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曲安奈德联合其他皮损内药物治疗瘢痕疙瘩和增生性瘢痕的复发率。

Recurrence rates in the treatment of keloids and hypertrophic scars with intralesional triamcinolone combined with other intralesional agents.

机构信息

Department of Dermatology, Center for Dermatology Research, Wake Forest University School of Medicine, Winston-Salem, NC, USA.

Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, NC, USA.

出版信息

Arch Dermatol Res. 2023 Dec;315(10):2757-2767. doi: 10.1007/s00403-023-02662-x. Epub 2023 Jul 11.

Abstract

Hypertrophic scars (HTS) and keloids are pathologic scars that are products of a wound healing pathway error attributed to genetic and inflammatory causes (Leventhal et al., Arch Facial Plast Surg 8(6):362-368. https://doi.org/10.1001/archfaci.8.6.362 , 2006). Methods of pathologic scar treatment include intralesional agents, cryotherapy, surgical excision, pressure dressings, topical agents, laser resurfacing, radiotherapy, and other investigational therapies (Leventhal et al. 2006). The recurrence of pathologic scar is high across all treatment modalities, including the use of intralesional agents (Trisliana Perdanasari et al., Arch Plast Surg 41(6):620-629. https://doi.org/10.5999/aps.2014.41.6.620 , 2014). In the treatment of pathologic scar, combination approaches using intralesional agents, such as triamcinolone (TAC), 5-fluorouracil (5FU), verapamil (VER), bleomycin (BLM), and botulinum toxin (BTX), are superior therapies when compared to monotherapy (Yosipovitch et al., J Dermatol Treat 12(2):87-90. https://doi.org/10.1080/095466301317085363 , 2001; Yang et al., Front Med 8:691628. https://doi.org/10.3389/fmed.2021.691628 , 2021; Sun et al., Aesthetic Plast Surg 45(2):791-805. https://doi.org/10.1007/s00266-019-01570-8 , 2021). This review assesses recurrence and the reporting of recurrence in pathologic scar after treatment with intralesional triamcinolone (TAC) in combination with another intralesional agent. A literature review was conducted using research journals from PubMed using the following search terms: [(keloid) AND (triamcinolone) AND (combination) AND (intralesional)], as well as [(keloid) AND (triamcinolone) AND (combination)]. Articles were reviewed and included if the article analyzed  or compared intralesional agents for pathologic scar treatment within the last 10 years. The average follow-up period of included articles (n = 14) that utilized combination intralesional therapy (TAC-X) was approximately 11 months (range 1-24 months). Consistent recurrence rate reporting across studies was lacking. The combination agent with the highest recurrence rate was TAC-5FU (23.3%). The range of reported recurrence rates was 7.5-23.3%. Six studies using various intralesional combination regimens reported 0% recurrence over the follow-up period (TAC-5FU, TAC-BTX, TAC-BLM, TAC-CRY). Three studies did not report recurrence rates. While the efficacy of combination therapy is typically assessed via scar scales, the assessment of recurrence across studies of combination therapy is inconsistent and inadequate, with truncated follow-up periods. While scar recurrence can take place during 1-year post-treatment, long-term follow-up (18-24 months) is needed to characterize recurrence in the treatment of pathologic scar using various intralesional agents. Long-term follow-up periods allow patients to receive accurate prognostic information regarding recurrence after combination intralesional therapy. There are limitations to this review in that comparisons were made across studies with varying outcome variables, including scar size, injection concentration and interval, and follow-up period. Standardized follow-up periods and recurrence rate reporting are integral to furthering the understanding of these therapies and enhancing patient care.

摘要

增生性瘢痕(HTS)和瘢痕疙瘩是病理性瘢痕,是由于遗传和炎症等原因导致的伤口愈合途径错误的产物(Leventhal 等人,Arch Facial Plast Surg 8(6):362-368. https://doi.org/10.1001/archfaci.8.6.362, 2006)。病理性瘢痕的治疗方法包括病灶内药物、冷冻疗法、手术切除、压力敷料、局部药物、激光换肤、放射治疗和其他研究性治疗方法(Leventhal 等人,2006 年)。包括病灶内药物在内的所有治疗方式都存在病理性瘢痕复发率高的问题(Trisliana Perdanasari 等人,Arch Plast Surg 41(6):620-629. https://doi.org/10.5999/aps.2014.41.6.620, 2014)。在病理性瘢痕的治疗中,与单一疗法相比,使用病灶内药物(如曲安奈德[TAC]、5-氟尿嘧啶[5FU]、维拉帕米[VER]、博来霉素[BLM]和肉毒杆菌毒素[BTX])的联合治疗方法是更优越的治疗方法(Yosipovitch 等人,J Dermatol Treat 12(2):87-90. https://doi.org/10.1080/095466301317085363, 2001;Yang 等人,Front Med 8:691628. https://doi.org/10.3389/fmed.2021.691628, 2021;Sun 等人,Aesthetic Plast Surg 45(2):791-805. https://doi.org/10.1007/s00266-019-01570-8, 2021)。本综述评估了在使用曲安奈德(TAC)与另一种病灶内药物联合治疗病理性瘢痕后,病灶内曲安奈德(TAC)联合另一种病灶内药物治疗病理性瘢痕的复发率和复发报告情况。使用 PubMed 研究期刊进行文献回顾,使用以下搜索词:[(keloid) AND (triamcinolone) AND (combination) AND (intralesional)],以及[(keloid) AND (triamcinolone) AND (combination)]。如果文章分析了过去 10 年内病理性瘢痕治疗中病灶内药物的比较,则将文章进行审查和纳入。纳入文章(n=14)的平均随访期约为 11 个月(范围为 1-24 个月),均使用联合病灶内疗法(TAC-X)。研究之间缺乏一致的复发率报告。复发率最高的联合药物是 TAC-5FU(23.3%)。报告的复发率范围为 7.5-23.3%。六篇使用各种病灶内联合方案的研究报告在随访期间无复发(TAC-5FU、TAC-BTX、TAC-BLM、TAC-CRY)。三篇研究未报告复发率。虽然联合治疗的疗效通常通过瘢痕量表进行评估,但联合治疗研究中对复发的评估不一致且不充分,随访时间较短。虽然瘢痕复发可能发生在治疗后 1 年内,但需要长达 18-24 个月的长期随访才能确定使用各种病灶内药物治疗病理性瘢痕的复发情况。长期随访期可以使患者获得有关联合病灶内治疗后复发的准确预后信息。本综述存在一定局限性,因为对不同研究的比较是基于不同的结果变量,包括瘢痕大小、注射浓度和间隔以及随访期。标准化的随访期和复发率报告对于进一步了解这些治疗方法和提高患者护理水平至关重要。

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