Saray Yasemin, Güleç A Tülin
Department of Dermatology, Başkent University Faculty of Medicine, Ankara, Turkey.
Int J Dermatol. 2005 Sep;44(9):777-84. doi: 10.1111/j.1365-4632.2005.02633.x.
Numerous treatment modalities have been used to treat keloids and hypertrophic scars, but the optimal treatment has not been established.
The aim of this study was to determine the efficacy and safety of intralesional jet injection of bleomycin as therapy for keloids and hypertrophic scars that are unresponsive to intralesional steroid injection.
The study included 14 patients with 15 keloids or hypertrophic scars that had not responded to a minimum of three intralesional injections of triamcinolone acetonide. Multiple jet injections of 0.1 ml of bleomycin (1.5 IU/ml) were administered to each lesion, with injection sites spaced 0.5 mm apart. Injections were repeated each month. Scar height was measured, and scar pliability and erythema were scored at baseline and then monthly during the treatment and follow-up periods. Patients' self-assessments of subjective symptoms (pruritus and pain) were also scored. Clinical improvement was defined primarily on the basis of scar height reduction (percentage reduction from baseline), and was classified using the following scale: complete flattening (100%), highly significant flattening (> 90%), significant flattening (75-90%), moderate flattening (50-75%), and minimal flattening (< 50%). Pre- and post-treatment mean values for scar height, scar pliability, erythema, pruritus and pain were statistically compared.
The number of sessions required to successfully treat the lesions ranged from two to six. Eleven lesions (73.3%) showed complete flattening, one (6.7%) showed highly significant flattening, two (13.3%) showed significant flattening, and one scar (6.7%) showed moderate flattening. The mean scar height was significantly lower, and the mean scores for scar pliability and erythema were significantly better at the end of treatment (P < 0.001, P < 0.001 and P < 0.001, respectively). The mean scores for pruritus and pain also improved significantly (P < 0.001 and P = 0.01, respectively). The observed side-effects were hyperpigmentation (four lesions) and skin atrophy (three lesions). No recurrences were noted during follow up (mean duration of 19 months).
Intralesional jet injection of bleomycin is an effective and safe method of treating keloids and hypertrophic scars that are unresponsive to intralesional steroid therapy.
多种治疗方式已被用于治疗瘢痕疙瘩和增生性瘢痕，但尚未确定最佳治疗方法。
本研究的目的是确定病灶内注射博来霉素对病灶内注射类固醇无反应的瘢痕疙瘩和增生性瘢痕的疗效和安全性。
该研究纳入了14例患者，他们有15个瘢痕疙瘩或增生性瘢痕，对至少三次病灶内注射曲安奈德均无反应。对每个病灶进行多次0.1毫升博来霉素（1.5国际单位/毫升）的喷射注射，注射部位间隔0.5毫米。每月重复注射。在基线时测量瘢痕高度，并在治疗和随访期间每月对瘢痕柔韧性和红斑进行评分。还对患者主观症状（瘙痒和疼痛）的自我评估进行评分。临床改善主要根据瘢痕高度降低（相对于基线的降低百分比）来定义，并使用以下量表进行分类：完全扁平（100%）、高度显著扁平（>90%）、显著扁平（75-90%）、中度扁平（50-75%）和最小扁平（<50%）。对治疗前后瘢痕高度、瘢痕柔韧性、红斑、瘙痒和疼痛的平均值进行统计学比较。
成功治疗病灶所需的疗程数为2至6个。11个病灶（73.3%）显示完全扁平，1个（6.7%）显示高度显著扁平，2个（13.3%）显示显著扁平，1个瘢痕（6.7%）显示中度扁平。治疗结束时，平均瘢痕高度显著降低，瘢痕柔韧性和红斑的平均评分显著改善（分别为P<0.001、P<0.001和P<0.001）。瘙痒和疼痛的平均评分也显著改善（分别为P<0.001和P=0.01）。观察到的副作用为色素沉着（4个病灶）和皮肤萎缩（3个病灶）。随访期间（平均持续时间19个月）未观察到复发。
病灶内喷射注射博来霉素是治疗对病灶内类固醇治疗无反应的瘢痕疙瘩和增生性瘢痕的一种有效且安全的方法。
