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      Toxina botulinica tipo a en el tratamiento del queloide Translated title: Botulinic toxin type a in the treatment of keloid

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          Abstract

          Resumen Introducción y objetivo. El proceso de cicatrización, cuando se ve perturbado o interrumpido, puede conllevar una reparación cutánea descontrolada como la observada en los queloides. Son reconocidos como tumores fibroproliferativos únicos en humanos, lesiones difíciles de tratar debido a que la mayoría de los enfoques terapéuticos siguen siendo clínicamente insatisfactorios. Sin embargo, estudios recientes sugieren que la toxina botulínica tipo A (TBA) influye en la apoptosis y proliferación celular, razón por lo cual nos planteamos demostrar si la TBA intralesional produce mejoría no solo clínica, sino también histológica en el queloide. Material y método. Seleccionamos 11 queloides y realizamos biopsias de los mismos, además de medición previa y en 3 controles posteriores a la aplicaciónn de TBA. Hacemos descripción histopatológica de los cambios observados a los 3 meses mediante el Sofware Image Pro Plus, versión 5.0 (Olympus®) y tinciones con hematoxilina-eosina (H/E) y tricrómico de Masson. Aplicamos tratamiento estadístico mediante análisis de las características demográficas y clínicas. A las variables nominales se le determinaron frecuencia y porcentajes, por lo que elaboramos tablas descriptivas. Con las variables cuantitativas trabajamos con medidas de tendencia central (media). Para la comparación y el análisis de las variables utilizamos medidas de tendencia central (media), coeficiente de relación de Pearson y desviación estándar. Resultados. La edad promedio fue de 31 años, el sexo predominante fue el femenino (63%), la etiología más frecuente fue postraumática (35%), predominó el tipo de piel IV (50%), clínicamente hubo mejoría significativa de altura y anchura del queloide confirmada mediante coeficiente de relación de Pearson con un -0.91 y -0.88 respectivamente, así como del dolor, prurito, coloración y consistencia; también reducción del diámetro de la epidermis verificado por desviación estándar y cambios en la dermis en cuanto a distribución del colágeno, vascularización, infiltrado inflamatorio y unión dermoepidermica se refiere. Conclusiones. Dados los resultados obtenidos en nuestro estudio desde el punto de vista clínico e histopatológico, planteamos la TBA como una nueva opción terapéutica para el tratamiento del queloide.

          Translated abstract

          Abstract Background and objective. When the healing process is disturbed or interrupted, uncontrolled skin repair can occur, such as that observed in keloid. These are recognized as unique fibroproliferative tumors in humans, always representing difficult-to-treat lesions because most therapeutic approaches remain clinically unsatisfactory. However, recent studies have suggested that botulinum toxin type A (BTA) influences apoptosis and cell proliferation. This is why we set out to demonstrate whether intralesional BTA produces improvement not only clinically but also histologically in the keloid. Methods. Eleven keloids were selected and biopsies were performed as well as previous measurements and 3 controls after the application of BTA. Histopathological description of the changes observed 3 months after therapy using the Software Image Pro Plus, version 5.0 (Olympus®) and stains with hematoxylin-eosin (H/E) and Masson's trichomic. Statistical treatment was applied through analysis of demographic and clinical characteristics. The frequency and percentages were determined for the nominal variables, so descriptive tables were made. With the quantitative variables we worked with measures of central tendency (average). For the comparison and analysis of the variables, measures of central tendency (mean), coefficient of Pearson relation and standard deviation were used. Results. The average age was 31 years, the predominant sex was female (63%), the most frequent etiology was posttraumatic (35%), the skin type IV predominated (50%). Clinically there was significant improvement in height and width of the keloid confirmed by Pearson's coefficient of relationship with -0.91 and -0.88 respectively and improvement of pain, pruritus, coloration and consistency, as well as reduction of the diameter of the epidermis verified by standard deviation and changes on the dermis in terms of collagen distribution, vascularization, inflammatory infiltrate and dermo-epidermal junction. Conclusions. Due to the results obtained in our study from the clinical and histopathological point of view, BTA could be considered as a new therapeutic option for the treatment of keloid.

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          Most cited references25

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          Management of keloids and hypertrophic scars.

          Keloids and hypertrophic scars represent an exuberant healing response that poses a challenge for physicians. Patients at high risk of keloids are usually younger than 30 years and have darker skin. Sternal skin, shoulders and upper arms, earlobes, and cheeks are most susceptible to developing keloids and hypertrophic scars. High-risk trauma includes burns, ear piercing, and any factor that prolongs wound healing. Keloid formation often can be prevented if anticipated with immediate silicone elastomer sheeting, taping to reduce skin tension, or corticosteroid injections. Once established, however, keloids are difficult to treat, with a high recurrence rate regardless of therapy. Evidence supports silicone sheeting, pressure dressings, and corticosteroid injections as first-line treatments. Cryotherapy may be useful, but should be reserved for smaller lesions. Surgical removal of keloids poses a high recurrence risk unless combined with one or several of these standard therapies. Alternative postsurgical options for refractory scars include pulsed dye laser, radiation, and possibly imiquimod cream. Intralesional verapamil, fluorouracil, bleomycin, and interferon alfa-2b injections appear to be beneficial for treatment of established keloids. Despite the popularity of over-the-counter herb-based creams, the evidence for their use is mixed, and there is little evidence that vitamin E is helpful.
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            Keloids and Hypertrophic Scars: A Spectrum of Clinical Challenges.

            Since their earliest description, keloids and hypertrophic scars have beleaguered patients and clinicians alike. These scars can be aesthetically disfiguring, functionally debilitating, emotionally distressing, and psychologically damaging, culminating in a significant burden for patients. Our current understanding of keloid pathophysiology has grown and continues to advance while molecular biology, genetics, and technology provide ever-deepening insight into the nature of wound healing and the pathologic perturbations thereof. Greater understanding will lead to the development and application of refined therapeutic modalities. This article provides an overview of our current understanding of keloids, highlighting clinical characteristics and diagnostic criteria while providing a comprehensive summary of the many therapeutic modalities available. The proposed mechanism, application, adverse events, and reported efficacy of each modality is evaluated, and current recommendations are summarized.
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              Botulinum toxin to improve facial wound healing: A prospective, blinded, placebo-controlled study.

              To test whether botulinum toxin-induced immobillzation of facial lacerations enhances wound healing and results in less noticeable scars. In this blinded, prospective, randomized clinical trial, patients were randomized from February 1, 2002, until January 1, 2004, to botullnum toxin vs placebo injection into the musculature adjacent to the wound within 24 hours after wound closure. Blinded assessment of standardized photographs by experienced facial plastic surgeons using a 10-cm visual analog scale served as the main outcome measure. Thirty-one patients presenting with traumatic forehead lacerations or undergoing elective excisions of forehead masses were included in the study. The overall median visual analog scale score for the botulinum toxin-treated group was 8.9 compared with 7.2 for the placebo group (P=.003), indicating enhanced healing and Improved cosmesis of the experimentally immobilized scars. Botullnum toxin-induced Immobilization of forehead wounds enhances healing and is suggested for use in selected patients to improve the eventual appearance of the scar.
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                Author and article information

                Journal
                cpil
                Cirugía Plástica Ibero-Latinoamericana
                Cir. plást. iberolatinoam.
                Sociedad Española de Cirugía Plástica, Reparadora y Estética (SECPRE) (Madrid, Madrid, Spain )
                0376-7892
                1989-2055
                June 2021
                : 47
                : 2
                : 187-200
                Affiliations
                [1] orgnameHospital General del Este Dr. Domingo Luciani
                [2] Caracas orgnameHospital Vargas de Caracas Venezuela
                Article
                S0376-78922021000200010 S0376-7892(21)04700200010
                10.4321/s0376-78922021000200010
                39cbcc18-65e4-43b8-b9f8-b22340a2c7d7

                This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

                History
                : 14 February 2021
                : 13 May 2021
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 25, Pages: 14
                Product

                SciELO Spain

                Categories
                Reconstructiva

                Toxina botulínica tipo A,Colágeno hialinizado,Queloide,Botulinum toxin type A,Hyalinized collagen,Keloid

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