JURNAL KELOID DISUSUN OLEH : RIDHO OKTIANSAH NPM : RUMAH SAKIT UMUM HAJI MEDAN

Transcription

1 JURNAL KELOID DISUSUN OLEH : RIDHO OKTIANSAH NPM : RUMAH SAKIT UMUM HAJI MEDAN

2 keloids I. INTRODUCTION Keloids was first proposed by a dermatology named Jean-Louis Albert in France in 1835, but said the keloid had never been used before in 1817 by Nouveau Petit Robert dictionary. The literature says the word comes from the Greek keloid which consists of the word "Ex" (tumor) + "eidos" (form) = shaped tumor.1,2 Keloid is excessive formation of scar tissue (proliferative growth) that appear on the skin traumatized or above the surgical wound and not in accordance with the severity of the trauma, it can not resolve spontaneously and can be repeated after eksisi.1,2,3,4, 5.6 Must be distinguished between the terms keloid and hypertrophic scarring. In hypertrophic scarring, the scars still in keeping with the wound, never cross the line wound edges and at some point will experience the maturation phase. Grate hypertrophic can also recover spontaneously within months although it is not complete. While the keloid, scar beyond the borders of the wound but rarely extends to the subcutaneous tissue, active and showed signs of inflammation such as redness, itching and mild pain. 1.3 If multiple or recurrent keloids are then called keloidosis.5,6 II. INCIDENCE AND EPIDEMIOLOGY Most people have never had a keloid. The tendency of larger keloids arising in the colored race gelap.3,6

3 reported around 16% of black African people suffering from keloids, while white people and albinos are very few who suffer keloid.1 Keloids are also reported more young women than young men. However, without classifying age, the prevalence of keloid between men and women is sama.1,4 According to age, keloids often occur in the age group ear (young adults) and rarely occurs at age tua.1,3 III. Anatomy and physiology The skin is an organ located at the outer limit of the environment and human life. Adult skin Size 1.5 m2 with a weight of about 15% by weight bada. The skin is the organ most essential and vital, and is a mirror of health and life. Leather is also too complex, elastic and sensitive, varies on climatic conditions, age, sex, race and also depends on the location of the body. The division of the outline skin is composed of three main layers, namely: 1. layer of the epidermis or cuticle, consisting of: the stratum corneum, stratum lusidum, stratum granulosum, stratum spinosum and stratum basale (composed of two types of cells: cells are columnar and melanin-forming cells). 2. dermis layer (korium, cutis vera, true skin). Broadly divided into two parts, namely: papillare pars and pars retikulare.

4 3. Layer subcutaneous (hypodermic) is kelanjuta dermis, composed of loose connective tissue containing fat cells in it. Vascularization in the skin is governed by two plexus, the plexus located in the upper dermis (superficial plexus) and is located in the subcutaneous (deep plexus). Plexus in the upper dermis held anastomosis in papil dermis, subcutaneous plexus in and pars papillare also held anastomosis, in this part of the larger blood vessels. Hand with blood vessels are lymph channels bening.7 The main function of the skin is a function of protection (protection against physical injury, drought, chemicals, germs and radiation), absorption, excretion, perception (physiology of taste and touch are run by sensory nerve endings Vater Paccini, Meisner, Krause and Ruffini contained in the dermis), a picturesque body temperature (thermoregulation due to their extensive network of capillaries in the dermis, the subcutaneous fat and sweat glands), the formation of pigment, the formation of vitamin D, and keratinization).3,7 IV. ETIOLOGY The exact cause is unknown, no specific gene identified as a cause of the development of a keloid, despite the increased prevalence of keloid associated with increased skin pigmentation which shows the influence genetik.1,4

5 Keloids are genetically associated with HLA-B14, HLA- B21, HLA-Bw16, HLA-Bw35, HLA-DR5, HLA-DQw3, and blood type A. Transmission reported autosomal dominant and autosomal resesif.1 Keloids can be caused by surgical incisions, wounds, injecting vaccination (BCG), burns, acne scars, after smallpox, insect bites, use anting.1,2,3,4,5,6 V. Pathophysiology Keloids can be described as a variety of wound healing. In a wound, anabolic and catabolic processes reach equilibrium for approximately 6-8 weeks after a trauma. At this stage, the power cuts of approximately 30-40% relative to healthy skin. Along with maturnya scarring (scars), stretch the strength of scarring also increases as a result of progressive convergence of the collagen fibers. At that time, the scars will be visible hyperemia and possibly thickened, thickening the edge will be reduced gradually over several months to be flat, white, limp, can be stretched as a mature scars. If there is an imbalance between the anabolic and catabolic phases of the healing process, more collagen is produced than were issued, and the scar grows in all directions. Skar up above the surface of the skin and become hiperemis.5 Scar extends this would arise as a keloid is influenced by several factors, among others: all the stimuli fibroplasia ongoing (chronic infections, foreign bodies in the wound, there is no strain local healing time, strain

6 excessively on convergence injury), age and growth, talent, race and lokasi.3 VI. DIAGNOSIS Diagnosis is made on clinical keloid (the appearance of the skin or scar tissue): 1,4,5 Consistency keloid varying from soft, rubbery to hard. Early lesions are usually red Lesions become brownish-red or the color of meat They usually do not contain hair follicles or adnexal glands more) Keloids provide varying clinical picture. Most lesions grow for a few weeks to several months, but some are grown in a few years. Growth is usually slow, but sometimes widened rapidly, to 3 times wider in a few months. There is also a keloid yng stopped growing, keloid does not always give symptoms and become stable. Keloids on the ears, neck, and abdomen usually stemmed Keloids in the middle of the chest area and extremities are usually flat, which is essentially wider than its height. Most keloids are round, oval, or rectangular with regular edges, but some are shaped like scratches with irregular edges. Most patients present with 1-2 keloid, but there are also plenty of keloid as in patients with keloid scars arising from acne or chickenpox.

7 Keloids can interfere with the movement of the joints due to contractures. Keloids never become malignant and cause only a cosmetic problem only. Frequency location keloid Asians typically on earlobes, upper extremities, neck, breasts, shoulders, sternum, waist, and wajah.1,3,4,5,6 VII. MANAGEMENT Conservative Keloids managed conservatively by the injection of a corticosteroid preparation intrakeloid are repeated 2-3 weeks until the desired effect is achieved. These injections can typically reduce keloid and reduce iritasi.3,4,6 New treatments for keloids also include interferon injections, verapamil, bleomycin, retinoic acid, a toxin botolinum intrakeloid. Surgery 1. Cryotherapy Used nitroge liquid affecting the microvasculature and cause cell damage through intracellular crystals that lead to anoxic cells. The use of cryotherapy without modality without other treatment modalities resulted in resolution without recurrence in 51-74% of patients after 30 months observasi.1,3,4,5,6 2. excision Recurrence may occur around % in patients with excision therapy without other therapeutic modalities

8 such as radiotherapy or injection of corticosteroid post eksisi.1 3. Laser therapy Can be used a carbon dioxide laser, argon laser or a YAG laser. With a carbon dioxide laser, the lesion may be cut and burned with trauma network minimal.1 VIII. COMPLICATIONS Trauma to the keloid may cause erosion of the lesion and become a hotbed of bacterial infections. Recurrence Psychological Stress if the keloid is very broad and raises cacat.1,5 IX. PROGNOSIS Keloids usually are not medically dangerous, but very influential on the appearance (cosmetic). Keloids rarely heal spontaneously, but treatment of keloids may become smaller and softer, without pain and itching. In some cases, keloids can spontaneously shrink over time. Treatment of keloid excision without other therapies can cause rekurensi.1,5.