Adjunctive treatment of keloids: comparison of photodynamic therapy with brachytherapy
Purchase on Springer.com
$39.95 / €34.95 / £29.95*
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.
The aesthetic result after brachytherapy, especially hypopigmentation, remains a significant problem. Given that brachytherapy may be carcinogenic, it is difficult to recommend this treatment in young patients. For these reasons, there is a need for alternatives to radiation.
The purpose of this study was to evaluate the effectiveness of adjuvant photodynamic therapy (PDT) using aminolevulinic acid after keloid excision and to compare it to keloid excision followed by brachytherapy. To assess outcome, the Patient and Observer Scar Assessment Scale (POSAS) was used.
Thirty-four patients treated for 45 keloids were evaluated. Twenty-two patients (27 lesions) received brachytherapy and 12 (18 lesions) received PDT. The observers scored a mean POSAS of 19.1 (range 13.0–34.0) for brachytherapy and 24.6 (range 11.0–37.0) for PDT (p = 0.005). The independent observers scored a mean POSAS of 14.6 (range 10.0–20.0) for brachytherapy and 18.6 (range 9.0–42.0) for PDT (p = 0.018). The patients reported a significantly better mean POSAS score after brachytherapy (22.8, range 7.0–53.0) than following PDT (34.2, range 11.0–63.0). The patients’ POSAS score showed no significant difference for the item “general impression” for both treatment groups; the observers scored significantly higher for PDT treatment. The independent observers revealed a higher score for general impression after PDT although not reaching significance.
Patients and observers appear to be more satisfied with the results after brachytherapy than PDT. However, patients still have a positive general impression after PDT. Adjunctive aminolevulinic acid–PDT for the treatment of keloids could be used as an alternative for brachytherapy.
Level of Evidence: Level IV, therapeutic study.
- Leventhal D, Furr M, Reiter D (2006) Treatment of keloids and hypertrophic scars a meta-analysis and review of the literature. Arch Facial Plast Surg 8:362–368 CrossRef
- Kelly AP (2009) Update on the management of keloids. Semin Cutan Med Surg 28:71–76 CrossRef
- Adegbidi H, Atadokpede F, Ango-Paponoud F, Yedomon H (2005) Keloid acne of the neck: epidemiological studies over 10 years. Int J Dermatol 44:49–50 CrossRef
- Kombate K, Pitche P, Tchangai-Walla K (2005) Keloids in dermatology outpatients in Lome, Togo. Int J Dermatol 44:51–52 CrossRef
- Alster TS, Tanzi EL (2003) Hypertrophic scars and keloids: etiology and management. Am J Clin Dermatol 4:235–243 CrossRef
- Bock O (2006) Quality of life of patients with keloid and hypertrophic scarring. Arch Dermatol Res 297:433–438 CrossRef
- Ragoowansi R, Cornes P, Moss A, Glees JP (2003) Treatment of keloids by surgical excision and immediate postoperative single-fraction radiotherapy. Plast Reconstr Surg 111(6):1853–1859 CrossRef
- Sclafani AP, Gordon L, Chadha M, Romo T 3rd (1996) Prevention of earlobe keloid recurrence with postoperative corticosteroid injections versus radiation therapy: a randomized, prospective study and review. Dermatol Surg 22:569–574 CrossRef
- Berman B, Bieley HC (1996) Adjunct therapies to surgical management of keloids. Dermatol Surg 22:126–130 CrossRef
- Nie Z, Bayat A, Behzad F, Rhodes LE (2010) Positive response of a recurrent keloid scar to topical methyl aminolevulinate-photodynamic therapy. Photodermatol Photoimmunol Photomed 26(6):330–332 CrossRef
- Karrrer S, Bosserhoff AK, Weiderer P, Landthaler M, Szeimies RM (2003) Influence of 5-aminolevulinic acid and red light on collagen metabolism of human dermal fibroblasts. J Invest Dermatol 120:325–331 CrossRef
- Heckenkamp J, Aleksic M, Gawenda M, Breuer S, Brabender J, Mahdavi A, Aydin F, Brunkwall JS (2004) Modulation of human adventitial fibroblast function by photodynamic therapy of collagen matrix. Eur J Vasc Endovasc Surg 28:651–659 CrossRef
- de Bruijn HS, de Haas ER, Hebeda KM, van der Ploeg-van den Heuvel A, Sterenborg HJ, Neumann HA, Robinson DJ (2007) Light fractionation does not enhance the efficacy of methyl 5-aminolevulinate mediated photodynamic therapy in normal mouse skin. Photochem Photobiol Sci 6:1325–1331 CrossRef
- de Bruijn HS, Sluiter W, van der Ploeg-van den Heuvel A, Sterenborg HJ, Robinson DJ (2006) Evidence for a bystander role of neutrophils in the response to systemic 5-aminolevulinic acid-based photodynamic therapy. Photodermatol Photoimmunol Photomed 22(5):238–246 CrossRef
- Robinson DJ, Collins P, Stringer MR, Vernon DI, Stables GI, Brown SB, Sheehan-Dare RA (1999) Improved response of plaque psoriasis after multiple treatments with topical 5-aminolaevulinic acid photodynamic therapy. Acta Derm Venereol 79:451–455 CrossRef
- Star WM, van’t Veen AJ, Robinson DJ, Munte K, de Haas ER, Sterenborg HJ (2006) Topical 5-aminolevulinic acid mediated photodynamic therapy of superficial basal cell carcinoma using two light fractions with a two-hour interval: long-term follow-up. Acta Derm Venereol 86(5):412–417 CrossRef
- Draaijers LJ, Tempelman FRH, Botman YAM, Tuinebreijer WE, Middelkoop E, Kreis RW, van Zuijlen PP (2004) The Patient and Observer Scar Assessment Scale: a reliable and feasible tool for scar evaluation. Plast Reconstr Surg 113(7):1960–1965 CrossRef
- Durani P, McGrouther DA, Ferguson MW (2009) The patient scar assessment questionnaire: a reliable and valid patient reported outcomes measure for linear scars. Plast Reconstr Surg 123(5):1481–1489 CrossRef
- Wolfram D, Tzankov A, Pülzl P, Piza-Katzer H (2009) Hypertrophic scars and keloids—a review of their pathophysiology, risk factors, and therapeutic management. Dermatol Surg 35(2):171–181, Review CrossRef
- Karrer S, Bosserhoff AK, Weiderer P, Landthaler M, Szeimies RM (2004) Keratinocyte-derived cytokines after photodynamic therapy and their paracrine induction of matrix metalloproteinases in fibroblasts. Br J Dermatol 151:776–783 CrossRef
- Karrer S, Bosserhoff AK, Weiderer P, Landthaler M, Szeimies RM (2003) Influence of 5-aminolevulinic acid and red light on collagen metabolism of human dermal fibroblasts. J Invest Dermatol 120(2):325–331 CrossRef
- Botwood N, Lewanski C, Lowdell C (1999) The risks of treating keloids with radiotherapy. Br J Radiol 72:1222–1224
- Olaitan PB (2009) Keloids: assessment of effects and psychosocial-impacts on subjects in a black African population. Indian J Dermatol Venereal Leprol 75(4):368–372 CrossRef
- Adjunctive treatment of keloids: comparison of photodynamic therapy with brachytherapy
European Journal of Plastic Surgery
Volume 36, Issue 5 , pp 289-294
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Aminolevulinic acid
- Photodynamic therapy
- Industry Sectors
- Author Affiliations
- 1. Department of Radiation Oncology, Erasmus MC-Daniel den Hoed Cancer Center, Erasmus University Medical Center, Groene Hilledijk 301, 3075 EA, Rotterdam, The Netherlands
- 2. The Center for Optical Diagnostics and Therapy, Department of Radiation Oncology, Erasmus MC, Erasmus University Medical Center, Rotterdam, The Netherlands
- 4. Department of Plastic and Reconstructive Surgery, Maasstad Ziekenhuis, Rotterdam, The Netherlands
- 3. Department of Plastic and Reconstructive Surgery, Erasmus MC, Erasmus University Medical Center, Rotterdam, The Netherlands