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Introduction: Depending on their location and size, keloids often pose functional, aesthetic and even psychological problems. Black Africans and Asians are more prone to keloids, whereas they are rare in whites and albinos. Bleomycin has been reported as a means of treating keloids, but to our knowledge no study in black Africa has looked at this molecule in the treatment of keloids. The aim of this study is to evaluate the efficacy and safety of bleomycin in the treatment of new keloids by intracheloid infiltration in subjects with phenotype VI, who are the most predisposed to this condition. Material and Methods: From 1 January to 31 December 2021, we identified 99 cases, 27 of whom met our inclusion criteria. They received intra-lesional bleomycin spaced 2 weeks apart or more for some with clinical parameters to evaluate the treatment. We judged the evolution: satisfactory, when pruritus and/or pain disappeared, the keloid mass subsided; more or less satisfactory, when pruritus and/or pain decreased, the keloid mass subsided; unsatisfactory, when pruritus and/or pain persisted, the keloid mass remained unchanged. Our data were processed and analysed using Epi Info 7.2.2.6. Results: The mean age of the patients was 30.70 years, with extremes of 2 and 85 years. The sex ratio was 1.25. The major functional sign was isolated pruritus in 66.66%. The consistency of the lesions was hard in 11%. The median number of infiltrations was 3, with extremes of 1 and 5. The local effects observed were pain on infiltration in 92% and necrosis in 77.77% of cases. No systemic effects were noted. Treatment efficacy was satisfactory in 66.66% of cases. Conclusions: Although bleomycin is less available in our countries and less accessible to patients, it could be proposed as a treatment for keloids, although a large study would be needed to evaluate it in large keloids. [ABSTRACT FROM AUTHOR]

Keloids and hypertrophic scars occur in 30-90% of patients. The two entities have different clinical and histochemical characteristics and unfortunately still represent a great challenge for clinicians due to the lack of effective treatments. Current advances reveal new preventive and therapeutic options that offer hope for managing this widespread, chronic and debilitating problem. Case report: We report the efficacy of the combination of fractionated carbon dioxide (FCO2) laser and intra-lesional 5-fluorouracil (5-FU) for the treatment of a mid-thoracic keloid scar resistant to intra-lesional infiltration steroids and pressotherapy. Discussion: The appearance of cortisone dermatitis at the site of corticosteroid infiltration makes it necessary to seek an effective therapeutic alternative to minimize the risk of recurrence and resistance without hesitating to combine several therapeutic means such as laser, 5-FU or Bleomycin and cryosurgery… Conclusion: Effort is needed to choose the treatment with maximum results. Combination therapy appears to be an acceptable method for the treatment of keloids. [ABSTRACT FROM AUTHOR]

The therapeutic use of cupping is present in several medical traditions. Based on clinical experience of over 37 years, we report here the therapeutic use of cupping in the treatment of pain related to pathogenic scars. [ABSTRACT FROM AUTHOR]

Résumé: Une cicatrice atypique chez un Brésilien : lobomycose, une observation en Guyane française. La lobomycose est une infection fongique rare de la peau, endémique au bassin amazonien. D'évolution lente, elle se manifeste par des nodules cutanés semblables à des chéloïdes et est responsable d'une réaction granulomateuse histologique. L'agent causal, Lacazia loboi , n'a jamais été isolé du milieu extérieur et n'a jamais pu être cultivé. Le diagnostic est possible par son aspect unique en microscopie. La prise en charge thérapeutique est souvent décevante, avec un fort taux de rechute. Nous rapportons un nouveau cas en Guyane française et réalisons une revue de la littérature. Seuls 10 cas hors zone d'endémie ont été publiés, dont 2 n'ayant jamais voyagé, avec un délai diagnostic moyen de 21 ans. La phylogénétique a prouvé récemment que la lobomycose du dauphin n'est pas due à L. loboi mais à un agent fongique proche de Paracoccidioides brasiliensis. Le diagnostic par biologie moléculaire est possible dans certains centres. Du fait des modifications climatiques, la lobomycose pourrait atteindre des régions du monde jusque-là indemnes. Case report from French Guiana of an atypical keloid in a Brazilian man: Lobomycosis. Lobomycosis is a rare fungal skin infection, endemic to the Amazon basin. Its clinical manifestations are slow-growing keloid-like nodules, with a granulomatous reaction on histopathology. The etiological agent, Lacazia loboi , has never been isolated in the environment or cultured in a laboratory. Diagnosis is based on the typical appearance on microscopy. Treatment is disappointing, with a high recurrence rate. We report a new case in French Guiana and review the literature. Only 10 cases have been reported outside of the endemic area, 2 involving no travel; the mean time to diagnosis was 21 years. Phylogenetic analysis has recently proved that lobomycosis in dolphins is caused by a fungus more closely related to Paracoccidioides brasiliensis than to L. loboi (two very closely related species). Molecular diagnosis is possible in a few centers. Climate change may result in spreading lobomycosis to currently disease-free areas of the world. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 57 year old patient was operated for botriomycoma at umbilical, causing him a keloid scar at the excision site. It mentions Keloid scars are the origin of aesthetic discomfort for patients and had benefited from sessions of ablative laser, with improvement of botriomycoma. It also mentions infectious episodes by orally, with initiation of a benzathine antibiotic prophylaxis benzylpenicillin and laser hair removal.

Summary: The keloid scar is a thick skin or the cornea of man, due to excessive accumulation of type I collagen in the dermis. Morbidity of the keloid is high, given the frequent recurrences and unpredictable. African blacks and Asians are most affected. The purpose of this study was to analyze the results of treatment of 149 cases of keloids and discuss the reality of keloids in the dark. Patients and methods: From 1990 to 2011, 98 patients were supported for 149 keloid tumors. Results: Seventy-eight adults (79.6%) and 20 children (20.4%) were received. Sixty-four women (65.3%) and 34 men (34.7%) were supported, including 94 blacks (96%) and four redheads (4%). The average age was 25 years with extremes of 2 years and 54 years. The trauma was the dominant etiology in 63.1% of cases. The infection, burns and surgery were implicated in 16.8%, respectively, 15% and 4.7% of cases. The cephalic end, was the seat of choice for keloids, with 84 cases or 56.4%. The ear has been the preferred unit in 38 cases, or 25.5%. The body, legs and genital area were the site of keloids, respectively, in 22.8%, 17.5%) and 3.3% of cases. Keloidal field was found in 24.5% of our cases. The reasons for consultation were the disgrace aesthetics (56.4%), pain (65%), households suppurative intrakeloidal (44.9%), functional impairment (40.8%), and the psychological impact minor (15.3%) and no major suicide attempt (66.3%). Two surgical techniques were used: total excision (TE), with total skin graft immediate or deferred, or not expanded, and intrakeloid excision (IKE) with suture surgery was associated with intra-lesional steroids. Many complications have favored the occurrence of early or late recurrence in 100% of our cases. Conclusion: The keloid is not a homogenous biological entity. Its prevalence is higher among black and yellow, and lowest among whites. The research results are still being evaluated. The best prevention is to avoid the scar itself. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: Evaluation of perioperative treatment of keloid scars with electron beam therapy or iridium 192 low dose rate brachytherapy. Patients and methods: From 1994 to 2010, 95 patients with 142 keloid scars have been treated by immediate perioperative irradiation and retrospectively reviewed in our institute: 116 scars were treated by electrontherapy and 26 by brachytherapy. Results: In the electrontherapy group treated locations were: earlobe (n =88, 76%), thorax (n =14, 12%), neck (n =9, 8%), limbs (n =5, 4%). The median size of lesions was 3cm (range [R]: 0.5–18cm). In 95.6% of cases, a dose of 15Gy was delivered in five fractions of 3Gy. The median follow-up was 70 months (R: 7–161 months). The 2-year and 5-year local control were respectively 69% (95% confidence interval [95% CI]: 59–76%) and 55% (95% CI: 45–64%). In the brachytherapy group treated locations were: neck (n =3, 11%), earlobe (n =8, 32%), abdomen (n =3, 11%), thorax (n =2, 8%), limbs (n =10, 38%). The median size of lesions was 6.6cm (R: 1.7–28cm). The median dose delivered at 5mm from the source was 20Gy (R: 15–20.69). The median follow-up was 113 months (R: 21–219 months). The 2-year and 5-year local control were respectively 84.6% (95% CI: 64–94%) and 73.5% (95% CI: 49–87%). So far, no radiation-induced cancer has occurred. A trend to a better local control with brachytherapy was noted (compared to electrontherapy, 2-year relapse is halved with brachytherapy) though this difference did not reach the significance (P =0.0991), probably due to the reduced number of patients in the brachytherapy group. Conclusion: Brachytherapy seems to provide better local control compared to electrontherapy, and should be proposed as first line treatment. However, electrontherapy is an interesting alternative in case of difficulty to realize brachytherapy. There is probably a dose effect: according to published data, 25 to 30Gy should at least be proposed. [Copyright &y& Elsevier]

Abstract: The keloid scar is a fibrous skin tumor, intradermal, and exuberant. It is commonly found on the glabrous skin. The keloid of the palms and soles are rare. Small series are reported in English literature. The authors report a case of large keloids located on both palms and soles, within a context of keloid disease, in a man of 37 years. On the left hand, the keloid scar caused a partial syndactyly IV-V. Large keloid tumors occupied the inner edge and, weight-bearing areas of both feet. These tumors rendered wearing of shoes impossible and interfered with walking. The treatment consisted of total excision of palmar and plantar keloid tumors. The residual defects were covered by a total skin graft taken from the suprapubic region. The results were satisfactory aesthetically, functionally and psychosocially. [Copyright &y& Elsevier]

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Abstract: Purpose: Evaluation of the results of perioperative interstitial brachytherapy with low dose-rate (LDR) Ir-192 in the treatment of keloid scars. Patients and methods: We performed a retrospective analysis of 73 histologically confirmed keloids (from 58 patients) resistant to medicosurgical treated by surgical excision plus early perioperative brachytherapy. All lesions were initially symptomatic. Local control was evaluated by clinical evaluation. Functional and cosmetic results were assessed in terms of patient responses to a self-administered questionnaire. Results: Median age was 28 years (range 13–71 years). Scars were located as follows: 37% on the face, 32% on the trunk or abdomen, 16% on the neck, and 15% on the arms or legs. The mean delay before loading was four hours (range, 1–6h). The median dose was 20Gy (range, 15–40Gy). Sixty-four scars (from 53 patients) were evaluated. Local control was 86% (follow-up, 44.5 months; range, 14–150 months). All relapses occurred early – within 2 years posttreatment. At 20 months, survival without recurrence was significantly lower when treated lengths were more than 6cm long. The rate was 100% for treated scars below 4.5cm in length, 95% (95% CI: 55–96) for those 4.5–6cm long, and 75% (95% CI: 56–88) beyond 6cm (p =0.038). Of the 35 scars (28 patients) whose results were reassessed, six remained symptomatic and the esthetic results were considered to be good in 51% (18/35) and average in 37% (13/35) (median follow-up, 70 months; range, 16–181 months). Conclusion: Early perioperative LDR brachytherapy delivering 20Gy at 5mm reduced the rate of recurrent keloids resistant to other treatments and gave good functional results. [Copyright &y& Elsevier]

Keloid is a benign fibroblastic tumor which is most often secondary to a scar, but it can occur spontaneously in a subject with black skin. We report the case of a 19-year old patient, electrician, presenting with giant right retroauricular mass evolving over two years. For some time, the patient has experienced a feeling of heaviness on the pavilion of the right ear. The lesion had manifested as a hard, pruritic, non-painful patch gradually increasing in size. The patient had received several topical and antiseptics treatments without any effect. He had a history of traumatic injury in the right retroauricular sulcus. A month after, pruritic hypertrophic scar occurred. Physical examination showed voluminous hard, fixed, retroauricular tumor (10 × 6 cm) with normal skin color, non-painful on movement (A). Its base was sessile. The remainder of the physical examination was normal. Ultrasound showed little vascularized skin tumor of the right retroauricular sulcus with more or less sharp margins, measuring 9 x 5 cm. Two diagnoses were suspected: post-traumatic keloid (most likely) and Darier Ferrand dermatofibrosarcoma. Biopsy was performed and histological examination showed keloid. The patient underwent intramarginal excision (B). The surgical specimens weighed 75 grams (C). The postoperative course was simple with disappearance of the feeling of heaviness. [ABSTRACT FROM AUTHOR]

The authors, through their experience, take stock of current secondary management of scars whether they are pathological (hypertrophic, cheloid) or dystrophic (enlarged, hypo- or hyper-pigmented, adherent) by presenting surgical or medical solutions., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

The paralysis of the external branch of spinal nerve is very rare. It manifests clinically by a weakness and abnormal morphology of the shoulder. We must think about it in front of any simple surgery of the cervical region. We report the case of a 20 year old patient, who consulted several doctors for pain and progressive weakness of the left shoulder appeared a few days after resumption of a keloid scar complicating surgical excision of a cervical lipoma operated some months earlier. Physical examination revealed a strength of the left shoulder listed on 3 without articular limitation, atrophy of the trapezius muscle with ipsilateral asymmetry and fall of the left shoulder. A lesion of spinal nerve was suspected and an EMG was executed. The EMG objectified a partial lesion of the left spinal Nerve. The patient was sent in Plastic and Reconstructive surgery for nerve repair. The achievement of the external branch of spinal nerve is manifested by pain and weakness in the shoulder triggered by the anteflexion movements of the upper limb. The most usual cause is cervical lymph node biopsy. In our case, the spinal nerve lesion occurred while the resumption in keloid skin scar. This is explained by the very superficial location of the Spinal Nerve. [ABSTRACT FROM AUTHOR]

Purpose: Evaluation of a new treatment for keloid scars using a 40% phenol solution in accordance with a predefined protocol., Patients and Methods: A retrospective study was made of the files of 25 patients treated with phenol from June 2010 to March 2012., Results: The keloids were located predominantly on the trunk (48%) and upper extremities (34%). The total number of keloids was 52, with a median size of 11.16 cm(2). Phenol was the sole and first-line treatment in 40% of cases. Patient adherence to the protocol of phenol was noted in 81% of cases. The mean number of phenol sessions was 14.2. Seventy-two percent of patients were satisfied with the treatment. Mean regression in keloid size of 75.5% was noted. A change in local keloid pigmentation was observed in 75% of patients. Local adverse reactions (itching, infection, ulceration) were seen in 6 patients (28.6%). No cases of systemic signs of phenol were observed. After mean follow-up of 12.8 months, no recurrence of keloids was noted., Conclusion: Use of phenols in the topical treatment of keloids appears valuable since it is easy to apply and provides good results with few side effects., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)