VERAPAMIL HYDROCHLORIDE INFILTRATION IN THE MANAGEMENT OF KELOIDS

Abstract
Keloids and hypertrophic scars are the results of a deregulated wound healing process. They occur most commonly in children and young adults and they show a strong predilection for darkly pigmented races. Hypertrophic scars and keloids initially have the same clinical appearance: they are red, raised, and firm and possess a smooth, shiny surface. Hypertrophic scars flatten spontaneously in the course of one or several years, whereas keloids persist forever. Three important factors are involved in keloid development: cell growth, apoptosis and cytokine production, but the pathogenesis is still unknown. Calcium antagonists decreases collagen production in the matrix and stimulates collagenase synthesis. These findings have suggested the utilization of calcium-channel blockers in the prevention and treatment of keloid. Preliminary results in vivo have proved the effectiveness of intralesional infiltration of verapamil hydrochloride at 2.5 mg/ml, associated with topical silicone sheet, in the treatment of keloids, with a success rate of more than 50%. Verapamil action on normal fibroblasts was also analyzed in an attempt to improve prevention and treatment in a more informed manner. We have shown that verapamil treatment of cultured fibroblasts, obtained from human keloid tissues, reduced cellular proliferation and an increased apoptosis. Moreover we found a significant decreasing in IL-6 and VEGF production in keilodal fibroblasts cultures treated with verapamil, but the most important finding was that this drug had no effect on cytokine production and cellular proliferation in cultures of nonkeloid fibroblasts, excluding a hypothetic toxic effect. These finding open the way to new larger clinical trials in vivo to confirm the effectiveness of verapamil hydrochloride injection in the treatment of keloids.

Key words
Keloid, hypertrophic scar, wound healing abnormality, verapamil, intralesional infiltration, calcium chaneel blockers, VEGF, IL-6, silicone gel sheeting

Bibliografía del artículo

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