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      The 1470 nm diode laser with an intralesional fiber device: a proposed solution for the treatment of inflamed and infected keloids

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          Abstract

          Background

          Keloids are the result of abnormal wound healing and often are subject to infections and recurrent inflammation. We present a study conducted with a 1470 nm diode laser using an intralesional optical fiber device for the treatment of inflamed keloid scars. We evaluate its efficacy as a novel alternative method to decrease keloid infection and inflammation.

          Methods

          The patients who underwent 1470 nm laser treatment from February 2016 to February 2018 at the plastic and reconstructive surgery department of the Shanghai Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University with keloid accompanying serious local infection and fester were included. Patients took curative effect evaluation before and 1 year after the treatment. The test items included infection frequency in each year; pain, by visual analogue scale (VAS); itch, using VAS; quality of life (QOL), using QOL scale; and blood supply, using PeriCam PSI.

          Results

          A total of 19 patients (mean age 35.21 years, range 11–66) with history of inflamed keloids with episodes of infection or abscess were enrolled. Patients underwent to a 1470 nm laser therapy for average of 1.16 times. After treatment, infection frequency and blood supply in keloids were reduced ( p < 0.001). Pain, itching, and QOL were improved ( p < 0.001).

          Conclusion

          The present study shows that 1470 nm fiber laser treatment could improve inflamed keloids fairly well by decreasing inflammation, and a relative stabilization of collagen composition. Therefore, it is an effective minimally invasive scar therapy, but further studies are essential to confirm the present results.

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          Most cited references30

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          Keloid and Hypertrophic Scars Are the Result of Chronic Inflammation in the Reticular Dermis

          Rei Ogawa (2017)
          Keloids and hypertrophic scars are caused by cutaneous injury and irritation, including trauma, insect bite, burn, surgery, vaccination, skin piercing, acne, folliculitis, chicken pox, and herpes zoster infection. Notably, superficial injuries that do not reach the reticular dermis never cause keloidal and hypertrophic scarring. This suggests that these pathological scars are due to injury to this skin layer and the subsequent aberrant wound healing therein. The latter is characterized by continuous and histologically localized inflammation. As a result, the reticular layer of keloids and hypertrophic scars contains inflammatory cells, increased numbers of fibroblasts, newly formed blood vessels, and collagen deposits. Moreover, proinflammatory factors, such as interleukin (IL)-1α, IL-1β, IL-6, and tumor necrosis factor-α are upregulated in keloid tissues, which suggests that, in patients with keloids, proinflammatory genes in the skin are sensitive to trauma. This may promote chronic inflammation, which in turn may cause the invasive growth of keloids. In addition, the upregulation of proinflammatory factors in pathological scars suggests that, rather than being skin tumors, keloids and hypertrophic scars are inflammatory disorders of skin, specifically inflammatory disorders of the reticular dermis. Various external and internal post-wounding stimuli may promote reticular inflammation. The nature of these stimuli most likely shapes the characteristics, quantity, and course of keloids and hypertrophic scars. Specifically, it is likely that the intensity, frequency, and duration of these stimuli determine how quickly the scars appear, the direction and speed of growth, and the intensity of symptoms. These proinflammatory stimuli include a variety of local, systemic, and genetic factors. These observations together suggest that the clinical differences between keloids and hypertrophic scars merely reflect differences in the intensity, frequency, and duration of the inflammation of the reticular dermis. At present, physicians cannot (or at least find it very difficult to) control systemic and genetic risk factors of keloids and hypertrophic scars. However, they can use a number of treatment modalities that all, interestingly, act by reducing inflammation. They include corticosteroid injection/tape/ointment, radiotherapy, cryotherapy, compression therapy, stabilization therapy, 5-fluorouracil (5-FU) therapy, and surgical methods that reduce skin tension.
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            Keloids and Hypertrophic Scars: Pathophysiology, Classification, and Treatment.

            Keloid and hypertrophic scars represent an aberrant response to the wound healing process. These scars are characterized by dysregulated growth with excessive collagen formation, and can be cosmetically and functionally disruptive to patients.
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              International clinical recommendations on scar management.

              Many techniques for management of hypertrophic scars and keloids have been proven through extensive use, but few have been supported by prospective studies with adequate control groups. Several new therapies showed good results in small-scale trials, but these have not been repeated in larger trials with long-term follow-up. This article reports a qualitative overview of the available clinical literature by an international panel of experts using standard methods of appraisal. The article provides evidence-based recommendations on prevention and treatment of abnormal scarring and, where studies are insufficient, consensus on best practice. The recommendations focus on the management of hypertrophic scars and keloids, and are internationally applicable in a range of clinical situations. These recommendations support a move to a more evidence-based approach in scar management. This approach highlights a primary role for silicone gel sheeting and intralesional corticosteroids in the management of a wide variety of abnormal scars. The authors concluded that these are the only treatments for which sufficient evidence exists to make evidence-based recommendations. A number of other therapies that are in common use have achieved acceptance by the authors as standard practice. However, it is highly desirable that many standard practices and new emerging therapies undergo large-scale studies with long-term follow-up before being recommended conclusively as alternative therapies for scar management.
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                Author and article information

                Contributors
                18817821624@163.com
                dr.fabionicoli@gmail.com
                xiwenjing@gmail.com
                zhangzheng958@sina.com
                hellobaboon@qq.com
                342090769@qq.com
                lkbeley@sjtu.edu.cn
                18817821624@139.com
                +862123271699 , zhangyixin6688@163.com
                Journal
                Burns Trauma
                Burns Trauma
                Burns & Trauma
                BioMed Central (London )
                2321-3868
                2321-3876
                15 February 2019
                15 February 2019
                2019
                : 7
                : 5
                Affiliations
                [1 ]ISNI 0000 0004 0368 8293, GRID grid.16821.3c, Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, , Shanghai JiaoTong University School of Medicine, ; 639 Zhi Zao Ju Road, Shanghai, 200011 China
                [2 ]ISNI 0000 0001 2300 0941, GRID grid.6530.0, Department of Plastic and Reconstructive Surgery, , University of Rome “Tor Vergata”, ; Rome, Italy
                [3 ]ISNI 0000 0004 0444 2244, GRID grid.420004.2, Department of Plastic and Reconstructive Surgery, , Newcastle Hospitals NHS Foundation Trust, ; Newcastle upon Tyne, UK
                [4 ]Department of Medical Cosmetology Surgery, Jinhua People’s Hospital, Jinhua, China
                Article
                143
                10.1186/s41038-019-0143-6
                6376646
                30783604
                2c8fdff5-c90a-46e3-947b-8d5c0f32e12e
                © The Author(s) 2019

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 1 October 2018
                : 21 January 2019
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100001809, National Natural Science Foundation of China;
                Award ID: 81772098
                Award ID: 81071569
                Funded by: Shanghai Health Municipal Bureau foundation
                Award ID: 20152227
                Funded by: Clinical research booster program
                Award ID: JYL027
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2019

                hypertrophic scars,keloid scars,1470 nm,diode laser,fiber laser

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