| Auricular keloids form following ear piercing, skin trauma, or otoplasty andthen gradually proliferate indefinitely and finally cause different degree of auriculardeformity. Its pathological changes are characterized by increased fibroblastproliferation rates and excessive depositing of extracellular matrix, especially withcollagen. The incidence of auricular keloids is high,but its treatment is still achallenging problem. The keloid should be remove completely in order to avoidrelapse, and the anatomy of the auricle should be maintained. The recurrence rate forsurgery only is reported from45%to100%.The lesion recurs repeatedly aftersurgery and cause serious auricular deformity,so the treatment of auricular keloidshas become a challenge to otorhinolaryngology, plastic surgery and dermatology.At present, there are two main problems in the aspect of studying this disease.In the first place, Despite of a wide variety of therapeutic methods described in theliterature, such as surgical removal, corticosteroid injections, radiotherapy,compression, laser ablation, cryosurgery, imiquimod therapy etc, recurrencefollowing treatment is generally the norm and even it also happens after combinedtherapy, currently there is no agreed policy, thus it is high time to conductmulticentric, large, controlled clinical trial. In the second place, because there is solittle known about the pathogenesis of auricular keloids, no specific treatment isavailable, therefore, to study its development and evolution mechanism ismeaningful to the positive and effective prevention and treatment of auricularkeloids.This research is composed of two parts. In the part one, in order to access theeffectiveness and safety of surgical excision and postoperative radiotherapy, weretrospectively reviewed39auricular keloids. This study found that, after1year oftreatment, the responsive rate was89.7%, and4lateral ears(10.3%) relapsed, up tonow，the mean follow-up was37.3months,11lateral ears relapsed, the relapse rate was28.2%,the mean time interval between treatment end and recurrence was19.7months. These data show that the approach of surgical removal and postoperativeradiotherapy has a satisfying effect on auricular keloids in the short term,but in thelong term it is not enough effective, so it is necessary to follow up at least2years ormore.In the part two, in consideration of the research thinking for monocytechemoattractant protein-1（MCP-1）and Bone Morphogenetic Protein-7（BMP-7）in pulmonary fibrosis, renal fibrosis and hepatic fibrosis etc, we attempted tomeasure the expression of MCP-1and MBP-7in auricular keloids and analyze thecorrelation between them, with the purpose of exploring the development andevolution mechanism of auricular keloids and doing exploratory work for soonapplying rh BMP-7as genetic therapy target. We measured the expression of MCP-1and MBP-7by immunohistochemistry in tissues of20cases of normal auricularskins,20cases of non-pathological scars and39cases of auricular keloids, and thecorrelation between MCP-1and MBP-7was analyzed in auricular keloids. The resultof this study was that a significant increase of expression of MCP-1could be foundin auricular keloids, while the expression of MBP-7was dramatically decreased, andboth were significantly negative correlation. Thus it can be seen that both theover-expression of MCP-1and the down-regulation of expression of MBP-7contribute to the pathological process of fibrosis in auricular keloids, and MBP-7might be a very promising genetic therapy target. |
PDF Full Text Request