Keloid pathogenesis and treatment.
BACKGROUND
Keloid management can be difficult and frustrating, and the mechanisms underlying keloid formation are only partially understood.


METHODS
Using original and current literature in this field, this comprehensive review presents the major concepts of keloid pathogenesis and the treatment options stemming from them.


RESULTS
Mechanisms for keloid formation include alterations in growth factors, collagen turnover, tension alignment, and genetic and immunologic contributions. Treatment strategies for keloids include established (e.g., surgery, steroid, radiation) and experimental (e.g., interferon, 5-fluorouracil, retinoid) regimens.


CONCLUSIONS
The scientific basis and empiric evidence supporting the use of various agents is presented. Combination therapy, using surgical excision followed by intradermal steroid or other adjuvant therapy, currently appears to be the most efficacious and safe current regimen for keloid management.
Al-Attar
Ali
A
Division of Dermatology, Department of Plastic Surgery, Georgetown University Medical Center, Washington, DC 20007, USA.
Mess
Sarah
S
Thomassen
John Michael
JM
Kauffman
C Lisa
CL
Davison
Steven P
SP
D000963:Antimetabolites / Q000627:therapeutic use; D003094:Collagen / Q000378:metabolism; D003131:Combined Modality Therapy; D005109:Extracellular Matrix / Q000502:physiology; D005347:Fibroblasts / Q000502:physiology; D005472:Fluorouracil / Q000627:therapeutic use; D006801:Humans; D015552:Injections, Intralesional; D007372:Interferons / Q000627:therapeutic use; D007627:Keloid / Q000276:immunology / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology* / Q000628:therapy*; D053685:Laser Therapy; D011312:Pressure; D012176:Retinoids / Q000627:therapeutic use; D012629:Sebum / Q000276:immunology; D020034:Silicone Gels / Q000008:administration & dosage; D013314:Stress, Mechanical; D016212:Transforming Growth Factor beta / Q000502:physiology; D014222:Triamcinolone Acetonide / Q000008:administration & dosage
D000963:Antimetabolites; D012176:Retinoids; D020034:Silicone Gels; D016212:Transforming Growth Factor beta; D003094:Collagen; D007372:Interferons; D014222:Triamcinolone Acetonide; D005472:Fluorouracil