Übersichtsarbeit


Narben und Keloide

SCARS AND KELOIDS

Keywords | Summary | Correspondence | Literature

Keywords

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Schlüsselworte

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Summary

Scars develop after a traumatic damaging of the skin; the generated substance erosion in the connective tissue is replaced only imperfectly. In most of the cases, scars create only a minor disturbance, whose degree is dependant on the localisation, size and the activity of the reparative development of the connective tissue. Most scars can be concealed without a problem, if at all necessary. If hypertrophic scars create a psychologic strain, they should be treated. In contrast, keloids represent a massive problem for doctors and patients. These scars cause tension, itchiness, are painful and can lead to restrictive movement. The available treatment modalities are numerous but mostly afflicted with undesirable side effects and no safe efficacy. Increased interest is being focused on the treatment with the immuno modulator imiquimod after scar excision.

Zusammenfassung

Narben bilden sich nach einer traumatischen Schädigung der Haut; die entstandenen Substanzverluste im Hautbindegewebe werden nur unvollkommen ersetzt. In der überwiegenden Mehrzahl der Fälle verursacht eine Narbe höchstens eine erscheinungsmedizinische Störung, deren Ausmaß von Lokalisation, Größe und der Aktivität des reparativ gebildeten Bindegewebes abhängig ist. Die meisten Narben lassen sich gut verstecken, wenn überhaupt nötig. Wenn hypertrophe Narben einen Leidensdruck schaffen, sollten sie behandelt werden. Keloide hingegen stellen für Arzt und Patient ein oft massives Problem dar. Diese Narben spannen, jucken und schmerzen, auch führen sie oft zu einer Bewegungseinschränkung. Die zur Verfügung stehenden Behandlungsmöglichkeiten sind zahlreich, aber meistens mit unerwünschten Effekten behaftet und nicht sicher wirksam. Zunehmendes Interesse in der Keloidbehandlung gewinnt die nach einer Narbenexzision empfohlene Anwendung des Immunmodulators Imiquimod.

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Korrespondenz-Adresse

Univ. Prof. Dr. Wolfgang Raab
Raabstraße 11
A-2500 Baden
wraab@profderm.at

Conflict of Interests

Autor

Literatur

1. Aalamiharandi S, Akbari E, Balighi K, Lajevardi V (2011): Subcisionsuction method: A new highly effective treatment of atrophic acne scars and other depressed scars of the face. J am Acad Dermatol 64/2, Suppl 1: AB 14
2. Aigner, F et al (2008): Anale HPV-Infektionen. Wien Klin Wschr 120: 631-641
3. Alster TS, Tanzi EL (2003): Hypertrophic scars and keloids: etiology and management. Am J Clin Dermatol 4: 235-243
4. Balighi K, Robati RM, Moslehi H, Robati AM (2008): Subcision in acne scar with and without subdermal implant: a clinical trial. J Eur Acad Dermatol Venereol 22: 707-711
5. Beer TW (2005): Keloids are not angiogenic lesions. J Am Acad Dermatol 53: 1097
6. Berman B (2002): Imiquimod: a new immune response modifier for the treatment of external genital warts and other diseases in dermatology. Int J Dermatol 41, Suppl 1: 7-11
7. Berman B, Perez OA, Konda S, Kohut BE, Viera MH, Delgado S, Zell D, Li Q (2007): A review of the biologic effects, clinical efficacy, and safety of silicone elastomer sheeting for hypertrophic and keloid scar treatment and management. Dermatol Surg 33: 1291-1302
8. Berman B, Poochareon VN, Villa AM (2002): Novel dermatologic use of the immune response modifier imiquimod 5% cream. Skin Ther Lett 7: 1-6
9. Berman B, Viera M, Perez O, Huo R, Amini S (2009): Tolerability and efficacy of two marketed topical preparations versus placebo for the treatment of keloids and hypertrophic scars: Interactions and end of study analysis. J Am Acad Dermatol 60/3, Suppl 1; AB194
10. Beuth, J, Hunzelmann N, Van Leendert R, Basten R, Noehle M, Schneider B (2006): Safety and efficacy of local administration of Contractubex to hypertrophic scars in comparison to corticosteroid treatment. Resulsts of as multicenter, comparative epidemiological cohort study in Germany. In vivo 20: 277-284
11. Cho J-W, Cho S-Y, Lee S-R, Lee K-S (2010): Onion extract and quercetin induce matrix metalloproteinase-1 in vitro and in vivo. Int J Molecular Med 25: 347-352
12. Chwalek J, Goldberg DJ (2011): Ablative skin resurfacing. Curr Probl Dermatol 42: 40-47
13. D’Andrea F, Brongo S, Ferraro G, Baroni A (2002): Prevention and treatment of keloids with intralesional verapamil. Dermatology 204: 60-62
14. Darougheh A, Asilian A, Shariati F (2009): Intralesional triamcinolone alone or in combination with 5-fluorouracil for the treatment of keloid and hypertrophic scars. Clin Exp Dermatol 34: 219-223
15. Davison SP, Dayan JH, Clemens MW, Sonni S, Wang A, Crane A (2009): Efficacy of intralesional 5-fluorouracil and triamcinolone in the treatment of keloids. Aesthet Surg J 29: 40-46
16. Fishelevich R, Zhao Y, Tuchinda P, Liu H, Nakazono A, Tammaro A, Meng TC, Lee J, Gaspari AA (2011): Imiquimod-induced TLR7 signaling enhances repair of DNA damage induced by ultraviolet light in bone marrow-derives cells. J Immunol 187: 1664-1673
17. Foo CW, Tristani-Firouzi P (2011): Topical modalities for treatment and prevention of postsurgical hypertrophic scars. Facial Plast Surg Clin North Am 19: 551-557
18. Gauglitz GG, Kunte C (2011): Empfehlungen zur Prävention und Therapie hypertropher Narben und Keloide. Hautarzt 62: 337-346
19. Gira AK, Brown LF, Cohen C, Arbiser JL (2004): Keloids demonstrate high level dermal expression of vascular endothelial growth factor. J Am Acad Dermatol 50: 850-853
20. Gold MH, Foster TD, Adair MA, Burlison K, Lewis T (2001): Prevention of hypertrophic scars and keloids by the prophylactic use of topical silicone gel sheets following a surgical procedure in an office setting. Dermatol Surg 27: 641-644
21. Hatamipour E, Mehrabi S, Hatamipour M, Ghafarian-Shirazi HR (2011): Effects of combined intralesional 5-Fluorouracil and topical silicone in prevention of keloids: a double blind randomized clinical trial study. Acta Med Iran 49: 127-130
22. Horjet CP, Moya AIS, Monne CB, Schoendorf-Ortega C (2011): Scar sarcoidosis associated with systemic sarcoidosis: A case report. J Am Acad Dermatol 64/2, Suppl 1: AB112
23. Hosnuter M, Payasli C, Isikdemir A, Tekerekoglu B (2007): The effect of onion extract on hypertrophic and keloid scars. J Wound Care 16: 251-254
24. Juckett G, Hartman-Adams H (2009): Management of keloids and hypertrophic scars. Am Fam Physician 80: 253-260
25. Jung JY, Ryo DJ, Kim JH, Lee JH, Chung KY, (2010): Treatment of scarsusing ablative dioxide fractional laser. J Am Acad Dermatol 62/3, Suppl 1: AB149
26. Katz TM, Glaich AS, Goldberg LH, Friedman PM (2010): 595-nm long pulsed dye laser and 1450-nm diode laser in combination with intralesional triamcinolone/5-fluorouracil for hypertrophic scarring following a phenol peel. J Am Acad Dermatol 62: 1945-1049
27. Kim TY, Kim DH, Yoon MS (2009): Solitary superficial angiomyxoma on a caesarean section surgical scar. J Am Acad Dermatol 60/3, Suppl 1: AB54
28. Koc E, Arca E, Surucu B, Kurumlu Z (2008): 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. Dermatol Surg 34: 1507-1514
29. Klode J, Schöttler L, Stoffels I, Körber A, Schadendorf E, Dissemond J (2011): Investigation of adhesion of modern wound dressings: a comparative analysis of 56 different wound dressings. J Eur Acad Dermatol Venereol 25: 933-939
30. Kontochristopoulos G, Stefanaki C, Panagiotopoulos A, Stefanaki K, Argyrakos T, Petridis A, Katsambas A (2005): Intralesional 5-fluorouracil in the treatment of keloids: An open clinical and histopathological study. J Am Acad Dermatol 52: 474-479
31. Manuskiatti W, Varothai S, Eimpunth S, Wanithphakdeedecha R (2010): Efficacy and safety of a carbon-dioxide ablative fractional resurfacing device for the treatment of atrophic acne scars in Asians. J Am Acad Dermatol 63: 274-283
32. Medina C, Vilar J, Bastida J, Dehesa L (2011): Scars worthening and thickening as a initial sign of systemic sarcoidosis. J Am Acad Dermatol 64/2, Suppl 1: AB113
33. Moore A, Sachdeva S, Anderson N, Wright E (2008): Topical therapy of keloids with imiquimod. J Am Acad Dermatol 58/2, Suppl 2: AB144
34. Morganroth P, Cowden-Wilmot A, Miller C (2009): Over-the-counter scar products for postsurgical patients: Disparities between online advertised benefits and evidence regarding efficacy. J Am Acad Dermatol 61: e31-e47
35. Morris C, Emsley P, Marland E, Meuleneire F, White R (2009): Use of wound dressings with soft silicone adhesive technology. Paediatr Nurs 21: 38-43
36. Mustoe TA (2008): Evolution of silicone therapy and mechanism of action in scar management. Aesthet Plast Surg 32: 82-92
37. Na CH, Shin BS (2010): Primary cutaneous extraskeletal osteosarcoma occurring on operation scar. J Am Acad Dermatol 62/3, Suppl 1: AB104 38. O’Brien L, Pandit A (2006): Silicone gel sheeting for preventing and treating hypertrophic and keloid scars. Cochrane Database Syst Rev 25: CD003826
39. Parish JL, Rhouth HB, Parish LC (2010): Keloids: Innovative therapy. J Am Acad Dermatol 62/3, Suppl 1: AB147
40. Raab W (2011): Aktinische Keratosen. Haut 3: 116-124
41. Ramadan SA, El-Komy MH, Bassiouny DA, El-Tobshy SA (2011): Subcision versus 100% trichloroacetic acid in the treatment of rolling acne scars. Dermatol Surg 37: 626-633
42. Rao J (2011): Treatment of acne scarring. Facial Plast Surg Clin North Am 19: 275-291
43. Sage RJ, Lopiccolo MC, Liu A, Mahmoud BH, Tiemey EP, Kouba DJ (2011): Subcuticular incision versus naturally sourced porcine collagen filler for acne scars: a randomized split-face comparison. Dermatol Surg 37: 426-431
44. Schmidt A, Gassmueller J, Hughes-Formella B, Bierlfeldt S (2001): Treating hypertrophic scars with a self-adhesive hydroactive polyurethane dressing. J Wound Care 10: 149-153
45. Shaffer JJ, Taylor SC, Cook-Bolden F (2002): Keloidal scars: A review with a critical look at therapeutic options. J Am Acad Dermatol 46/2, Suppl 2: S63-S97
46. Shapiro SD (2004): Imiquimod 5% cream as a novel agent in the treatment of skin scarring. J Am Acad Dermatol 50/3, Suppl P36
47. Siegel G, Bangert S, Hebert A (2008): Treatment of keloids and hypertrophic scars with a novel polymer skin coating. J Am Acad Dermatol 58/2, Suppl 2: AB142
48. Wigger-Albert W, Kuhlmann M, Wilhelm D, Mrowietz U, Eichhorn K, Ortega J, Wilhelm KP (2009): Efficacy of a polyurethane dressing versus a soft silicone sheet on hypertrophic scars. J Wound Care 18: 208-214
49. Worret W-I (2008): Narben. In Worret-Gehring “Kosmetische Dermatologie“, Springer, Heidelberg, 2. Auflage
50. Zurada JM, Kriegel D, Davis IC (2006): Topical treatments for hypertrophic scars. J Am Acad Dermatol 55: 1024-1031

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