title: Psychological stress as a risk factor for postoperative keloid recurrence.
abstract: OBJECTIVE
  To investigate psychological stress on the prognosis of the postoperative recurrence of keloids.
  
  
  METHODS
  Patients with keloids (n=25), candidates for surgical resection and postoperative radiotherapy, had their psychological stress evaluated on the day before the surgical procedure. The parameters evaluated were pain and itching (Visual Numerical Scale), quality of life (Questionnaire QualiFibro/Cirurgia Plástica-UNIFESP), perceived stress (Perceived Stress Scale), depression and anxiety (Hospital Depression and Anxiety Scale), salivary cortisol and minimum and maximum galvanic skin responses (GSR) at rest and under stress (i.e., while the questionnaires were being filled out). Patients were evaluated during the 3rd, 6th, 9th and 12th months of postoperative care. During each return visit, two experts classified the lesions as non-recurrent and recurrent.
  
  
  RESULTS
  The recurrence group presented the greatest values in GSR during a stressful situation. The chance of recurrence increased by 34% at each increase of 1000 arbitrary units in maximum GSR during stress.
  
  
  CONCLUSIONS
  Psychological stress influenced the recurrence of keloids.
authors.affiliation: Postgraduate Program in Plastic Surgery, Universidade Federal de São Paulo, Brazil.
authors.forename: Fabianne
authors.initials: F
authors.lastname: Furtado
authors.forename: Bernardo
authors.initials: B
authors.lastname: Hochman
authors.forename: Paulo Luiz
authors.initials: PL
authors.lastname: Farber
authors.forename: Marisa Campio
authors.initials: MC
authors.lastname: Muller
authors.forename: Lilian Fukusima
authors.initials: LF
authors.lastname: Hayashi
authors.forename: Lydia Masako
authors.initials: LM
authors.lastname: Ferreira
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000175:diagnosis / Q000523:psychology; D001143:Arousal / Q000502:physiology; D003866:Depressive Disorder / Q000175:diagnosis / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D005712:Galvanic Skin Response / Q000502:physiology; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007627:Keloid / Q000523:psychology* / Q000601:surgery*; D008297:Male; D010147:Pain Measurement; D010555:Personality Inventory / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000523:psychology*; D011379:Prognosis; D011594:Psychometrics; D011788:Quality of Life / Q000523:psychology; D012008:Recurrence; D012307:Risk Factors; D012463:Saliva / Q000737:chemistry; D013315:Stress, Psychological / Q000150:complications*; D055815:Young Adult
chemical_list: D006854:Hydrocortisone