So what is a keloid scar?

摘要

I am not sure if the word embarrassing is quite right but we are all, to a greater or lesser extent, part of a scientific community which can send rockets deep into space on the one hand, map the human genome on the other and yet cannot answer the simple question: What is a keloid scar? Of course we all have our individual concepts of what a keloid scar might be, but concepts are one thing, and a well-defined, characterized and categorized entity is another. Part of the problem is that for too many years the term keloid and hypertrophic have been used without clarity and distinction, and this practice continues. A meta analysis of treatments that looks at both keloids and hypertrophic scars is bound to be inconclusive.1 A systematic review of the thoroughness of the Cochrane Style which fails to distinguish between the two types of scar is again going to provide no useful evidence.2 The excellent and comprehensive review which Leads this issue of the journal focuses just on keloid disease. Durani and Bayat are reporting on the levels of evidence provided by clinical studies of treatments for keloid scar.3 Their conclusions are as important as they are humbling. There is no good evidence about treatment. Collectively we are failing our patients by not thinking more clearly about what we are dealing with before embarking on clinical studies. Two years ago a review of reviews was published which focused on the differences between hypertrophic and keloid scars.4 ] wrote this with my colleague Professor Lin Huang and we concluded that much of the scientific and clinical research in the field of keloid scarring is fundamentally flawed because investigators are failing to define their subject matter. A rather damming comment but it has evoked no dissent. Durani and Bayat succinctly precised this paper and I quote,on accurate molecular characterization of the scar type related to the clinical history and subsequent response to treatment. The variable response to treatment reflects the heterogeneity within keloid scars and future studies may have to first identify cohorts of scar according to molecular profiles, before assessing response to different therapeutic interventions and arriving at conclusions on efficacy. These important concepts have not been adequately addressed in the clinical studies to date.'