European Journal of Plastic Surgery

, Volume 36, Issue 5, pp 289–294 | Cite as

Adjunctive treatment of keloids: comparison of photodynamic therapy with brachytherapy

  • Harie Basdew
  • Robert Mehilal
  • Abrahim Al-Mamgani
  • Peter van Rooij
  • Anand Bhawanie
  • Henricus J. C. M. Sterenborg
  • Rudi Tjong Joe Wai
  • Marc Mureau
  • Dominic J. Robinson
  • Peter C. Levendag
Original Paper

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords

Brachytherapy Keloid Aminolevulinic acid Photodynamic therapy POSAS 

References

  1. 1.
    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 8:362–368PubMedCrossRefGoogle Scholar
  2. 2.
    Kelly AP (2009) Update on the management of keloids. Semin Cutan Med Surg 28:71–76PubMedCrossRefGoogle Scholar
  3. 3.
    Adegbidi H, Atadokpede F, Ango-Paponoud F, Yedomon H (2005) Keloid acne of the neck: epidemiological studies over 10 years. Int J Dermatol 44:49–50PubMedCrossRefGoogle Scholar
  4. 4.
    Kombate K, Pitche P, Tchangai-Walla K (2005) Keloids in dermatology outpatients in Lome, Togo. Int J Dermatol 44:51–52PubMedCrossRefGoogle Scholar
  5. 5.
    Alster TS, Tanzi EL (2003) Hypertrophic scars and keloids: etiology and management. Am J Clin Dermatol 4:235–243PubMedCrossRefGoogle Scholar
  6. 6.
    Bock O (2006) Quality of life of patients with keloid and hypertrophic scarring. Arch Dermatol Res 297:433–438PubMedCrossRefGoogle Scholar
  7. 7.
    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):1853–1859PubMedCrossRefGoogle Scholar
  8. 8.
    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 22:569–574PubMedCrossRefGoogle Scholar
  9. 9.
    Berman B, Bieley HC (1996) Adjunct therapies to surgical management of keloids. Dermatol Surg 22:126–130PubMedCrossRefGoogle Scholar
  10. 10.
    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):330–332PubMedCrossRefGoogle Scholar
  11. 11.
    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 120:325–331CrossRefGoogle Scholar
  12. 12.
    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 28:651–659PubMedCrossRefGoogle Scholar
  13. 13.
    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 6:1325–1331PubMedCrossRefGoogle Scholar
  14. 14.
    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):238–246PubMedCrossRefGoogle Scholar
  15. 15.
    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 79:451–455PubMedCrossRefGoogle Scholar
  16. 16.
    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):412–417PubMedCrossRefGoogle Scholar
  17. 17.
    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):1960–1965PubMedCrossRefGoogle Scholar
  18. 18.
    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):1481–1489PubMedCrossRefGoogle Scholar
  19. 19.
    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, ReviewPubMedCrossRefGoogle Scholar
  20. 20.
    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 151:776–783PubMedCrossRefGoogle Scholar
  21. 21.
    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):325–331PubMedCrossRefGoogle Scholar
  22. 22.
    Botwood N, Lewanski C, Lowdell C (1999) The risks of treating keloids with radiotherapy. Br J Radiol 72:1222–1224PubMedGoogle Scholar
  23. 23.
    Olaitan PB (2009) Keloids: assessment of effects and psychosocial-impacts on subjects in a black African population. Indian J Dermatol Venereal Leprol 75(4):368–372CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Harie Basdew
    • 1
  • Robert Mehilal
    • 1
  • Abrahim Al-Mamgani
    • 1
  • Peter van Rooij
    • 1
  • Anand Bhawanie
    • 1
  • Henricus J. C. M. Sterenborg
    • 2
  • Rudi Tjong Joe Wai
    • 4
  • Marc Mureau
    • 3
  • Dominic J. Robinson
    • 2
  • Peter C. Levendag
    • 1
  1. 1.Department of Radiation Oncology, Erasmus MC-Daniel den Hoed Cancer CenterErasmus University Medical CenterRotterdamThe Netherlands
  2. 2.The Center for Optical Diagnostics and Therapy, Department of Radiation Oncology, Erasmus MCErasmus University Medical CenterRotterdamThe Netherlands
  3. 3.Department of Plastic and Reconstructive Surgery, Erasmus MCErasmus University Medical CenterRotterdamThe Netherlands
  4. 4.Department of Plastic and Reconstructive SurgeryMaasstad ZiekenhuisRotterdamThe Netherlands

Personalised recommendations