Aktuelle Dermatologie 2011; 37(3): 75-80
DOI: 10.1055/s-0030-1256156
Übersicht

© Georg Thieme Verlag KG Stuttgart · New York

Behandlung von Keloiden

Current Therapeutic Approaches for the Treatment of KeloidsG.  G.  Gauglitz1
  • 1Klinik für Dermatologie und Allergologie der Ludwig-Maximilian-Universität München
Further Information

Publication History

Publication Date:
10 March 2011 (online)

Zusammenfassung

Keloide bilden sich meist nach operativ oder traumatisch entstandenen Wunden. Sie werden zusätzlich nach Tätowierungen, Piercings und in Folge lang anhaltender, entzündlicher Erkrankungen der Haut beobachtet. Eine genetische Disposition wird diskutiert. Besonders gefährdete Regionen sind die vordere Brustregion, die Schulterpartie und die Ohrläppchen. Bei disponierten Personen können Keloide sogar spontan entstehen. Trotz vieler verschiedener Therapiekonzepte und Studien zur Behandlung von Keloiden, gestaltet sich deren Therapie aufgrund der hohen Rezidivrate nach wie vor schwierig. Neben etablierten Techniken zur Vorbeugung und Behandlung von Keloiden werden heute neuere, weniger etablierte Verfahren (Farbstofflaser, Imiquimod), zum Teil in Kombination, erfolgreich eingesetzt.

Abstract

Keloids may arise following any insult to the deep dermis or develop after minor injuries and may even form spontaneously on the mid-chest in the absence of any known injury. In the majority of cases, keloids develop in wounds at anatomic locations with high tension, such as anterior chest, shoulders and earlobes. Multiple studies on keloid formation have been conducted for decades and have led to a plethora of therapeutic strategies in order to prevent or attenuate excessive scar formation. However, most therapeutic approaches remain clinically unsatisfactory, mostly due to the high recurrence rates of keloids. Besides well known therapeutic approaches, today, emerging treatment strategies including pulsed dye laser and imiquimod crème extend the spectrum of keloid therapy.

Literatur

  • 1 Marneros A G, Krieg T. Keloids – clinical diagnosis, pathogenesis, and treatment options.  J Dtsch Dermatol Ges. 2004;  2 905-913
  • 2 Karrer S. [Therapy of keloids].  Hautarzt. 2007;  58 979-989
  • 3 Lu L, Saulis A S, Liu W R et al. The temporal effects of anti-TGF-beta1, 2, and 3 monoclonal antibody on wound healing and hypertrophic scar formation.  J Am Coll Surg. 2005;  201 391-397
  • 4 Deitch E A, Wheelahan T M, Rose M P et al. Hypertrophic burn scars: analysis of variables.  J Trauma. 1983;  23 895-898
  • 5 Baisch A, Riedel F. [Hyperplastic scars and keloids. Part I: basics and prevention].  HNO. 2006;  54 893-904
  • 6 Gassner H G, Sherris D A, Otley C C. Treatment of facial wounds with botulinum toxin A improves cosmetic outcome in primates.  Plast Reconstr Surg . 2000;  105 1948-1953
  • 7 Mustoe T A, Cooter R D, Gold M H et al. International clinical recommendations on scar management.  Plast Reconstr Surg. 2002;  110 560-571
  • 8 Slemp A E, Kirschner R E. Keloids and scars: a review of keloids and scars, their pathogenesis, risk factors, and management.  Curr Opin Pediatr. 2006;  18 396-402
  • 9 Phan T T, Lim I J, Sun L et al. Quercetin inhibits fibronectin production by keloid-derived fibroblasts. Implication for the treatment of excessive scars.  J Dermatol Sci. 2003;  33 192-194
  • 10 Ho W S, Ying S Y, Chan P C, Chan H H. Use of onion extract, heparin, allantoin gel in prevention of scarring in Chinese patients having laser removal of tattoos: a prospective randomized controlled trial.  Dermatol Surg. 2006;  32 891-896
  • 11 Koc E, Arca E, Surucu B, Kurumlu Z. An Open, Randomized, Controlled, Comparative Study of the Combined Effect of Intralesional Triamcinolone Acetonide and Onion Extract Gel and Intralesional Triamcinolone Acetonide Alone in the Treatment of Hypertrophic Scars and Keloids.  Dermatologic Surgery. 2008;  34 1507-1514
  • 12 Danneberg S D. Fast effects with a scar gel under therapeutic ultrasound: Results of a single-centre investigation.  Cosmetic Medicine. 2007;  3 133-138
  • 13 Koller J. Therapie pathologischer Narben (hypertrophe Narben und Keloide).  Leitlinie. JDDG. 2004;  2 308-312
  • 14 Ernst K, Hundeiker M. Results of cryosurgery in 394 patients with hypertrophic scars and keloids.  Hautarzt. 1995;  46 462-466
  • 15 Sharpe D. Of apples and oranges, file drawers and garbage: why validity issues in meta-analysis will not go away.  Clin Psychol Rev Dec. 1997;  17 881-901
  • 16 Atiyeh B S. Nonsurgical management of hypertrophic scars: evidence-based therapies, standard practices, and emerging methods.  Aesthetic Plast Surg. 2007;  31 468-494
  • 17 Leventhal D, Furr M, Reiter D. Treatment of keloids and hypertrophic scars: a meta-analysis and review of the literature.  Arch Facial Plast Surg. 2006;  8 362-368
  • 18 Tang Y W. Intra- and postoperative steroid injections for keloids and hypertrophic scars.  Br J Plast Surg. 1992;  45 371-373
  • 19 Hackert I, Aschoff R, Sebastian G. [The treatment of keloids].  Hautarzt. 2003;  54 1003-1015
  • 20 Baisch A, Riedel F. [Hyperplastic scars and keloids: part II: Surgical and non-surgical treatment modalities].  HNO. 2006;  54 981-992
  • 21 Arco G HRE. Chirurgie der Narben.  Chirurgische Allgemeine. 2009;  10 17-28
  • 22 De Lorenzi F, Tielemans H J, van der Hulst R R et al. Is the treatment of keloid scars still a challenge in 2006?.  Ann Plast Surg. 2007;  58 186-192
  • 23 Hoffman S. Radiotherapy for keloids.  Ann Plast Surg. 1982;  9 265
  • 24 Caccialanza M, Piccinno R, Schiera A. Postoperative radiotherapy of keloids: a twenty-year experience.  Eur J Dermatol. 2002;  12 58-62
  • 25 Alster T. Laser scar revision: comparison study of 585-nm pulsed dye laser with and without intralesional corticosteroids.  Dermatol Sur. 2003;  29 25-29
  • 26 Bouzari N, Davis S C, Nouri K. Laser treatment of keloids and hypertrophic scars.  Int J Dermatol. 2007;  46 80-88
  • 27 Kumar K, Kapoor B S, Rai P, Shukla H S. In-situ irradiation of keloid scars with Nd:YAG laser.  J Wound Care. 2000;  9 213-215
  • 28 Berman B, Kaufman J. Pilot study of the effect of postoperative imiquimod 5 % cream on the recurrence rate of excised keloids.  J Am Acad Dermatol. 2002;  47 209-211
  • 29 Patel P J, Skinner Jr R B. Experience with keloids after excision and application of 5 % imiquimod cream.  Dermatol Surg. 2006;  32 462
  • 30 Martin-Garcia R F, Busquets A C. Postsurgical use of imiquimod 5 % cream in the prevention of earlobe keloid recurrences: results of an open-label, pilot study.  Dermatol Surg. 2005;  31 1394-1398
  • 31 Apikian M, Goodman G. Intralesional 5-fluorouracil in the treatment of keloid scars.  Australas J Dermatol. 2004;  45 140-143
  • 32 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
  • 33 Fitzpatrick R E. Treatment of inflamed hypertrophic scars using intralesional 5-FU.  Dermatol Surg. 1999;  25 224-232
  • 34 Tredget E E, Shankowsky H A, Pannu R et al. Transforming growth factor-beta in thermally injured patients with hypertrophic scars: effects of interferon alpha-2b.  Plast Reconstr Surg. 1998;  102 1317-1328
  • 35 Mutalik S. Treatment of keloids and hypertrophic scars.  Indian J Dermatol Venereol Leprol. 2005;  71 3-8

Dr. med. Gerd G. Gauglitz, MMS 

Klinik für Dermatologie und Allergologie der Ludwig-Maximilian-Universität München

Frauenlobstraße 9 – 11
80337 München

Email: gerd.gauglitz@med.uni-muenchen.de

    >