (1):363. doi: 10.1186/s13063-019-3465-6.

(17) Komenan K, Yves B, Alexander K, Kanga K, Ange A, Isidore K, et al. Keloid scars of the earlobe in young black African. Risks factors and care. Eur J Pediatr Dermatol [internet]. 2019 [citado 2 Mar 2020];29 (4):206-208.

Disponible en:

http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=141180281&Lang=es&site=ehost-live

(18) Leventhal D, Furr M, Reiter D. Treatment of keloids and hypertrophic scars. A meta-analysis and review of the literature. Arch. Facial Plast. Sure. 2006; 8: 362-368. 10.1001/archfaci.8.6.362. 17116782

(19) Ogawa R, Akaishi S, Huang C, Dohi T, Aoki M, Omori Y, Koike S, Kobe K, Akimoto M, Hyakusoku H. Clinical applications of basic research that shows reducing skin tension could prevent and treat abnormal scarring: The importance of fascial/subcutaneous tensile reduction sutures and flap surgery for keloid and hypertrophic scar reduction. J. Nippon Med. Sch. 2011; 78: 68-76. 101272/ jnms.7868. 21551962

(20) Kasyanju Carrero LM, Ma WW, Liu HF, Yin XF, Zhou BR. Botulinum toxin type A for the treatment and prevention of hypertrophic scar and keloids: Updated review. Journal Of Cosmetic Dermatology [Internet]. 2019 Feb [cited 2020 Apr 4]; 18(1):10-5. Available from: http://searchebscohost.com/login.aspx?direct=true&db=mdc&AN=30548742〈=es&site=ehost-live

(21) Bi M, Sun P, Li D, Dong Z, Chen Z. Intralesional injection of Botulinum Toxin Type A Compared with intralesional Injection of Corticosteroid for the treatment of hypertrophic scar and keloid: A systematic review and Meta-Analysis. Medical Science Journal of Experimental and clinical research [internet]. 2019 Apr 22 [cited 2020 Apr 4]; 25: 2950-8. Available from: http://searchebscohost.com/login.aspx?direct=true&db=mdc&AN=31006769〈=es&site=ehost-live

(22) Wong TS, Li JZ, Chen S, Chan JY, Gao W. The efficacy of triamcinolone Acetonide in Keloid Treatment: A sistematic review and Meta-analysis. Front. Med. 2016; 3: 71. 10.3389/fmed.2016.00071. 28083534

(23) Baur PS, Larson DL, Stacey TR, Barratt GF, Dobrkovsky M. Ultrastructural analysis of pressure-treated human hypertrophic scars. J. Trauma. 1976; 16:958-967. 10.1097/00005373-197612000-00004. 1003586

(24) Macintyre L, Baird M. Pressure garments for use in the treatment of hypertrophic scars- A review of the problems associated with their use. Burns. 2006; 32: 10-15. 10.1016/j.burns.2004.06.018. 16413399

(25) Mustoe TA. Evolution of silicone therapy and mechanism of action in scar management. Aesthetic Plast Surg. 2008 Jan; 32(1): 82-92.

(26) Atkinson JA, Mckenna KT, Barnett AG, McGrath DJ, Rudd M. A randomized, controlled trial to determine the efficacy of paper tape in preventing hypertrophic scar formation in surgical incisions that traverse Langer´s skin tension lines. Plast. Reconstr. Surg. 2005; 116:1648-1656. 10.1097/01.prs.0000187147.73963.a5. 16267427

(27) Reish RG, Eriksson E. Scar treatments: Preclinical and clinical studies. J. Am. Coll. Surg. 2008; 206:719-730. 10.1016/j.jamcollsurg.2007.11.022. 18387479

(28) Dalkowski A, Fimmel S, Beutler C, Zouboulis CC. Cryotherapy modifies synthetic activity and differentiation of keloid fibroblasts in vitro. Exp Dermatol. 2003 Oct; 12(5): 673-81.

(29) Dawbwe R, Colver G, Jackson A, Cutaneous Criosurgery. Principles and Clinical Practice. (2nda edi). London. Martin Dunitz Ltd 1997: 54.

(30) Ogawa R. Keloid and hypertrophic scars are the result of chronic inflammation in the reticular dermis. Int J Mol Sci. 2017; 18(3) : 606. 103390/ijms1800606. 28287424

(31) Herranz P, Heredero XS, Cicatrices, Guía de Valoración y Tratamiento. MEDA FARMA. Dic 2012; p. 3-54.

(32) Iturra GB. Queloides. Desde la fisiopatología a la terapéutica. Act Terap Dermatol 2006; 29: p.156

(33) Cheraghi N, Cognetta A. Jr, Goldverg D. Radiation Therapy for the adjunctive Treatment of surgically Excised Keloids: A review. J Clin Aesthet Dermatol. 2017; 10(8): 12-15.

(34) Ji. J, Tian Y, Zhu YQ, Zhang LY, Ji SJ, Huan J, Zhou XZ, Cao JP. Ionizing radiation inhibits keloid fibroblast cell proliferation and induces premature cellular senescence. J.Dermatol.2015; 42: 56-63. 10.1111/1346-8138.12702. 25425417

(35) Calderon W, Camacho JP, Obaid RS, Vinés E. Manejo de queloides mediante combinación de cirugía y radioterapia con haz de electrones. Cir Plasta Iberolatinoam. 2020; 46 (1): p. 57-64.

(36) Hannuksela Svahn A, Grandal OJ, Thorstensen T. UVA 1 for treatment of keloids. Acta Derm. Venereol. 1999; 79: 496.

(37) Tanzi EL, Alster TS. Laser treatment of scars. Skin Ther. Lett. 2004; 9: 4-7.

(38) Goldman M, Fitzpatrick R. Laser treatment of scars. Dermal Surg. 1995; 21:685-687.

(39) Nanda S, Reddy BS. Intralesional 5-fluorouracil as a treatment modality of keloids. Dermatol. Surg. 2004 Jan; 30: 54-56. 14692928

(40) Espana A, Solano T, Quintanilla E. Bleomycin in the treatment of keloids and hypertrophic scars by multiple needle punctures. Dermatol. Surg. 2001; 27:23-27. 11231236

(41) Bodokh I, Brun P. Traitement des chéloides par infiltrations de bléomicine. Ann Dermatol Venereol. 1996; 123: 791-794

(42) Gutierrez C, Quinto P, Andrade L, Alfaro HJ. Uso de la colchicina como adyuvante en el tratamiento de cicatrices queloides recidivantes. Reporte de un caso. Cir. Plást. 2001, 11(3): 126.

(43) Peacock EE. Pharmacologic control of surface scarring in human beings. Ann. Surg. 1981, 193: 592.

(44) Beuth J, Hunzelmann N, van Leendert R, Basten R, Noehle M, Schneider B. Safety and efficacy of local administration of contractubex to hypertrophic scars in comparison to corticosteroid treatment. Results of a multi center, comparative epidemiological cohort study in Germany. In Vivo. 2006; 20: 277-283. 16634531

(45) Phan TT, Lim IJ, Sun L, Chan SY, Bay BH, Tan EK, Lee ST. Quercitin inhibits fibronectin production by keloid-derived fibroblasts. Implication for the treatment of excessive scars. J. Dermatol. Sci. 2003; 33: 192-194. 10.1016/j.jdermsci.2003.08.008. 14643528

(46) Al Khawajah MM. Failure of interferon- a 2b in the treatment of mature keloids. Int .J. Dermal. 1996; 35: 515-517. 10.1111/j.1365-4362.1996.tb01671.x. 18211495

(47) Shah M, Foreman DM, Ferguson MW. Neutralisation of TGFB1 and TGF B2 or exogenous addition of TGF B3 to cutaneous rat wounds reduces scarring. J. Cell Sci. 1885; 108Pt 3: 985-1002. 7542672

(48) Jones ME, Hardy C, Ridgway J. Keloid Management: A Retrospective Case Review on a New Approach Using Surgical Excision, Platelet-Rich Plasma, and In-office Superficial Photon X-ray Radiation Therapy. Adv Skin Wound Care. 2016 Jul;29 (7): 303-7. doi: 10.1097/01.ASW.0000482993.64811.74

(49) Uyulmaz S, Macedo NS, Rezaeian F, Giovanoli P, Lindenblatt N. Nanofat grafting for scar treatment and skin quality improvement. J. Aesth Surg. Cos Med . 2018; 38 (4): 421-428. DOI: 10.1093/asj/sjx183

(50) Bruno A, Delli Santi G, Fasciani L, Cempanari M, Palombo M, Palombo P. Burn scar lipofilling: Immunohistochemical and clinical outcomes. J. Craniofac. Surg. 2013; 24: 1806-1814. 10.1097/SCS.0b013e3182a148b9. 24036785

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