Ogawa Rei, Akita Sadanori, Akaishi Satoshi, Aramaki-Hattori Noriko, Dohi Teruyuki, Hayashi Toshihiko, Kishi Kazuo, Kono Taro, Matsumura Hajime, Muneuchi Gan, Murao Naoki, Nagao Munetomo, Okabe Keisuke, Shimizu Fumiaki, Tosa Mamiko, Tosa Yasuyoshi, Yamawaki Satoko, Ansai Shinichi, Inazu Norihisa, Kamo Toshiko, Kazki Reiko, Kuribayashi Shigehiko
1Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School, 1-1-5 Sendagi Bunkyo-ku, Tokyo, 113-8603 Japan.
2Department of Plastic Surgery, Wound Repair and Regeneration, Fukuoka University, Fukuoka, 814-0180 Japan.
Burns Trauma. 2019 Dec 27;7:39. doi: 10.1186/s41038-019-0175-y. eCollection 2019.
There has been a long-standing need for guidelines on the diagnosis and treatment of keloids and hypertrophic scars that are based on an understanding of the pathomechanisms that underlie these skin fibrotic diseases. This is particularly true for clinicians who deal with Asian and African patients because these ethnicities are highly prone to these diseases. By contrast, Caucasians are less likely to develop keloids and hypertrophic scars, and if they do, the scars tend not to be severe. This ethnic disparity also means that countries vary in terms of their differential diagnostic algorithms. The lack of clear treatment guidelines also means that primary care physicians are currently applying a hotchpotch of treatments, with uneven outcomes. To overcome these issues, the Japan Scar Workshop (JSW) has created a tool that allows clinicians to objectively diagnose and distinguish between keloids, hypertrophic scars, and mature scars. This tool is called the JSW Scar Scale (JSS) and it involves scoring the risk factors of the individual patients and the affected areas. The tool is simple and easy to use. As a result, even physicians who are not accustomed to keloids and hypertrophic scars can easily diagnose them and judge their severity. The JSW has also established a committee that, in cooperation with outside experts in various fields, has prepared a Consensus Document on keloid and hypertrophic scar treatment guidelines. These guidelines are simple and will allow even inexperienced clinicians to choose the most appropriate treatment strategy. The Consensus Document is provided in this article. It describes (1) the diagnostic algorithm for pathological scars and how to differentiate them from clinically similar benign and malignant tumors, (2) the general treatment algorithms for keloids and hypertrophic scars at different medical facilities, (3) the rationale behind each treatment for keloids and hypertrophic scars, and (4) the body site-specific treatment protocols for these scars. We believe that this Consensus Document will be helpful for physicians from all over the world who treat keloids and hypertrophic scars.
长期以来，一直需要基于对这些皮肤纤维化疾病潜在病理机制的理解而制定的瘢痕疙瘩和增生性瘢痕的诊断与治疗指南。对于处理亚洲和非洲患者的临床医生来说尤其如此，因为这些种族极易患上这些疾病。相比之下，白种人患瘢痕疙瘩和增生性瘢痕的可能性较小，而且即便患病，瘢痕往往也不严重。这种种族差异还意味着不同国家在鉴别诊断算法方面存在差异。缺乏明确的治疗指南也意味着基层医疗医生目前采用的治疗方法五花八门，效果参差不齐。为克服这些问题，日本瘢痕研讨会（JSW）创建了一种工具，使临床医生能够客观地诊断并区分瘢痕疙瘩、增生性瘢痕和成熟瘢痕。这种工具称为JSW瘢痕量表（JSS），它涉及对个体患者和受影响区域的风险因素进行评分。该工具简单易用。因此，即使是不熟悉瘢痕疙瘩和增生性瘢痕的医生也能轻松诊断并判断其严重程度。JSW还成立了一个委员会，该委员会与各领域的外部专家合作，编写了一份关于瘢痕疙瘩和增生性瘢痕治疗指南的共识文件。这些指南很简单，即使是经验不足的临床医生也能据此选择最合适的治疗策略。本文提供了这份共识文件。它描述了（1）病理性瘢痕的诊断算法以及如何将其与临床相似的良性和恶性肿瘤区分开来，（2）不同医疗机构对瘢痕疙瘩和增生性瘢痕的一般治疗算法，（3）瘢痕疙瘩和增生性瘢痕每种治疗方法背后的原理，以及（4）这些瘢痕的特定身体部位治疗方案。我们相信这份共识文件将对世界各地治疗瘢痕疙瘩和增生性瘢痕的医生有所帮助。
