Keloid ve Hipertrofik Skar
Özet
Keloid ve hipertrofik skarlar, retiküler dermis tabakasındaki yaralanmaların ardından gelişen sürekli inflamasyonla karakterize anormal bir yara iyileşmesi sürecidir. Cerrahi dikişler alındıktan sonra da dermal matriks olgunlaşmaya ve retiküler dermisteki iltihap devam etmeye eğilimlidir; bu süreçte uyarılara maruz kalındığında patolojik izler belirginleşir. Sürekli tekrarlayan yaralanmalar, enfeksiyonlar ve özellikle lokal mekanik kuvvetler dermal inflamasyonu artıran yerel risk faktörleridir. Ergenlik, gebelik, hipertansiyon ve sistemik sitokin fırtınaları gibi sistemik unsurlarla birlikte; koyu ten rengi ve belirli nükleotid polimorfizmleri gibi genetik yatkınlıklar da bu süreci tetikler. Histopatolojik olarak kalın eozinofilik hyalinize kollajen demetleri keloidleri hipertrofik skarlardan ayırsa da, her iki durumun aynı fibroproliferatif cilt bozukluğunun farklı yoğunluktaki tezahürleri olduğu düşünülmektedir. Tedavide kortikosteroidler, radyoterapi, kriyoterapi, kompresyon, lazer, 5-FU ve gerilimi azaltan özel fasyal cerrahi teknikler uygulanır. Hücresel boyutta tümör yapısında olmayan bu lezyonların tedavisinde temel strateji, fibroblastlardan ziyade kan damarlarını ve anjiyogenezi hedef alarak kronik doku iltihabını baskılamaktır.
Keloids and hypertrophic scars represent an abnormal wound healing process characterized by continuous inflammation following injuries to the reticular dermis layer. Even after surgical sutures are removed, the dermal matrix continues to mature and inflammation in the reticular dermis persists; exposure to stimuli during this period makes the pathological scars prominent. Continuous repetitive injuries, infections, and especially local mechanical forces are local risk factors that increase dermal inflammation. Along with systemic elements such as puberty, pregnancy, hypertension, and systemic cytokine storms, genetic predispositions like darker skin tone and specific nucleotide polymorphisms also trigger this process. Histopathologically, thick eosinophilic hyalinized collagen bundles differentiate keloids from hypertrophic scars, but both conditions are considered different intensity manifestations of the same fibroproliferative skin disorder. Treatments include corticosteroids, radiotherapy, cryotherapy, compression, laser, 5-FU, and special facial surgical techniques that reduce tension. The main strategy in treating these lesions, which are not tumorous at the cellular level, is to suppress chronic tissue inflammation by targeting blood vessels and angiogenesis rather than fibroblasts.
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