Alster Tina S, Tanzi Elizabeth L
The Washington Institute of Dermatologic Laser Surgery, DC 20037, USA.
Am J Clin Dermatol. 2003;4(4):235-43. doi: 10.2165/00128071-200304040-00003.
Keloid and hypertrophic scars have affected patients and frustrated physicians for centuries. Keloid and hypertrophic scars result from excessive collagen deposition, the cause of which remains elusive. Clinically, these scars can be disfiguring functionally, aesthetically, or both. A thorough understanding of the pathophysiology and clinical nature of the scar can help define the most appropriate treatment strategy. Although many articles have been published on the management of hypertrophic and keloid scars, there is no universally accepted treatment protocol. Prevention of keloid and hypertrophic scars remains the best strategy; therefore, those patients with a predisposition to develop excessive scar formation should avoid nonessential surgery. Once a scar is present, there are many treatments from which to choose. Hypertrophic scars and keloids have been shown to respond to radiation, pressure therapy, cryotherapy, intralesional injections of corticosteroid, interferon and fluorouracil, topical silicone or other dressings, and pulsed-dye laser treatment. Simple surgical excision is usually followed by recurrence unless adjunct therapies are employed. Biologic agents that are directed towards the aberrant collagen proliferation that characterizes keloid and hypertrophic scars might be an important addition to the current armamentarium of modalities in the near future.
几个世纪以来，瘢痕疙瘩和增生性瘢痕一直困扰着患者，也让医生们感到棘手。瘢痕疙瘩和增生性瘢痕是由胶原蛋白过度沉积所致，其病因尚不明确。在临床上，这些瘢痕在功能上、美观上或者二者兼具的情况下都会有损外观。对瘢痕的病理生理学和临床特性有透彻的了解有助于确定最合适的治疗策略。尽管已经发表了许多关于增生性瘢痕和瘢痕疙瘩治疗的文章，但尚无普遍接受的治疗方案。预防瘢痕疙瘩和增生性瘢痕仍然是最佳策略；因此，那些有形成过度瘢痕倾向的患者应避免不必要的手术。一旦出现瘢痕，就有多种治疗方法可供选择。已证明增生性瘢痕和瘢痕疙瘩对放射治疗、压力疗法、冷冻疗法、病灶内注射皮质类固醇、干扰素和氟尿嘧啶、外用硅酮或其他敷料以及脉冲染料激光治疗有反应。除非采用辅助治疗，单纯手术切除通常会导致复发。针对瘢痕疙瘩和增生性瘢痕所特有的异常胶原增生的生物制剂可能在不久的将来成为当前治疗手段中的重要补充。
