The Blood Perfusion Of Keloids And Its Application In The Diagnosis And Treatment System

BACKGROUNDKeloids are fibroproliferative diseases with unknown pathogenesis.Patients with keloids usually suffer pain and pruritus which have a huge impact on them.There are some contradictions on the perfusion of keloids among the existing reports.Nowadays,an ideal instrument which can evaluate the severity of keloids in an objective and quantitative way is still in need.Whether the perfusion of keloids is affected by gender,age,blood group and BMI is still unknown.Besides,the relationship between its perfusion and the severity of clinical appearances,symptoms,internal hypoxia,vascularization,inflammatory reactions is also unclear.Both of these two issues need further investigation.OBJECTIVESThe objectives of the current study are to investigate the perfusion of keloids by Laser Speckle Contrast Imaging(LSCI),the influence of gender,age,blood group and BMI on its perfusion and the correlation between its blood flow and the severity of its clinical appearances and symptoms.The second objective of this study is to detect the correlation between its perfusion and internal hypoxia,vascularization,inflammatory reactions and the expression of its pain and itching receptors.METHODSThe first part of the study included 70 patients with thoracic keloids which hadn't received any treatment at Peking Union Medical Hospital from January to April,2019.Patients were evaluated by Vancouver Scar Scale(VSS)and Visual Analogue Scale(VAS).Afterwards,perfusion values of the keloids and nonadjacent normal skin were measured by LSCI.The second part included 8 patients with thoracic keloids and 8 skin grafting patients with normal skin specimens.Immunohistochemistry and Western Blot were used to investigate the expression level of hypoxia induced factor-1?(HIF-1?),vascular endothelial growth factor(VEGF),interleukin-17(IL-17),histamine receptor(H1R)and 5-hydroxytryptamine receptor(5-HT2AR).RESULTSThe perfusion levels of keloids were significantly higher than those of their nonadjacent normal skin.There were no significant differences in the perfusion level of keloids among different genders and age groups.The perfusion level of keloids in patients with blood group A was significantly higher than that of keloids in patients with other blood groups.Keloid patients with BMI?28 had significantly higher perfusion levels than patients with BMI<28.Perfusion levels of keloids were significantly positively correlated with the scores of VSS and VAS.The expression levels of HIF-1?,VEGF,IL-17,H1R and 5-HT2AR of keloids were significantly higher than those of normal skin specimens.Perfusion levels of keloids were significantly positively correlated with the expression of the above-mentioned proteins.CONCLUSIONSObesity people with keloids need to strengthen control over their BMI.People with blood group A need to attach greater importance to precaution and protection in order to detect keloids and receive treatment timely.The expression levels of pain and itch-specific receptors of keloids were significantly higher than those of normal skin specimens.Thus inhibiting the release of pain and itching transmitters or antagonizing corrresponding receptors might be potential therapeutic targets to relieve symptoms in patients with keloids.The perfusion of keloids was significantly positively correlated with the expression levels of pain and itch-specific receptors and the severity of clinical appearances and symptoms of keloids.Consequently,preventing the blood flow in keloids will be effective in improving the clinical appearance and symptoms.The more abundant the blood supply in keloid was,its appearance,symptoms,the state of hypoxia,vascularization and inflammatory reactions within it would be more severe.In summary,perfusion of keloids can reflect the development and evolution of internal factors and can be used as a reliable and objective instrument to evaluate the severity of keloids which has vital importance for clinical diagnosis and treatment.