Evaluating keloid recurrence after surgical excision with prospective longitudinal scar assessment scales.

INTRODUCTION: Evaluation tools are used to quantify scar evolution and determine treatment effectiveness. In clinical practice, scar assessment scales are less costly, tend to cover a greater number of aspects related to scar characteristics and can incorporate a patient's opinion in the assessment. However, the scales have not yet been used as an evaluation method for the postoperative recurrence of keloids. OBJECTIVE: The study aims to evaluate the effectiveness of scar rating scales for keloid recurrence after surgical excision. METHODS: Patients (n = 25) with keloids on the trunk were treated by surgical resection and postoperative beta radiation therapy. On the 3rd, 6th, 9th and 12th postoperative months, two specialists classified the lesions qualitatively in recurrent and non-recurrent cases. Furthermore, in the objective evaluation, the items on the Seattle Scar Scale (SSS) and the Stony Brook Scar Evaluation Scale (SBSES) were assessed by specialists, and the patients assessed items on the Patient Scar Assessment Scale (PSAS) for the pre- and postoperative periods. The scars were classified qualitatively as "good" or "poor." RESULTS: Recurrence was observed in 18 patients (72%), according to the specialists' qualitative assessments. The best scores on the SSS and SBSES were given to the non-recurrent (p < 0.001) scars. The highest PSAS values were for the scars classified as "poor" (p < 0.001). There were no differences in the PSAS values for the preoperative period and outcomes for the recurrent scars (p = 0.519). The outcomes showed that the non-recurrent scars had lower values on the PSAS compared to the recurrent scars (p = 0.001) and compared to the preoperative period (p = 0.004). CONCLUSIONS: The PSAS, SSS and SBSES scales were effective methods in distinguishing keloid postoperative recurrence. It is necessary to establish the recurrence cut-off scores for each of the scales according to the treatment used.

The impact of facial lipoatrophy treatment with polymethyl methacrylate in AIDS patients as measured by four quality-of-life questionnaires.

Life-expectancy increased in patients infected with HIV/AIDS with the advent of highly active antiretroviral therapy (ART). Facial lipoatrophy is a common complication in these patients, eventually leading to stigma, segregation and a negative impact in quality of life (QOL). We measured the impact of the treatment of facial lipoatrophy with polymethyl methacrylate (PMMA) in the QOL of patients with HIV/AIDS by using four questionnaires that address QOL. Forty consecutive patients on ART referred for facial lipoatrophy treatment were enrolled in this study. The first 20 were allocated to the intervention group and were treated with tissue augmentation with PMMA. The other 20 were allocated to the control group, which received treatment only after six months. At baseline, four questionnaires were applied to all patients in both groups and again after six months. The variation in scores within the control group for all domains of all four instruments was significantly better when compared with that within the control group. We detected improvement in the QOL of patients with HIV/AIDS and facial lipoatrophy when they were treated with PMMA.