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Quality of life of patients with keloid and hypertrophic scarring
Primary Health Care Center, Jönköping.
Department of Psychosomatic and Psychotherapy, Hannover Medical School, Hannover, Germany.
Department of Psychosomatic and Psychotherapy, Hannover Medical School, Hannover, Germany.
Department of Dermatology, University of Kiel, Kiel, Germany.
2006 (English)In: Archives of dermatological research, ISSN 0340-3696 (print) 1432-069X (online), Vol. 297, no 10, 433-438 p.Article in journal (Refereed) Published
Abstract [en]

Keloid and hypertrophic scarring represent chronic disfiguring dermatoses with a high resistance to therapy. The aim of our study was to assess for the first time the quality of life of patients with hypertrophic scars and keloids, because they suffer from quality of life impairment as much as patients with other chronic skin diseases. An item-pool was created modifying and supplementing the items of the Questionnaire on Experience with Skin Complaints. This questionnaire was distributed to 100 outpatients with keloids and hypertrophic scars. A factor analysis was used to identify the underlying dimensions. Two scales (psychological and physical impairment) of the questionnaire with nine and five items, respectively, were established. Test–retest reliability of the questionnaire was excellent (corr>0.9). Good validity was suggested by the correlation of physical impairment with pain (P≤0.001), pruritus (P<0.001), and the amount of restriction of mobility (P<0.001). The psychological scale was associated with pain and restriction of mobility, although the correlations were lower. This study demonstrates for the first time an impairment of quality of life in a large group of patients with keloid and hypertrophic scarring.

Place, publisher, year, edition, pages
2006. Vol. 297, no 10, 433-438 p.
Keyword [en]
Quality of life, Keloid, Hypertrophic scarring
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-12815DOI: 10.1007/s00403-006-0651-7OAI: diva2:17109
Available from: 2007-12-03 Created: 2007-12-03 Last updated: 2010-05-19
In thesis
1. Keloids - A fibroproliferative disease
Open this publication in new window or tab >>Keloids - A fibroproliferative disease
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Keloids are a fibroproliferative disorder of unknown etiology developing in the skin after injury or spontaneously. The aim of this thesis is to gain deeper insight into the role of TGF-β and its signaling pathway proteins, SMADs, in the pathogenesis of keloids and describe the gene expression profile in different keloid sites in the search for potential target genes for future treatment. Further aim is to develop an instrument to describe the quality of life of patients with keloids.

We find cultured keloid fibroblasts to express an increased level of TGF-β1 mRNA and a decreased level of TGF-β3 mRNA compared to control skin. Keloid derived fibroblasts exhibit significantly decreased mRNA levels of TGF-β receptor type II (TβRII) and the ratio of TβRI/TβRII mRNA expression is increased. This suggests that a certain expression pattern of TGF-β subtypes and receptors may be important in keloid pathogenesis.

Analysis of keloid derived fibroblasts reveal decreased SMAD3 mRNA expression and decreased ratio of SMAD2/SMAD3 mRNA implicating a disturbed SMAD signaling. Keloid fibroblasts up-regulate SMAD4 protein after stimulation with TGF-β1 and display diminished levels of the inhibitory proteins SMAD6 and 7. This may contribute to unlimited and deregulated TGF-β signaling leading to increased extracellular matrix production (ECM).

The gene expression pattern is described in fibroblasts from different keloid sites using microarrays covering the whole human genome. This study reveals 105 regulated genes (79 genes are up- and 26 down-regulated) resulting in a unique gene expression profile in different sites of keloids, where progression or regression of the keloid process took place. In cells from the central part of keloids with clinical signs of regression, an up-regulation of apoptosis inducing genes as ADAM12 and ECM degrading genes as MMP19 is found. These genes may contribute to regression of keloids and might be possible future target genes for treatment. Overexpression of apoptosis inhibitors as AVEN and down-regulation of angiogenesis inhibiting genes as PTX3 found at the active margin of keloids may be responsible for the invasive character of the keloid margin.

We develop a disease specific questionnaire to measure the quality of life of patients with keloids. We find two scales, psychological and physical impairment, describing the dimensions of quality of life in patients with scars. These two scales are independent of each other and show a high test-retest reliability. Single items which clinically characterize the disease show correlations to these scales. The results of this study demonstrate for the first time a severe impairment of quality of life of patients suffering from keloids and hypertrophic scars.

In conclusion the described alteration in TGF-β expression and its receptors, the disrupted SMAD signaling pathway and the unique gene expression patterns in different keloid sites provide new knowledge on ECM formation and degradation in keloids. Regulatory genes in ECM homeostasis may be future target genes for keloid prevention, regression and treatment. The disease specific quality of life instrument of patients with keloids and scars is a useful tool to estimate success in future therapeutic efforts over time.

Place, publisher, year, edition, pages
Linköping University Electronic Press, 2008. 74 p.
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1023
keloid, TGF-beta, SMAD, quality of life
National Category
Dermatology and Venereal Diseases
urn:nbn:se:liu:diva-10360 (URN)978-91-85895-67-0 (ISBN)
Public defence
2008-01-11, Linden, Campus US, Linköpings universitet, Linköping, 09:00 (English)
Available from: 2007-12-03 Created: 2007-12-03 Last updated: 2015-11-19

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