Plastic and Reconstructive Surgery Research, Bayat Research Group, Manchester Institute of Biotechnology, University of Manchester, 131 Princess Street, Manchester, M1 7DN, U.K; University Hospital of South Manchester NHS Foundation Trust, Institute of Inflammation and Repair, Dermatology Group, Faculty of Medical and Human Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, M23 9LT, U.K.
Br J Dermatol. 2013 Oct;169 Suppl 3:71-81. doi: 10.1111/bjd.12588.
Keloid disease (KD) is a common, benign, dermal fibroproliferative growth of unknown aetiology. Lesions tend to grow over time; they often recur following therapy and do not regress spontaneously. KD causes considerable discomfort due to pain, pruritus and inflammation, and a significant psychosocial impact with reduced quality of life. It is unique to humans and occurrence is higher in individuals with dark, pigmented, ethnic skin. There is a strong familial heritability, with a high ethnic predisposition in individuals of African, Asian and Hispanic descent. High recurrence rates and unknown resolution rates present a major problem for both the patient and clinician. Many treatment modalities exist; however, there is no single advocated therapy. Therefore, the aim of this review was to explore the most current literature regarding the range of treatment options for KD and to offer a structured approach in the management of KD, based on evidence and experience, to aid clinicians in their current practice. A focused history involving careful evaluation of the patient's symptoms, signs, quality of life and psychosocial well-being should direct targeted therapy, complemented with regular follow-up and re-evaluation. Many treatment modalities, such as intralesional steroid injection, silicone gel application, cryotherapy, lasers, 5-fluorouracil and, relatively recently, photodynamic therapy, are currently being used in clinical practice for the management of KD. Combination therapies have also been shown to be beneficial. However, there is a lack of robust, randomized, level-one, evidence-controlled trials evaluating these treatment options. Management of KD in ethnic pigmented skin remains a clinical challenge. Thus, a strategic approach with structured assessment, targeted therapy and focus on prevention of recurrence is highly recommended. Quality evidence is essential in order to tailor treatment effectively for the ethnic patient presenting with KD.
瘢痕疙瘩病（KD）是一种常见的、良性的、真皮纤维组织增生性疾病，病因不明。病变随时间推移而生长；经治疗后往往会复发，且不会自发消退。KD 会引起疼痛、瘙痒和炎症，给患者带来相当大的不适，且对生活质量产生重大的心理社会影响。KD 仅发生于人类，在深色、色素沉着、有色人种中发病率更高。该病具有很强的家族遗传性，非洲、亚洲和西班牙裔人群的发病倾向更高。高复发率和未知的消退率给患者和临床医生都带来了重大问题。目前存在多种治疗方法，但没有一种被广泛推荐。因此，本综述旨在探讨 KD 的各种治疗选择的最新文献，并根据证据和经验提供 KD 的管理方法，以帮助临床医生在其当前实践中为患者提供治疗。详细的病史包括对患者症状、体征、生活质量和心理社会健康的仔细评估，应指导靶向治疗，并辅以定期随访和重新评估。目前，许多治疗方法，如皮质类固醇注射、硅凝胶应用、冷冻疗法、激光、5-氟尿嘧啶，以及最近的光动力疗法，都在临床上用于 KD 的治疗。联合治疗也已被证明是有益的。然而，目前缺乏针对这些治疗方案的稳健、随机、一级、证据对照试验。有色人种色素沉着皮肤的 KD 管理仍然是一个临床挑战。因此，强烈建议采用结构化评估、靶向治疗和预防复发的策略。为了为患有 KD 的有色人种患者提供有效的治疗，高质量的证据至关重要。
