RSS-Feed abonnieren
PDF herunterladen
DOI: 10.1055/s-0033-1358482
Funktionelle und ästhetische Therapiekonzepte von Keloiden im Kopf-Hals Bereich
Functional and Aesthetic Therapy Concepts of Keloids in the Head- and Neck AreaPublikationsverlauf
Publikationsdatum:
11. Februar 2014 (online)
Zusammenfassung
Keloide sind fibroproliferative Maximalvarianten einer gestörten Wundheilung, welche infiltrativ tumorähnlich wachsen. Im HNO-Bereich treten Keloide vor allem an der Ohrmuschel auf. Meist durch Piercings oder Traumen verursacht. Sie wachsen wulstartig über den ursprünglichen Narbenrand hinaus und können teilweise eine groteske Morphologie annehmen. Die Patienten klagen häufig über Dysästhesien, wie bspw. brennende Beschwerden, einen quälenden Juckreiz und leiden unter ihrer Stigmatisierung. Die Vielzahl der therapeutischen Methoden, die in der Literatur zur Behandlung des Keloids beschrieben werden (u. a. Silikontherapie, Kompressionstherapie, Applikation von Kortikosteroiden, intra- oder extraläsionale chirurgische Exzision, Kryochirurgie, Radiatio, Interferon- oder Bleomycin-Therapie) weisen auf die enorme Herausforderung für den behandelnden Arzt, insbesondere im Bereich der plastischen Gesichtschirurgie hin.
Abstract
Functional and Aesthetic Therapy Concepts of Keloids in the Head- and Neck Area
Keloids are fibroproliferative extreme variants of an impaired wound healing, developing a tumour-like growth. In the ENT area keloids arise mainly at auricle. Often caused by piercings or trauma. They grow bulging excessively over the original scar edges and adopt sometimes bizarre morphologies. The patients complain often of dysesthesias such as burning pain, severe itching and are suffering often from stigmatization. The huge number of therapy methods, for the treatment of keloids described in the literature (silicon therapy, compression, intralesional corticoids, intra- or extralesional surgical excision, kryosurgery, radiatio, Interferon- or Bleomycin-therapy) emphasize the enormous challenge for the treating doctor, particularly in facial plastic surgery.
-
Literatur
- 1 Gupta S, Sharma VK Standard guidelines of care: Keloids and hypertrophic scars. Indian J Dermatol Venereol Leprol 2011; 77: 94-100
- 2 Bran GM, Goessler UR, Hormann K, Riedel F, Sadick H. Keloids: current concepts of pathogenesis (review). Int J Mol Med 2009; 24: 283-293
- 3 Haisa M, Okochi H, Grotendorst GR. Elevated levels of PDGF alpha receptors in keloid fibroblasts contribute to an enhanced response to PDGF. J Invest Dermatol 1994; 103: 560-563
- 4 Kikuchi K, Kadono T, Takehara K. Effects of various growth factors and histamine on cultured keloid fibroblasts. Dermatology 1995; 190: 4-8
- 5 Wu Y, Zhang Q, Ann DK, Akhondzadeh A, Duong HS, Messadi DV et al. Increased vascular endothelial growth factor may account for elevated level of plasminogen activator inhibitor-1 via activating ERK1/2 in keloid fibroblasts. Am J Physiol Cell Physiol 2004; 286: C905-C912
- 6 Shockman S, Paghdal KV, Cohen G. Medical and surgical management of keloids: a review. J Drugs Dermatol 2010; 9: 1249-1257
- 7 Hackert I, Aschoff R, Sebastian G. The treatment of keloids. Hautarzt 2003; 54: 1003-1005 quiz 1016–1017
- 8 Butler PD, Longaker MT, Yang GP. Current progress in keloid research and treatment. J Am Coll Surg 2008; 206: 731-741
- 9 Fong EP, Bay BH. Keloids – the sebum hypothesis revisited. Med Hypotheses 2002; 58: 264-269
- 10 Abbas AK, Lichtman AH, Pober JS. Effector mechanism of T-cell-mediated immune response. Cellular and Molecular Immunology. 2nd edition. W.B. Saunders; 1994
- 11 Kazeem AA. The immunological aspects of keloid tumor formation. J Surg Oncol 1988; 38: 16-18
- 12 Wang Z, Fong KD, Phan TT, Lim IJ, Longaker MT, Yang GP. Increased transcriptional response to mechanical strain in keloid fibroblasts due to increased focal adhesion complex formation. J Cell Physiol 2006; 206: 510-517
- 13 Koonin AJ. The Aetiology of Keloids: A Review of the Literature and a New Hypothesis. S Afr Med J 1964; 38: 913-916
- 14 Nemeth AJ. Keloids and hypertrophic scars. J Dermatol Surg Oncol 1993; 19: 738-746
- 15 Viera MH, Caperton CV, Berman B. Advances in the treatment of keloids. J Drugs Dermatol 2011; 10: 468-480
- 16 Marneros AG, Norris JE, Watanabe S, Reichenberger E, Olsen BR. Genome scans provide evidence for keloid susceptibility loci on chromosomes 2q23 and 7p11. J Invest Dermatol 2004; 122: 1126-1132
- 17 Teofoli P, Barduagni S, Ribuffo M, Campanella A, De Pita O, Puddu P. Expression of Bcl-2, p53, c-jun and c-fos protooncogenes in keloids and hypertrophic scars. J Dermatol Sci 1999; 22: 31-37
- 18 Placik OJ, Lewis Jr VL. Immunologic associations of keloids. Surg Gynecol Obstet 1992; 175: 185-193
- 19 Kerl HAl, Bayer U. Über die Entstehung und Behandlung pathologischer Narben – Klinische und mikromorphologische Untersuchungen. Z Hautkr 1980; 56: 282-300
- 20 Al-Attar A, Mess S, Thomassen JM, Kauffman CL, Davison SP. Keloid pathogenesis and treatment. Plast Reconstr Surg 2006; 117: 286-300
- 21 Robles DT, Moore E, Draznin M, Berg D. Keloids: pathophysiology and management. Dermatol Online J 2007; 13: 9
- 22 Bock O, Mrowietz U. Keloids. A fibroproliferative disorder of unknown etiology. Hautarzt 2002; 53: 515-523
- 23 Gauglitz GG, Korting HC, Pavicic T, Ruzicka T, Jeschke MG. Hypertrophic scarring
and keloids: pathomechanisms and current and emerging treatment strategies. Mol Med
2011; 17: 113-125
MissingFormLabel
- 24 Brissett AE, Sherris DA. Scar contractures, hypertrophic scars, and keloids. Facial Plast Surg 2001; 17: 263-272
- 25 Kim HD, Hwang SM, Lim KR, Jung YH, Ahn SM, Kim Song J. Recurrent Auricular Keloids during Pregnancy. Arch Plast Surg 2013; 40: 70-72
- 26 Love PB, Kundu RV. Keloids: an update on medical and surgical treatments. J Drugs Dermatol 2013; 12: 403-409
- 27 Bran GM, Brom J, Hormann K, Stuck BA. Auricular keloids: combined therapy with a new pressure device. Arch Facial Plast Surg 2012; 14: 20-26
- 28 Niessen FB, Spauwen PH, Schalkwijk J, Kon M. On the nature of hypertrophic scars and keloids: a review. Plast Reconstr Surg 1999; 104: 1435-1458
- 29 Kadouch DJ, van der Veer WM, Mahdavian Delavary B, Kerkdijk D, Niessen FB. Therapeutic hotline: An alternative adjuvant treatment after ear keloid excision using a custom-made methyl methacrylate stent. Dermatol Ther 2010; 23: 686-692
- 30 Zouboulis CC, Blume U, Buttner P, Orfanos CE. Outcomes of cryosurgery in keloids and hypertrophic scars. A prospective consecutive trial of case series. Arch Dermatol 1993; 129: 1146-1151
- 31 Ernst K, Hundeiker M. Results of cryosurgery in 394 patients with hypertrophic scars and keloids. Hautarzt 1995; 46: 462-466
- 32 Weidmann M, Har-Shai Y. The treatment of keloids and hypertrophic scars through intralesional cryotherapy. Kosmetische Medizin 2012; 2: 4-8
- 33 Escarmant P, Zimmermann S, Amar A, Ratoanina JL, Moris A, Azaloux H, Francios H, Grosserez O, Michel M, G' Baguidi R. The treatment of 783 keloid scars by iridium 192 interstitial irradiation after surgical excision. Int J Radiat Oncol Biol Phys 1993; 26: 245-251
- 34 Guix B, Henriquez I, Andres A, Finestres F, Tello JI, Martinez A. Treatment of keloids by high-dose-rate brachytherapy: A seven-year study. Int J Radiat Oncol Biol Phys 2001; 50: 167-172
- 35 Sallstrom KO, Larson O, Heden P, Eriksson G, Glas JE, Ringborg U. Treatment of keloids with surgical excision and postoperative X-ray radiation. Scand J Plast Reconstr Surg Hand Surg 1989; 23: 211-215
- 36 O’Brien L, Pandit A. Silicon gel sheeting for preventing and treating hypertrophic and keloid scars. Cochrane Database Syst Rev. 2006: CD003826
- 37 Mustoe TA, Cooter RD, Gold MH, Hobbs FD, Ramelet AA, Shakespeare PG, Stella M, Téot L, Wood FM, Ziegler UE. International clinical recommendations on scar management. Plast Reconstr Surg 2002; 110: 560-571
- 38 Music EN, Engel G. Earlobe keloids: a novel and elegant surgical approach. Dermatol Surg 2010; 36: 395-400
- 39 Rosen DJ, Patel MK, Freeman K, Weiss PR. A primary protocol for the management of ear keloids: results of excision combined with intraoperative and postoperative steroid injections. Plast Reconstr Surg 2007; 120: 1395-1400
- 40 Park TH, Seo SW, Kim JK, Chang CH. Outcomes of surgical excision with pressure therapy using magnets and identification of risk factors for recurrent keloids. Plast Reconstr Surg 2011; 128: 431-439
- 41 Hassel JC, Loser C, Koenen W, Kreuter A, Hassel AJ. Promising results from a pilot study on compression treatment of ear keloids. J Cutan Med Surg 2011; 15: 130-136
- 42 Ragoowansi R, Cornes PG, Moss AL, Glees JP. Treatment of keloids by surgical excision and immediate postoperative single-fraction radiotherapy. Plast Reconstr Surg 2003; 111: 1853-1859
- 43 van de Kar AL, Kreulen M, van Zuijlen PP, Oldenburger F. The results of surgical excision and adjuvant irradiation for therapy-resistant keloids: a prospective clinical outcome study. Plast Reconstr Surg 2007; 119: 2248-2254
- 44 Gupta S, Kalra A. Efficacy and safety of intralesional 5-fluorouracil in the treatment of keloids. Dermatology 2002; 204: 130-132
- 45 Shridharani SM, Magarakis M, Manson PN, Singh NK, Basdag B, Rosson GD. The emerging role of antineoplastic agents in the treatment of keloids and hypertrophic scars: a review. Ann Plast Surg 2010; 64: 355-361