From the Departments of Otolaryngology, Experimental Surgery, and Otolaryngology, McGill University; McGill Auditory Sciences Laboratory; and the Department of Pathology, McGill University Health Centre.
Plast Reconstr Surg. 2019 Mar;143(3):760-767. doi: 10.1097/PRS.0000000000005323.
Keloid scarring is a serious condition that mostly affects patients of African or Asian descent. Often disfiguring, this condition can have devastating psychosocial consequences. To date, no treatment modality has been proven ideal. The authors' objectives were (1) to determine the efficacy of botulin toxin type A injection for the treatment of keloid scars compared to steroid injection and to control saline injection (this was achieved through a basic science animal model using athymic nude mice and implanted human keloid tissue); and (2) to analyze the histopathologic changes that occur in an organized keloid scar following botulinum toxin type A injection as compared to steroid and saline injections.
Keloid scars from four patients were excised and implanted subcutaneously into 28 mice. Three small keloid tissue samples were implanted in each of the 28 mice. One week after implantation, each implant received one of three injections: botulinum toxin type A (treatment drug), saline (control), or steroid injection (first-line gold standard). The keloid tissue was extracted 3 weeks after implantation. Weight analysis, immunohistochemistry, and standard hematoxylin and eosin pathologic analysis were performed on each extracted tissue sample.
Paired t test analysis of pretreatment and posttreatment tissue weights revealed a statistically significant difference between the treatment and control groups (p < 0.05). Analysis by a blinded pathologist confirmed fewer collagen bundles in the treatment group. Immunohistochemistry with Ki-67, a marker of cell proliferation, revealed significantly less staining in the treatment groups.
Botulinum toxin type A could be an effective treatment for keloid scars.
瘢痕疙瘩是一种严重的疾病，主要影响非洲裔或亚洲裔患者。这种情况常常会导致毁容，并可能产生毁灭性的心理社会后果。迄今为止，还没有一种治疗方法被证明是理想的。作者的目的是：（1）确定肉毒杆菌毒素 A 注射治疗瘢痕疙瘩的疗效，与类固醇注射和生理盐水注射相比（通过使用无胸腺裸鼠和植入的人瘢痕疙瘩组织的基础科学动物模型实现了这一目标）；（2）分析肉毒杆菌毒素 A 注射后发生在有组织的瘢痕疙瘩中的组织病理学变化，与类固醇和生理盐水注射相比。
从 4 名患者中切除瘢痕疙瘩，并皮下植入 28 只小鼠。在 28 只小鼠中，每只小鼠植入 3 小块瘢痕疙瘩组织。植入后 1 周，每个植入物接受 3 种注射中的 1 种：肉毒杆菌毒素 A（治疗药物）、生理盐水（对照）或类固醇注射（一线金标准）。植入后 3 周提取瘢痕疙瘩组织。对每个提取的组织样本进行重量分析、免疫组织化学和标准苏木精和伊红病理分析。
预处理和后处理组织重量的配对 t 检验分析显示，治疗组和对照组之间存在统计学显著差异（p < 0.05）。由盲法病理学家进行的分析证实，治疗组的胶原束较少。Ki-67 是细胞增殖的标志物，用 Ki-67 进行免疫组织化学染色显示，治疗组的染色明显减少。
肉毒杆菌毒素 A 可能是瘢痕疙瘩的有效治疗方法。
