| Abstract | Keloide smatramo benignim tumorima kože jedinstvenim za ljude. Potaknuti su raznim kožnim ozljedama i iritacijama, a najčešće se stvaraju nakon trauma i kirurških incizija. Posljedica su prekomjernog nakupljanja elemenata izvanstaničnog matriksa, posebno kolagena, u dermisu i potkožnom tkivu. Etiopatogeneza nije do kraja razriješena, ali smatramo da transformirajući čimbenik rasta beta ima glavnu ulogu u poticanju fibroznog procesa. Najviše je prijavljenih slučajeva između 10. i 30. godine života, a učestaliji su kod osoba sa pigmentiranijom kožom. Pojavljuju se kao egzofitične mase koje prodiru izvan mjesta izvorne ozljede, u susjednu normalnu kožu, i rijetko spontano regrediraju. Ne samo da predstavljaju estetski problem, nego su često praćeni bolnošću i svrbežom i mogu uzrokovat kontrakture. Za postavljanje dijagnoze najčešće je dovoljna anamneza i klinički pregled, a u rijetkim slučajevima, kada ih je teško razlikovati od hipertrofičnih ožiljaka ili drugi tumora kože, preporuča se napraviti patohistološki nalaz.
Trenutačno ne postoji specifična terapija kojom se može potpuno i trajno ukloniti keloide. Unatoč velikim naporima, teško se postiže regresija i visoke su stope recidiva. Kod osoba s povećanom sklonošću stvaranja keloida, najbitnija je primarna prevencija u obliku nenapetog zatvaranja rane, fiksacije ožiljka i lokalnih preparata koji smanjuju fibrozu. Trenutačne terapijske mogućnosti uključuju farmakoterapiju, radioterapiju, krioterapiju, lasersku terapiju te zadnje, kiruršku terapiju s raznim tehnikama zaštite od napetosti. Farmakoterapiju svrstavamo u tri kategorije, s obzirom na koji čimbenik u nastajanju djeluje, a to su lijekovi koji djeluju na upalu, kemoterapeutici i ciljana terapija. Svaki oblik terapije ima određenu stopu recidiva i pojavu nuspojava te se često mora koristiti kombinacija nekoliko terapija kako bi se dobili zadovoljavajući rezultati. Brojne terapijske mogućnosti još su u eksperimentalnoj fazi i potrebne su dodatne studije kako bi se svrstale u konvencionalnu terapiju. |
| Abstract (english) | We consider keloids to be benign skin tumors that are unique to humans. Their formation is triggered by various skin injuries and irritations, appearing most frequently as an outcome of a trauma and surgical incisions. They are the result of excessive accumulation of extracellular matrix elements, especially collagen, in the dermis and subcutaneous tissue. The etiopathogenesis is not fully resolved, but we believe that transforming growth factor beta plays a major role in stimulating the fibrotic process. Most cases are reported between the ages of 10 and 30, and they are more common in people with more pigmented skin. Keloids appear as exophytic masses that penetrate beyond the site of the original injury into the surrounding normal skin and rarely regress spontaneously. Not only are they an aesthetic problem, but they are also often accompanied by pain and itching and can cause contractures. Patient history and clinical examination are usually sufficient to make a diagnosis, and in rare cases, when it is difficult to distinguish them from hypertrophic scars or other skin tumors, it is recommended to make a histopathological analysis.
Currently, there is no specific therapy that can completely and permanently treat keloids. Despite great efforts, regression is difficult to achieve, and relapse rates are high. In people with an increased tendency to form keloid, primary prevention in the form of tensionless wound closure, scar fixation, and topical preparations that reduce fibrosis is the most important. Current therapeutic options include pharmacotherapy, radiotherapy, cryotherapy, laser therapy, and finally, surgical therapy with various tension protection techniques. Pharmacotherapy is classified into three categories depending on which emerging factor works, namely drugs that act on inflammation, chemotherapeutics, and targeted therapy. Each form of therapy has a certain rate of recurrence and occurrence of side effects, and often a combination of several therapies must be used to obtain satisfactory results. Numerous therapeutic options are still in the experimental phase, and additional studies are needed to classify them as conventional therapy. |
