켈로이드의 병변내 절제술 치료에 대한 연구 (A Study on Intra-lesional Excision of Keloids)

서지정보

· 발행기관 : 대한피부과학회
· 수록지 정보 : 대한피부과학회지 / 47권 / 6호 / 641 ~ 648페이지
· 저자명 : 남재희, 최영준, 김태환, 이가영, 박수홍, 김원석, 김계정

초록

Background: Keloid is one of the most frustrating clinical problems in wound healing. There are numerous
treatments for keloids such as surgical excision, steroid injection, radiation therapy, laser, silicone gel application and
so on. Surgical excision of a keloid is generally not accepted as a first treatment of choice. However, there have
been many reports of successful cosmetic results from specialized surgical treatments such as intra-lesional/intramarginal
excision with or without post surgical adjuvant treatments.
Objective: The aims of this study areto evaluate the effectiveness of intralesional excision of keloids, the optimal
surgical conditions and the proper adjuvant therapy after surgery.
Methods: We analyzed the medical records and clinical photographs of 20 patients who underwent intra-lesional
excision of their keloids and who had regular follow-ups for at least for 3 months. The clinical outcomes were
assessed by three independent physicians based on their interpretation of the photographs before and after surgery
with using a global assessment 5 point scale that ranged from bad, poor, fair and good to excellent.
Results: General surgical outcomes after intra-lesional excision: the average improvement score was 4.05 after
intra-lesional excision and adjuvant therapy. The average improvement score after intra-lesional excision was 4.71 for
ear keloids and 2.83 for keloids in other areas (p=0.000). The average improvement score after intra-lesional
excision was 5 for earlobe keloids and 4.42 for ear-helix keloids (p=0.014). The average improvement score was
3.92 for the steroid intra-lesional injection and topical silicone gel combination treatment group after intra-lesional
excision and the average improvement score was 4.29 for the single topical silicone gel treatment group (p=0.858).
Conclusion: Although surgery is not a first treatment of choice for the management of keloids, large recalcitrant
keloids need massive surgical removal for faster clinical results. In this study, we found that surgery, and especially
intra-lesional excision, is not an absolute contraindication for treating keloids and this is sometimes considered as the
first treatment of choice, and especially for ear keloids. However, a more careful surgical approach is necessary for
the case of keloids that develop in other areas. Further studies about the optimal surgical indications for keloids and
the recommended adjuvant therapy after surgery are necessary.

영어초록

Background: Keloid is one of the most frustrating clinical problems in wound healing. There are numerous
treatments for keloids such as surgical excision, steroid injection, radiation therapy, laser, silicone gel application and
so on. Surgical excision of a keloid is generally not accepted as a first treatment of choice. However, there have
been many reports of successful cosmetic results from specialized surgical treatments such as intra-lesional/intramarginal
excision with or without post surgical adjuvant treatments.
Objective: The aims of this study areto evaluate the effectiveness of intralesional excision of keloids, the optimal
surgical conditions and the proper adjuvant therapy after surgery.
Methods: We analyzed the medical records and clinical photographs of 20 patients who underwent intra-lesional
excision of their keloids and who had regular follow-ups for at least for 3 months. The clinical outcomes were
assessed by three independent physicians based on their interpretation of the photographs before and after surgery
with using a global assessment 5 point scale that ranged from bad, poor, fair and good to excellent.
Results: General surgical outcomes after intra-lesional excision: the average improvement score was 4.05 after
intra-lesional excision and adjuvant therapy. The average improvement score after intra-lesional excision was 4.71 for
ear keloids and 2.83 for keloids in other areas (p=0.000). The average improvement score after intra-lesional
excision was 5 for earlobe keloids and 4.42 for ear-helix keloids (p=0.014). The average improvement score was
3.92 for the steroid intra-lesional injection and topical silicone gel combination treatment group after intra-lesional
excision and the average improvement score was 4.29 for the single topical silicone gel treatment group (p=0.858).
Conclusion: Although surgery is not a first treatment of choice for the management of keloids, large recalcitrant
keloids need massive surgical removal for faster clinical results. In this study, we found that surgery, and especially
intra-lesional excision, is not an absolute contraindication for treating keloids and this is sometimes considered as the
first treatment of choice, and especially for ear keloids. However, a more careful surgical approach is necessary for
the case of keloids that develop in other areas. Further studies about the optimal surgical indications for keloids and
the recommended adjuvant therapy after surgery are necessary.

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