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New approach to the understanding of keloid: psychoneuroimmune–endocrine aspects

Authors Hochman B, Isoldi F, Furtado F, Masako Ferreira L

Received 21 June 2014

Accepted for publication 21 September 2014

Published 10 February 2015 Volume 2015:8 Pages 67—73

DOI https://doi.org/10.2147/CCID.S49195

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 4

Editor who approved publication: Dr Jeffrey Weinberg

Bernardo Hochman, Felipe Contoli Isoldi, Fabianne Furtado, Lydia Masako Ferreira

Plastic Surgery Division, Federal University of São Paulo, São Paulo, Brazil

Bernardo Hochman passed away on April 21, 2014

Abstract: The skin is a dynamic and complex organ that relies on the interrelation among different cell types, macromolecules, and signaling pathways. Further, the skin has interactions with its own appendages and other organs such as the sebaceous glands and hair follicles, the kidney, and adrenal glands; systems such as the central nervous system; and axes such as the hypothalamic–pituitary–adrenal axis. These continuous connections give the skin its versatility, and when an injury is caused, some triggers start a cascade of events designed to restore its integrity. Nowadays, it is known that this psychoneuroimmune–endocrine intercommunication modulates both the homeostatic condition and the healing process. In this sense, the skin conditions before a trauma, whether of endogenous (acne) or exogenous origin (injury or surgical incision), could regulate the process of tissue repair. Most skin diseases such as psoriasis and atopic dermatitis, among others, have in their pathophysiology a psychogenic component that triggers integrated actions in the nervous, immune, and endocrine systems. However, fibroproliferative disorders of wound healing, such as hypertrophic scar and keloid, are not yet included in this listing, despite showing correlation with stress, especially with the psychosocial character. This review, by understanding the "brain–skin connection", presents evidence that allows us to understand the keloid as a psychomediated disease.

Keywords: keloid, stress, psychological, psychoneuroimmunology, wound healing


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