Keloidbehandlung mit intraläsionaler
                    Kryochirurgie

C. C. Zouboulis; M. J. Weidmann; Y. Har-Shai

doi:10.1055/a-0960-6100

Laryngo-Rhino-Otologie, Table of Contents

Laryngorhinootologie 2019; 98(08): 536-544
DOI: 10.1055/a-0960-6100

Übersicht

Keloidbehandlung mit intraläsionaler Kryochirurgie

Eine Differenzierung der Keloidformen zur Verbesserung der PatientenselektionIntralesional Cryosurgery in the Treatment of KeloidsA Differentiation of Keloid Types for the Improvement of Patient Selection

C. C. Zouboulis

¹Klinik für Dermatologie, Venerologie und Allergologie/Immunologisches Zentrum, Städtisches Klinikum Dessau, Medizinische Hochschule Brandenburg Theodor Fontane, Dessau

,

M. J. Weidmann

²Praxis Dr. Weidmann und Kollegen, Augsburg

,

Y. Har-Shai

³Unit of Plastic Surgery, Carmel Medical Center and The Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel

› Author Affiliations

Abstract

Zusammenfassung

Die Überproduktion veränderter Kollagenfasern und die Überexpression von Tumor-Growth-Factor-β muss gehemmt werden, um den Wachstumsprozess innerhalb einer Keloidnarbe zu unterbrechen. Dies kann mit den klassischen Therapieverfahren kaum gelingen. Die Behandlungsergebnisse der Keloidtherapie sind nur schwer vorherzusagen und die Rezidivrate liegt meist über 50 %. Darüber hinaus können einige der eingesetzten Verfahren (z. B. Bestrahlung) zusätzliche gesundheitliche Risiken verursachen. Die intraläsionale Kryochirurgie bietet eine seit nunmehr 10 Jahren erprobte Therapiealternative an. Eigene Ergebnisse von weit über tausend Behandlungen von Patienten mit Keloiden ermöglichen eine kritische Analyse, um eine Unterscheidung der Keloide, die gut zu behandeln sind, von denen, die sich für eine Behandlung weniger oder gar nicht eignen, treffen zu können.

Abstract

The overproduction of altered collagen fibers and the overexpression of Tumor Growth Factor-β must be blocked in order to interrupt the growth process within a keloid scar. This can barely be achieved with the classical therapeutic methods. The results of keloid treatment are difficult to predict and the recurrence rate is usually over 50 %. In addition, some of the procedures used (e. g. irradiation) may induce additional health risks. Intralesional cryosurgery offers a therapeutic alternative that has been evaluated since more than a decade. Our own experience in more than one thousand keloid treatments allows a critical evaluation of the classification in those keloid types, which are recommended to be treated with the technique and those, which may not respond.

Full Text

References

Literatur
1 Zouboulis CC, Blume U, Büttner P. et al. Outcomes of cryosurgery in keloids and hypertrophic scars. A prospective consecutive trial of case series. Arch Dermatol 1993; 129: 1146-1151
2 Dalkowski A, Schuppan D, Orfanos CE. et al. Increased expression of tenascin-C by keloids in vivo and in vitro. Br J Dermatol 1999; 141: 50-56
3 Har-Shai Y, Zouboulis CC. Intralesional cryosurgery for the treatment of hypertropic scars and keloids. In: Abramovits W, Graham G, Har-Shai Y. et al., eds. Dermatological Cryosurgery and Cryotherapy. London: Springer; 2016: 453-474
4 Zouboulis CC, Weidmann MJ. Eine erste Bestandsaufnahme – Intraläsionale Kryochirurgie von Keloiden. Haut 2015; 2: 76-82
5 Zouboulis CC. Principles of cutaneous cryosurgery: An update. Dermatology 1999; 198: 111-117
6 Zouboulis CC, Rosenberger AD, Forster T. et al. Modification of a device and its application for intralesional cryosurgery of old recalcitrant keloids. Arch Dermatol 2004; 140: 1293-1294
7 Zouboulis CC, Zouridaki E, Rosenberger A. et al. Current developments and uses of cryosurgery in the treatment of keloids and hypertrophic scars. Wound Repair Regen 2002; 10: 98-102
8 Chopinaud M, Pham A, Labbé D. et al. Intralesional cryosurgery to treat keloid scars: Results from a retrospective study. Dermatology 2014; 229: 263-270
9 Har-Shai Y, Dujovny E, Rohde E. et al. Effect of skin surface temperature on skin pigmentation during contact and intralesional cryosurgery of keloids. J Eur Acad Dermatol Venereol 2007; 21: 191-198
10 Har-Shai Y, Amar M, Sabo E. Intralesional cryotherapy for enhancing the involution of hypertrophic scars and keloids. Plast Reconstr Surg 2003; 111: 1841-1852
11 Zouboulis CC, Har-Shai Y, Orfanos CE. Cryosurgical treatment of keloids and hypertrophic scars. In: Abramovits W, Graham G, Har-Shai Y. et al., eds. Dermatological Cryosurgery and Cryotherapy. London: Springer; 2016: 413-451
12 Har-Shai Y, Sabo E, Rohde E. et al. Intralesional cryosurgery enhances the involution of recalcitrant auricular keloids: a new clinical approach supported by experimental studies. Wound Rep Reg 2006; 14: 18-27
13 Dalkowski A, Fimmel S, Beutler C. et al. Cryotherapy modifies synthetic activity and differentiation of keloidal fibroblasts in vitro. Exp Dermatol 2003; 12: 673-681
14 Mirmovich O, Gil T, Goldin I. et al. Pain evaluation and control during and following the treatment of hypertrophic scars and keloids by contact and intralesional cryosurgery – a preliminary study. J Eur Acad Dermatol Venereol 2012; 26: 440-447
15 Har-Shai Y, Mettanes I, Zilberstein Y. et al. Keloid histopathology after intralesional cryosurgery treatment. J Eur Acad Dermatol Venereol 2011; 25: 1027-1036
16 Faulhaber J. Keloid-Behandlung eines jungen Patienten mit intraläsionaler Kryochirurgie. derm 2016; 22: 510-516
17 Stromps JP, Dunda S, Eppstein RJ. Intralesional cryosurgery combined with topical silicone gel sheeting for the treatment of refractory keloids. Dermatol Surgery 2014; 40: 996-1003
18 Stromps JP, Kolios G, Cedidi C. et al. Intralesional cryosurgery combined with topical silicone gel sheeting for the hypertrophic scar and keloid formation after male circumcision. Ann Plast Surg 2005; 54: 676-680
19 Abdel-Meguid AM, Weshahy AH, Sayed DS. et al. Intralesional vs. contact cryosurgery in treatment of keloids: a clinical and immunohistochemical study. Int J Dermatol 2015; 54: 468-475
20 Baryza MJ, Baryza GA. The Vancouver Scar Scale: an administration tool and its interrater reliability. J Burn Care Rehabil 1995; 16: 535-538
21 Zouboulis CC. Cryosurgery in dermatology. Eur J Dermatol 1998; 8: 466-474
22 Aust MC, Bahte S, Fernandes D. Bildatlas der perkutanen Kollageninduktion. Grundlagen, Indikationen, Anwendungen. Berlin: KVM; 2013
23 Zouboulis CC. Kryochirurgie in der Dermatologie. Hautarzt 2015; 66: 834-848
24 Har-Shai Y, Brown W, Labbé D. et al. Intralesional cryosurgery for the treatment of hypertrophic scars and keloids following aesthetic surgery: the results of a prospective observational study. Int J Low Extrem Wounds 2008; 7: 169-175
25 Weidmann MJ. Keloide und hypertrophe Narben mit intraläsionaler Kryotherapie behandeln. Ärztliches Journal Reise und Medizin 2012; 7–8: 6-7
26 Weidmann MJ, Har-Shai Y. Die Behandlung von Keloiden und hypertrophen Narben durch intraläsionale Kryotherapie. Kosmetische Medizin 2012; 2 (12) 4-8
27 Goldenberg G, Luber AJ. Use of intralesional cryosurgery as an innovative therapy for keloid scars and a review of current treatments. J Clin Aesthet Dermatol 2013; 6: 23-26
28 Har-Shai Y, Har-Shai L. Intralesional cryosurgery for the treatment of upper lip keloid following deep chemical peeling. Eur J Plast Surg 2014; 37: 679-682
29 Defty C, Cubitt JJ, Murison MSC. Can intralesional cryotherapy reshape the management of difficult keloid scars?. Scars Burns & Healing 2016; 2: 1-5
30 O’Boyle CP, Shayan-Arani H, Hamada MW. Intralesional cryotherapy for hypertrophic scars and keloids: a review. Scars Burns & Healing 2017; 3: 1-9