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.
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. Med Sci Monit. 2019 Apr 22;25:2950-2958 Authors: Bi M, Sun P, Li D, Dong Z, Chen Z Abstract BACKGROUND The optimal treatment for hypertrophic scar and keloid remains controversial. Therefore, the aim of this systematic review and meta-analysis was to compare the effectiveness of intralesional injection of botulinum toxin type A compared with placebo and intralesional injection of corticosteroid compared with placebo in patients with hypertrophic scar and keloid. MATERIAL AND METHODS Six databases were searched using Medical Subject Headings (MeSH) keywords and included Web of Science, PubMed, EMBASE, the Cochrane Library, WanFang, and CNKI from their inception to March 1 2019, without language restriction. Randomized controlled trials (RCTs) and prospective controlled trials (PCTs) were identified that compared intralesional injection of botulinum toxin type A with placebo and corticosteroid with placebo in hypertrophic scar and keloid. The quality of controlled trials was assessed by the Newcastle-Ottawa Scale (NOS). RESULTS Comparison of intralesional botulinum toxin type A and corticosteroid showed significant differences in the Visual Analog Scale (VAS) (P
Midkine (MDK) is a 15.5kDa heparin-binding growth factor induced by retinoids and inhibited by corticosteroids. It is closely related in structure to another low molecular weight protein, Pleiotrophin (PTN, 18.9kDa). Both MDK and PTN are involved in many important biological pathways including embryogenesis, tumorigenesis, and wound healing. They bind to a number of different receptors, including Protein-Tyrosine Phosphatase, Receptor-Type Zeta-1 (PTZPRZ1), which is known to play a key role in regulating cell growth, differentiation and transformation.
Conclusion: Topical FTY720 induces M2 predominance and impairs angiogenesis. Therefore, its local immunosuppressive mechanisms differ from those of conventional immunosuppressive agents. Topical FTY720 can be a novel therapeutic option for abnormal scars that are difficult to control with corticosteroids. Its lymphocytopenic effects may be limited by careful optimization of the treatment regimen. PMID: 32377536 [PubMed - in process]
Conclusions: High-quality randomized controlled trials are currently lacking, and the existing literature is predominately not specific to use of 5-FU on the face. These studies, however, suggest that intralesional 5-FU is safe and probably more effective than other options in the management of cutaneous scars in the oculofacial region. The delivery methods, timing, dosing, and concomitant therapies were highly variable. Further high-quality controlled studies specific to oculofacial scars may be indicated to assess the efficacy of 5-FU and to establish the best protocols for administering this medication.
ConclusionIn the injection treatment of pathological scar, we recommend the combined injection of two drugs, especially botulinum toxin type A combined with corticosteroids. The effective treatment of botulinum toxin type A combined with corticosteroids in the treatment of pathological scar is as follows: Patients were treated once monthly with intralesional injection of TAC (0.1 ml/cm3) mixed with botulinum toxin type A (2.5 IU/cm3) for a total of 3 treatments. However, there are still limitations in this network meta-analysis, and its conclusion still needs to be further confirmed by more randomized controlle...
Abstract Following injury, the skin undergoes a wound healing process culminating in the formation of a mature scar. Millions of patients worldwide are left with scars every year as a result of trauma or surgery. Scars can be painful, disfiguring and disabling, yet patients report that clinicians are often dismissive of their concerns, unable to identify pathological scars and unaware of treatment options. The normal wound healing process comprises three overlapping stages: inflammation, proliferation and remodelling. In some patients this process is deranged, resulting in the formation of hypertrophic or keloid s...
ConclusionsOnce-daily application of dissolving triamcinolone-embedded microneedles significantly reduced the volume of keloids. The treatment was safe, can be self-administered and can serve as an alternative for patients unsuitable for conventional treatments.Trial RegistrationTrial Registry: Health Science Authority (Singapore) Clinical Trials Register Registration number: 2015/00440.
One of the first-line options to treat keloid scars is corticosteroid injection after excision of the existing scar. A thorough literature search has shown a lack of research on the injection of corticosteroid...
ConclusionThis case highlights one of the more serious complications of circumcision. Although penile keloids are rare, the techniques involved in traditional circumcision potentially predispose to keloid formation in a genetically prone population.
CONCLUSION Combination keloid therapy using fractional lasers, superficial cryotherapy, and intralesional triamcinolone injection is safe and more effective than individual monotherapies.
Autologous fat grafting is a technique with various applications in the craniofacial region ranging from the treatment of wounds, scars, keloids, and soft tissue deformities. In this review, alternative therapies to fat grafting are discussed. These are composed of established therapies like silicone gel or sheeting, corticosteroids, cryotherapy, and laser therapy. Novel applications of negative pressure wound therapy, botulinum toxin A injection, and biologic agents are also reviewed.