Observation And Analysis Of The Curative Effect And Adverse Reactions Of Two Treatment Regimens On Keloids

Part ⅠThe Combined Effects of Long-pulsed 1064 nm Neodymium-yttrium-aluminum-garnet laser,Diprospan and 5-Fluorouracil in the treatment of KeloidsBACKGROUNDClinically,keloids have been well documented to develop following injury or inflammation of the skin and are the result of excessive fibroblast proliferation and then over-abundant collagen deposition.The exact etiology of keloid scarring remains unknown,however recent studies have identified a number of factors needed for extensive scarring to occur.Keloids continue to pose a significant challenge to clinicians in everyday practice.Intralesional corticosteroid injection was the first-line therapy for the treatment of keloids.It had a certain curative effect,but the recurrence rate was high.According to the pathological characteristics of keloid,it is mainly the excessive proliferation of fibroblasts,increased capillary abnormalities,collagen and other connective tissue matrix of the transition.It has been proposed that the combination of 2 or more methods can improve the curative effect and reduce the recurrence rate and adverse reaction of corticosteroids..It has been reported that corticosteroids suppress healing and pathological scarring by three mechanisms:anti-inflammatory and immunosuppressive effect,vasoconstriction,and inhibition of fibroblast and keratinocyte proliferation due to an antimitotic effect.Five-fluorouracil(5-FU)is a pyrimidine analog that inhibits the synthesis of deoxyribonucleic acids by irreversibly inhibiting thymidine synthase,which is responsible for converting uridine to thymidine.5-fluorouracil may reduce keloid vascular endothelial cell proliferation.1064nm long-pulsed Nd:YAG laser,deep penetration,small skin damage,there is no other side effects except occasional superficial blisters,but commonly used to treat skin hemangiomas,spider and other clinic.Recently,it has been increasingly used in the treatment of deep vascular diseases,such as hypertrophic scar and scar,which can inhibit the angiogenesis in pathological scar.Considering the above factors,we propose the use of long-pulse 1064nm laser combined with corticosteroids Diprospan,5-fluorouracil treatment of keloids.METHODSIn a three-month single-center clinical trial,69 patients were randomly divided into three groups.Patients in group 1 were injected with intralesional diprospan at a monthly interval for three months.Patients in group 2 were injected with the mixture of 0.5 mL of 5-FU(25mg/mL)and 1 mL of Diprospan for three months also.Patients in group 3 were injected with Diprospan for one month and 5-FU for for 3 months.Before each injection,the lesions were irradiated by a 1064-nm Nd:YAG laser with a single pulse at an energy density of 90 to 100 J/cm2 and a pulse width of12 ms.Clinical responses were assessed by patient self-assessment,observer overall assessment and evaluated by clinical signs:erythema,pruritus,pliability.RESULTSThis study evaluated and discussed by sixty-two patients which completed the tests of study.At the 2nd and 3rd month follow-up visits,the patients of all treatment groups showed an acceptable improvement in nearly all measurements.At the end of the study,the erythema score was significantly low and itch reduction was statistically high in the Diprospan+5-FU+Nd:YAG group(p<0.05 for both indexes)when compared to other groups.The acceptable responses reported by blinded observers were as follows:12%in the Diprospan group,48%in the Diprospan+5-FU group,and 69%in the Diprospan+5-FU+Nd:YAG group.All of them showed statistically significant differences(p<0.05).There was no significant difference in the incidence of adverse reactions between the groups(P>0.05).CONCLUSIONThe total efficacy of Diprospan + 5-FU was similar to Dipro span+5-FU+N d:YAG,but the efficacy of Diprospan+5-FU+Nd:YAG combination was more acknowledged by the patients.It markedly alleviated the lesion.The combination of Diprospan+5-FU+Nd:YAG is probably the best therapy for keloid scars.Part ⅡCombination of 32P-patch contact brachyradiotherapy with surgery,continuous-wave CO2 laser and Diprospan on keloid treatmentBACKGROUNDPhosphorus 32 is widely used in medicine,biology,industry and agriculture.Isotope 32P has been widely used in the treatment of blood diseases,body surface hemangioma,nerve dermatitis,chronic eczema,and so on.Isotope 32P treatment of keloid has been used more than 10 years of history.its application in the treatment of keloid is mainly using beta ray inhibiting the proliferation of fibroblasts and vascular proliferation.It can alleviate the symptom of scar of different degree and has a good effect on the treatment of different stages of the disease and the failure of the glucocorticoid blocking.Although some scholars believe that the application of isotope therapy can lead to the occurrence of malignant transformation of irradiated sites may be,but this technique has been used for decades.The domestic and foreign scholars have carried out extensive research on the treatment of the application of the treatment of the keloid and recognized it is a safe and reliable method for the treatment of scar.There are few reports about cancer.This paper will respectively combined with surgery,CO2 laser,Diprospan in treatment of keloid,observe the efficacy and adverse reactions.METHODS126 cases of keloid patients with informed consent were randomly divided into four groups.Group 1 for 32P sticking group:to give a direct isotope 32P contact therapy,1 times/month;group 2 for diprospan combined with 32P application:Diprospan intralesional injection,group 0.1ml/cm2,1 times/month,3times in a row after sticking to 32P.group 3 continuous CO2 laser combined with 32P post:continuous CO2 laser scar tissue grinding to normal skin level about 1-2mm.After wound healing using 32P sticking therapy.Group 4 Operation combined weith 32P post:received surgical resection of scar tissue and tension reduced suture,stitches after 1 week using 32P sticking therapy.The fourth group with Clinical symptoms:erythema,pruritus,hardness,and overall assessment of clinical symptoms by patients themselves.RESULTSFour groups of patients with keloid,clinical symptoms were improved in different degree,doctor evaluation results show efficacy reached excellent respectively:single 32P 57%,Diprospan+32P 87%,CO2 laser+32P 90%,operation+32P 90%.There was significant difference in the treatment group compared with single 32P treatment group.The average number of 32P application in the four groups was:6.71±2.02,3.42±1.39,4.94±1.63,4.91±1.71.The cure rates were 51.6%,87.1%,75%,90.6%,respectively.The incidence rates of adverse reactions were 90.3%,61.3%,96.9%,71.9%,respectively.Recurrence rates were 6.5%,9.7%,15.6%,15.6%,respectively.CONCLUSIONThe groups of operation combined with 32P and diprospan combined with 32P in treatment of keloids have a high cure rate,fewer recurrence,lower adverse reactions,more worthy of clinical promotion.