Austin Evan, Koo Eugene, Jagdeo Jared
Department of Dermatology, University of California at Davis, Sacramento, California.
Dermatology Service, Sacramento VA Medical Center, Mather, California.
Dermatol Surg. 2018 Feb;44(2):149-157. doi: 10.1097/DSS.0000000000001360.
Keloids and hypertrophic scars are conditions of pathologic scarring characterized by fibroblast hyperproliferation and excess collagen deposition. These conditions significantly impact patients by causing psychosocial, functional, and aesthetic distress. Current treatment modalities have limitations. Clinical evidence indicates that botulinum toxin A (BoNT-A) may prevent and treat keloids and hypertrophic scars.
To examine investigated cellular pathways involved in BoNT-A therapeutic modulation of keloids and hypertrophic scars.
The authors searched PubMed, Embase, and Web of Science for basic science articles related to botulinum toxin therapy, scarring, fibroblasts, keloids, and hypertrophic scars.
Eleven basic science articles involving keloids and hypertrophic scars were reviewed.
BoNT-A may reduce skin fibrosis by decreasing fibroblast proliferation, modulating the activity of transforming growth factor-β, and reducing transcription and expression of profibrotic cytokines in keloid-derived and hypertrophic scar-derived dermal fibroblasts. BoNT-A may modulate collagen deposition, but there is a paucity of evidence regarding specific mechanisms of action.
Overall, BoNT-A has the potential to prevent or treat pathologic scars in patients with a known personal or family history of keloids and hypertrophic scars, which may improve patient psychosocial distress and reduce clinic visits and health care costs. Variability in keloid and hypertrophic scar response to BoNT-A may be due to interexperiment differences in dosing, tissue donors, and assay sensitivity.
瘢痕疙瘩和增生性瘢痕是病理性瘢痕形成的病症，其特征为成纤维细胞过度增殖和胶原蛋白过度沉积。这些病症通过引起心理社会、功能和美学方面的困扰，对患者产生重大影响。目前的治疗方式存在局限性。临床证据表明，A型肉毒毒素（BoNT-A）可能预防和治疗瘢痕疙瘩和增生性瘢痕。
研究BoNT-A对瘢痕疙瘩和增生性瘢痕进行治疗性调节所涉及的细胞途径。
作者在PubMed、Embase和科学网中搜索与肉毒毒素治疗、瘢痕形成、成纤维细胞、瘢痕疙瘩和增生性瘢痕相关的基础科学文章。
对11篇涉及瘢痕疙瘩和增生性瘢痕的基础科学文章进行了综述。
BoNT-A可能通过减少成纤维细胞增殖、调节转化生长因子-β的活性以及减少瘢痕疙瘩来源和增生性瘢痕来源的真皮成纤维细胞中促纤维化细胞因子的转录和表达，来减轻皮肤纤维化。BoNT-A可能调节胶原蛋白沉积，但关于具体作用机制的证据较少。
总体而言，BoNT-A有潜力预防或治疗有瘢痕疙瘩和增生性瘢痕个人或家族病史患者的病理性瘢痕，这可能改善患者的心理社会困扰，并减少门诊就诊次数和医疗保健成本。瘢痕疙瘩和增生性瘢痕对BoNT-A反应的变异性可能归因于实验间在剂量、组织供体和检测灵敏度方面的差异。
