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Published in: Trials 1/2024

Open Access 01-12-2024 | Keloid | Study protocol

A randomised clinical trial study assessing the efficacy of 5% losartan potassium loaded in ethosomal gel to treat human keloids: a trial protocol

Authors: Yuni Eka Anggraini, Niken Trisnowati, Ronny Martien, Retno Danarti

Published in: Trials | Issue 1/2024

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Abstract

Background

Keloid is a skin disorder that results from excessive fibrous tissue growth in the area of the initial trauma. Treating keloids can be challenging since the success of various treatments varies from one study to another. Triamcinolone acetonide injection, a standard treatment, can cause undesirable side effects. Meanwhile, the effectiveness of existing topical therapies for keloids is not always reliable. The pro-inflammatory, pro-proliferative, and pro-fibrotic effects of angiotensin II in human skin contribute to keloid formation. Losartan potassium, an angiotensin II blocker, has the potential to act as an anti-keloid agent. Due to the thicker skin structure of a keloid and ease of application, ethosome gel is chosen as a safe and comfortable carrier for losartan potassium, making it a good choice for treating keloids.

Methods

In this randomised clinical trial, 46 adults with keloids were divided into two treatment groups. One group of 23 participants received 5% losartan potassium loaded in ethosomal gel, while the other group of 23 participants received intralesional injections of 10% triamcinolone acetonide. Over 12 weeks, changes in POSAS 3.0 scores, degree of erythema and pigmentation, surface area, thickness, and pliability of the keloids will be measured at four different times: baseline, 4 weeks, 8 weeks, and 12 weeks. Statistical analysis will be conducted using SPSS software version 24, with a significance level of p < 0.05.

Discussion

Losartan potassium is believed to be beneficial for keloid management because it inhibits the angiotensin II receptor, which plays a role in inflammation, proliferation, and fibrosis. This study examines the efficacy of 5% losartan potassium loaded in ethosomal gel for human keloids.

Trial registration

Clinicaltrial.gov identifier NCT05893108. Registered on 7 June 2023.
Literature
1.
go back to reference Dinulos JGH. Keloid and hypertrophic scars. In: Habif’s Clinical Dermatology. 7th ed. Elsevier Inc.; 2021. p. 799–801. Dinulos JGH. Keloid and hypertrophic scars. In: Habif’s Clinical Dermatology. 7th ed. Elsevier Inc.; 2021. p. 799–801.
2.
go back to reference Bock O, Schmid-Ott G, Malewski P, Mrowietz U. Quality of life of patients with keloid and hypertrophic scarring. Arch Dermatol Res. 2006;297(10):433–8.PubMedCrossRef Bock O, Schmid-Ott G, Malewski P, Mrowietz U. Quality of life of patients with keloid and hypertrophic scarring. Arch Dermatol Res. 2006;297(10):433–8.PubMedCrossRef
3.
go back to reference Zhang X, Liu Y, Deng X, Deng C, Pan Y, Hu A. The correlation between quality of life and acceptability of disability in patients with facial burn scars. Front Bioeng Biotechnol. 2019;7:1–7.CrossRef Zhang X, Liu Y, Deng X, Deng C, Pan Y, Hu A. The correlation between quality of life and acceptability of disability in patients with facial burn scars. Front Bioeng Biotechnol. 2019;7:1–7.CrossRef
4.
go back to reference Elsaie ML. Update on management of keloid and hypertrophic scars: a systemic review. J Cosmet Dermatol. 2021;20(9):2729–38.PubMedCrossRef Elsaie ML. Update on management of keloid and hypertrophic scars: a systemic review. J Cosmet Dermatol. 2021;20(9):2729–38.PubMedCrossRef
5.
go back to reference Berman B, Maderal A, Raphael B. Keloids and hypertrophic scars: pathophysiology, classification, and treatment. Dermatol Surg. 2017;43:S3–18.PubMedCrossRef Berman B, Maderal A, Raphael B. Keloids and hypertrophic scars: pathophysiology, classification, and treatment. Dermatol Surg. 2017;43:S3–18.PubMedCrossRef
6.
go back to reference Wang ZC, Zhao WY, Cao Y, Liu YQ, Sun Q, Shi P, et al. The roles of inflammation in keloid and hypertrophic scars. Front Immunol. 2020;11:1–10. Wang ZC, Zhao WY, Cao Y, Liu YQ, Sun Q, Shi P, et al. The roles of inflammation in keloid and hypertrophic scars. Front Immunol. 2020;11:1–10.
7.
go back to reference Gauglitz GG, Korting HC, Pavicic T, Ruzicka T, Jeschke MG. Hypertrophic scarring and keloids: pathomechanisms and current and emerging treatment strategies. Mol Med. 2011;17(1–2):113–25.PubMedCrossRef Gauglitz GG, Korting HC, Pavicic T, Ruzicka T, Jeschke MG. Hypertrophic scarring and keloids: pathomechanisms and current and emerging treatment strategies. Mol Med. 2011;17(1–2):113–25.PubMedCrossRef
8.
go back to reference Steckelings UM, Czarnelzki BM. The renin-angiotensin-system in the skin: evidence for its presence and possible functional implications. Exp Dermatol. 1995;4(6):329–34.PubMedCrossRef Steckelings UM, Czarnelzki BM. The renin-angiotensin-system in the skin: evidence for its presence and possible functional implications. Exp Dermatol. 1995;4(6):329–34.PubMedCrossRef
9.
go back to reference Steckelings UM, Wollschläger T, Peters J, Henz BM, Hermes B, Artuc M. Human skin: source of and target organ for angiotensin II. Exp Dermatol. 2004;13(3):148–54.PubMedCrossRef Steckelings UM, Wollschläger T, Peters J, Henz BM, Hermes B, Artuc M. Human skin: source of and target organ for angiotensin II. Exp Dermatol. 2004;13(3):148–54.PubMedCrossRef
10.
go back to reference Yahata Y, Shirakata Y, Tokumaru S, Yang L, Dai X, Tohyama M, et al. A novel function of angiotensin II in skin wound healing: induction of fibroblast and keratinocyte migration by angiotensin II via heparin-binding epidermal growth factor (EGF)-like growth factor-mediated EGF receptor transactivation. J Biol Chem. 2006;281(19):13209–16.PubMedCrossRef Yahata Y, Shirakata Y, Tokumaru S, Yang L, Dai X, Tohyama M, et al. A novel function of angiotensin II in skin wound healing: induction of fibroblast and keratinocyte migration by angiotensin II via heparin-binding epidermal growth factor (EGF)-like growth factor-mediated EGF receptor transactivation. J Biol Chem. 2006;281(19):13209–16.PubMedCrossRef
11.
go back to reference Akershoek JJ, Vlig M, Brouwer K, Talhout W, Beelen RHJ, Middelkoop E, et al. The presence of tissue renin-angiotensin system components in human burn wounds and scars. Burn Open. 2018;2(3):114–21.CrossRef Akershoek JJ, Vlig M, Brouwer K, Talhout W, Beelen RHJ, Middelkoop E, et al. The presence of tissue renin-angiotensin system components in human burn wounds and scars. Burn Open. 2018;2(3):114–21.CrossRef
12.
go back to reference Niazi F, Hooshyar SH, Hedayatyanfard K, Ziai SA, Doroodgar F, Niazi S, et al. Detection of angiotensin II and AT1 receptor concentrations in keloid and hypertrophic scar. J Clin Aesthet Dermatol. 2018;11(10):36–9.PubMedPubMedCentral Niazi F, Hooshyar SH, Hedayatyanfard K, Ziai SA, Doroodgar F, Niazi S, et al. Detection of angiotensin II and AT1 receptor concentrations in keloid and hypertrophic scar. J Clin Aesthet Dermatol. 2018;11(10):36–9.PubMedPubMedCentral
13.
go back to reference Silva IMS, Assersen KB, Willadsen NN, Jepsen J, Artuc M, Steckelings UM. The role of the renin-angiotensin system in skin physiology and pathophysiology. Exp Dermatol. 2020;29:891–901.PubMedCrossRef Silva IMS, Assersen KB, Willadsen NN, Jepsen J, Artuc M, Steckelings UM. The role of the renin-angiotensin system in skin physiology and pathophysiology. Exp Dermatol. 2020;29:891–901.PubMedCrossRef
14.
go back to reference Hedayatyanfard K, Haddadi N, Ziai SA, Karim H, Niazi F, Steckelings UM, et al. The renin-angiotensin system in cutaneous hypertrophic scar and keloid formation. Exp Dermatol. 2020;29(9):902–9.PubMedCrossRef Hedayatyanfard K, Haddadi N, Ziai SA, Karim H, Niazi F, Steckelings UM, et al. The renin-angiotensin system in cutaneous hypertrophic scar and keloid formation. Exp Dermatol. 2020;29(9):902–9.PubMedCrossRef
15.
go back to reference Nor NM, Ismail R, Jamil A, Shah SA, Imran FH. A randomized, single-blind trial of clobetasol propionate 0.05% cream under silicone dressing occlusion versus intra-lesional triamcinolone for treatment of keloid. Clin Drug Investig. 2017;37(3):295–301.PubMedCrossRef Nor NM, Ismail R, Jamil A, Shah SA, Imran FH. A randomized, single-blind trial of clobetasol propionate 0.05% cream under silicone dressing occlusion versus intra-lesional triamcinolone for treatment of keloid. Clin Drug Investig. 2017;37(3):295–301.PubMedCrossRef
16.
go back to reference Mustoe TA, Cooter RD, Gold MH, Hobbs FDR, Ramelet AA, Shakespeare PG, et al. International clinical recommendations on scar management. Plastic Reconstruct Surg. 2002;110:560–71.CrossRef Mustoe TA, Cooter RD, Gold MH, Hobbs FDR, Ramelet AA, Shakespeare PG, et al. International clinical recommendations on scar management. Plastic Reconstruct Surg. 2002;110:560–71.CrossRef
17.
go back to reference Limmer EE, Glass DA. A review of current keloid management: mainstay monotherapies and emerging approaches. Dermatol Ther (Heidelb). 2020;10(5):931–48.PubMedCrossRef Limmer EE, Glass DA. A review of current keloid management: mainstay monotherapies and emerging approaches. Dermatol Ther (Heidelb). 2020;10(5):931–48.PubMedCrossRef
18.
go back to reference Coppola MM, Salzillo R, Segreto F, Persichetti P. Triamcinolone acetonide intralesional injection for the treatment of keloid scars: patient selection and perspectives. Clin Cosmet Investig Dermatol. 2018;11:387–96.CrossRef Coppola MM, Salzillo R, Segreto F, Persichetti P. Triamcinolone acetonide intralesional injection for the treatment of keloid scars: patient selection and perspectives. Clin Cosmet Investig Dermatol. 2018;11:387–96.CrossRef
19.
go back to reference Zhuang ZH, Li YT, Wei XJ. The safety and efficacy of intralesional triamcinolone acetonide for keloids and hypertrophic scars: a systematic review and meta-analysis. Burns. 2021;47(5):987–98.PubMedCrossRef Zhuang ZH, Li YT, Wei XJ. The safety and efficacy of intralesional triamcinolone acetonide for keloids and hypertrophic scars: a systematic review and meta-analysis. Burns. 2021;47(5):987–98.PubMedCrossRef
20.
go back to reference Berman B, Flores F. Recurrence rates of excised keloids treated with postoperative triamcinolone acetonide injections or interferon alfa-2b injections. J Am Acad Dermatol. 1997;37(5 I):755–7.PubMedCrossRef Berman B, Flores F. Recurrence rates of excised keloids treated with postoperative triamcinolone acetonide injections or interferon alfa-2b injections. J Am Acad Dermatol. 1997;37(5 I):755–7.PubMedCrossRef
21.
go back to reference McLenon J, Rogers MA. The fear of needles: A systematic review and meta‐analysis. J Adv Nurs. 2019;75(1):30–42. McLenon J, Rogers MA. The fear of needles: A systematic review and meta‐analysis. J Adv Nurs. 2019;75(1):30–42.
22.
go back to reference Sidgwick GP, McGeorge D, Bayat A. A comprehensive evidence-based review on the role of topicals and dressings in the management of skin scarring. Arch Dermatol Res. 2015;307(6):461–77.PubMedPubMedCentralCrossRef Sidgwick GP, McGeorge D, Bayat A. A comprehensive evidence-based review on the role of topicals and dressings in the management of skin scarring. Arch Dermatol Res. 2015;307(6):461–77.PubMedPubMedCentralCrossRef
23.
go back to reference Morrow D, McCarron P, Woolfson A, Donnely R. Innovative strategies for enhancing topical and transdermal drug delivery. Open Drug Deliv J. 2007;1:36–59.CrossRef Morrow D, McCarron P, Woolfson A, Donnely R. Innovative strategies for enhancing topical and transdermal drug delivery. Open Drug Deliv J. 2007;1:36–59.CrossRef
24.
25.
go back to reference Ardekani GS, Aghaie S, Nemati MH, Handjani F, Kasraee B. Treatment of a postburn keloid scar with topical captopril: report of the first case. Plast Reconst Surg. 2009;123(3):112e–3e. Ardekani GS, Aghaie S, Nemati MH, Handjani F, Kasraee B. Treatment of a postburn keloid scar with topical captopril: report of the first case. Plast Reconst Surg. 2009;123(3):112e–3e.
26.
go back to reference Demir CY, Ersoz ME, Erten R, Kocak OF, Sultanoglu Y, Basbugan Y. Comparison of enalapril, candesartan and intralesional triamcinolone in reducing hypertrophic scar development: an experimental study. Aesthetic Plast Surg. 2018;42(2):352–61.PubMedCrossRef Demir CY, Ersoz ME, Erten R, Kocak OF, Sultanoglu Y, Basbugan Y. Comparison of enalapril, candesartan and intralesional triamcinolone in reducing hypertrophic scar development: an experimental study. Aesthetic Plast Surg. 2018;42(2):352–61.PubMedCrossRef
27.
go back to reference Zheng B, Fang QQ, Wang XF, Shi BH, Zhao WY, Chen CY, Zhang MX, Zhang LY, Hu YY, Shi P, Ma L. The effect of topical ramipril and losartan cream in inhibiting scar formation. Biomed & Pharmacother. 2019;118:109394. Zheng B, Fang QQ, Wang XF, Shi BH, Zhao WY, Chen CY, Zhang MX, Zhang LY, Hu YY, Shi P, Ma L. The effect of topical ramipril and losartan cream in inhibiting scar formation. Biomed & Pharmacother. 2019;118:109394.
28.
go back to reference Rha EY, Kim JW, Kim JH, Yoo G. Angiotensin-converting enzyme inhibitor, captopril, improves scar healing in hypertensive rats. Int J Med Sci. 2021;18(4):975–83.PubMedPubMedCentralCrossRef Rha EY, Kim JW, Kim JH, Yoo G. Angiotensin-converting enzyme inhibitor, captopril, improves scar healing in hypertensive rats. Int J Med Sci. 2021;18(4):975–83.PubMedPubMedCentralCrossRef
29.
go back to reference Hedayatyanfard K, Ziai SA, Niazi F, Habibi I, Habibi B, Moravvej H. Losartan ointment relieves hypertrophic scars and keloid: a pilot study. Wound Repair Regen. 2018;26(4):340–3.PubMedCrossRef Hedayatyanfard K, Ziai SA, Niazi F, Habibi I, Habibi B, Moravvej H. Losartan ointment relieves hypertrophic scars and keloid: a pilot study. Wound Repair Regen. 2018;26(4):340–3.PubMedCrossRef
30.
go back to reference Mohammadi AA, Parand A, Kardeh S, Janati M, Mohammadi S. Efficacy of topical enalapril in treatment of hypertrophic scars. World J Plast Surg. 2018;7(3):326–31.PubMedPubMedCentralCrossRef Mohammadi AA, Parand A, Kardeh S, Janati M, Mohammadi S. Efficacy of topical enalapril in treatment of hypertrophic scars. World J Plast Surg. 2018;7(3):326–31.PubMedPubMedCentralCrossRef
31.
go back to reference Khodaei B, Nasimi M, Nassireslami E, Seyedpour S, Rahmati J, Haddady Abianeh S, et al. Efficacy of topical losartan in management of mammoplasty and abdominoplasty scars: a randomized, double-blind clinical trial. Aesthetic Plast Surg. 2022;46(5):2580–7.PubMedCrossRef Khodaei B, Nasimi M, Nassireslami E, Seyedpour S, Rahmati J, Haddady Abianeh S, et al. Efficacy of topical losartan in management of mammoplasty and abdominoplasty scars: a randomized, double-blind clinical trial. Aesthetic Plast Surg. 2022;46(5):2580–7.PubMedCrossRef
32.
go back to reference Limandjaja GC, Belien JM, Scheper RJ, Niessen FB, Gibbs S. A study looking at the differences between hypertrophic scars and keloid scars. Br J Dermatol. 2020;182(4):18219.CrossRef Limandjaja GC, Belien JM, Scheper RJ, Niessen FB, Gibbs S. A study looking at the differences between hypertrophic scars and keloid scars. Br J Dermatol. 2020;182(4):18219.CrossRef
33.
go back to reference Huang C, Wu Z, Du Y, Ogawa R. The epidemiology of keloids. Textbook on scar management: state of the art management and emerging technologies. 2020:29–35. Huang C, Wu Z, Du Y, Ogawa R. The epidemiology of keloids. Textbook on scar management: state of the art management and emerging technologies. 2020:29–35.
34.
go back to reference Patil P, Datir S, Saudagar R. A review on topical gels as drug delivery system. J Drug Deliv Ther. 2019;9(3):661–8. Patil P, Datir S, Saudagar R. A review on topical gels as drug delivery system. J Drug Deliv Ther. 2019;9(3):661–8.
35.
go back to reference Zsikó S, Csányi E, Kovács A, Budai-Szűcs M, Gácsi A, Berkó S. Methods to evaluate skin penetration in vitro. Scientia Pharmaceutica. 2019;87(3):1–21. Zsikó S, Csányi E, Kovács A, Budai-Szűcs M, Gácsi A, Berkó S. Methods to evaluate skin penetration in vitro. Scientia Pharmaceutica. 2019;87(3):1–21.
36.
go back to reference Zhang Z, Chen J, Huang J, Wo Y, Zhang Y, Chen X. Experimental study of 5-fluorouracil encapsulated ethosomes combined with CO2 fractional laser to treat hypertrophic scar. Nanoscale Res lett. 2018;13:1–12. Zhang Z, Chen J, Huang J, Wo Y, Zhang Y, Chen X. Experimental study of 5-fluorouracil encapsulated ethosomes combined with CO2 fractional laser to treat hypertrophic scar. Nanoscale Res lett. 2018;13:1–12.
37.
go back to reference Kunii T, Hirao T, Kikuchi K, Tagami H. Stratum corneum lipid profile and maturation pattern of corneocytes in the outermost layer of fresh scars: the presence of immature corneocytes plays a much more important role in the barrier dysfunction than do changes in intercellular lipids. Br J Dermatol. 2003;149(4):749–56.PubMedCrossRef Kunii T, Hirao T, Kikuchi K, Tagami H. Stratum corneum lipid profile and maturation pattern of corneocytes in the outermost layer of fresh scars: the presence of immature corneocytes plays a much more important role in the barrier dysfunction than do changes in intercellular lipids. Br J Dermatol. 2003;149(4):749–56.PubMedCrossRef
38.
go back to reference Limandjaja GC, van den Broek LJ, Waaijman T, van Veen HA, Everts V, Monstrey S, et al. Increased epidermal thickness and abnormal epidermal differentiation in keloid scars. Br J Dermatol. 2017;176(1):116–26.PubMedCrossRef Limandjaja GC, van den Broek LJ, Waaijman T, van Veen HA, Everts V, Monstrey S, et al. Increased epidermal thickness and abnormal epidermal differentiation in keloid scars. Br J Dermatol. 2017;176(1):116–26.PubMedCrossRef
39.
go back to reference Nandura HP, Prashant Puranik PG, Lone V. Ethosome: a novel drug carrier. Pharm Sci. 2013;2(3):18–30. Nandura HP, Prashant Puranik PG, Lone V. Ethosome: a novel drug carrier. Pharm Sci. 2013;2(3):18–30.
40.
go back to reference Zhang Z, Tsai PC, Ramezanli T, Michniak-Kohn BB. Polymeric nanoparticles-based topical delivery systems for the treatment of dermatological diseases. Wiley Interdiscip Rev Nanomed Nanobiotechnol. 2013;5(3):205–18.PubMedPubMedCentralCrossRef Zhang Z, Tsai PC, Ramezanli T, Michniak-Kohn BB. Polymeric nanoparticles-based topical delivery systems for the treatment of dermatological diseases. Wiley Interdiscip Rev Nanomed Nanobiotechnol. 2013;5(3):205–18.PubMedPubMedCentralCrossRef
41.
go back to reference Natsheh H, Touitou E. Phospholipid vesicles for dermal/transdermal and nasal administration of active molecules: The effect of surfactants and alcohols on the fluidity of their lipid bilayers and penetration enhancement properties. Molecules. 2020;25(13):1–42. Natsheh H, Touitou E. Phospholipid vesicles for dermal/transdermal and nasal administration of active molecules: The effect of surfactants and alcohols on the fluidity of their lipid bilayers and penetration enhancement properties. Molecules. 2020;25(13):1–42.
42.
go back to reference Paolino D, Lucania G, Mardente D, Alhaique F, Fresta M. Ethosomes for skin delivery of ammonium glycyrrhizinate: in vitro percutaneous permeation through human skin and in vivo anti-inflammatory activity on human volunteers. J Control Release. 2005;106(1–2):99–110.PubMedCrossRef Paolino D, Lucania G, Mardente D, Alhaique F, Fresta M. Ethosomes for skin delivery of ammonium glycyrrhizinate: in vitro percutaneous permeation through human skin and in vivo anti-inflammatory activity on human volunteers. J Control Release. 2005;106(1–2):99–110.PubMedCrossRef
43.
go back to reference Madsen JT, Vogel S, Karlberg AT, Simonsson C, Johansen JD, Andersen KE. Ethosome formulation of contact allergens may enhance patch test reactions in patients. Contact Dermatitis. 2010;63(4):209–14.PubMedCrossRef Madsen JT, Vogel S, Karlberg AT, Simonsson C, Johansen JD, Andersen KE. Ethosome formulation of contact allergens may enhance patch test reactions in patients. Contact Dermatitis. 2010;63(4):209–14.PubMedCrossRef
44.
go back to reference Madsen JT, Vogel S, Karlberg AT, Simonsson C, Johansen JD, Andersen KE. Ethosome formulations of known contact allergens can increase their sensitizing capacity. Acta Derm Venereol. 2010;90(4):374–8.PubMedCrossRef Madsen JT, Vogel S, Karlberg AT, Simonsson C, Johansen JD, Andersen KE. Ethosome formulations of known contact allergens can increase their sensitizing capacity. Acta Derm Venereol. 2010;90(4):374–8.PubMedCrossRef
45.
go back to reference Madsen JT, Vogel S, Johansen JD, Sørensen JA, Andersen KE, Nielsen JB. Percutaneous penetration characteristics and release kinetics of contact allergens encapsulated in ethosomes. Cutan Ocul Toxicol. 2011;30(1):38–44.PubMedCrossRef Madsen JT, Vogel S, Johansen JD, Sørensen JA, Andersen KE, Nielsen JB. Percutaneous penetration characteristics and release kinetics of contact allergens encapsulated in ethosomes. Cutan Ocul Toxicol. 2011;30(1):38–44.PubMedCrossRef
46.
go back to reference Madsen JT, Vogel S, Johansen JD, Andersen KE. Encapsulating contact allergens in liposomes, ethosomes, and polycaprolactone may affect their sensitizing properties. Cutan Ocul Toxicol. 2011;30(2):116–23.PubMedCrossRef Madsen JT, Vogel S, Johansen JD, Andersen KE. Encapsulating contact allergens in liposomes, ethosomes, and polycaprolactone may affect their sensitizing properties. Cutan Ocul Toxicol. 2011;30(2):116–23.PubMedCrossRef
47.
go back to reference Sguizzato M, Esposito E, Cortesi R. Lipid-based nanosystems as a tool to overcome skin barrier. Int J Mol Sci. 2021;22(15):1–16.CrossRef Sguizzato M, Esposito E, Cortesi R. Lipid-based nanosystems as a tool to overcome skin barrier. Int J Mol Sci. 2021;22(15):1–16.CrossRef
48.
go back to reference Bhana R, Verma A, Jain S. Development and characterization of ethosomes bearing losartan potassium for transdermal drug delivery. Int J Pharm Pharm Sci. 2013;5(1):35–40. Bhana R, Verma A, Jain S. Development and characterization of ethosomes bearing losartan potassium for transdermal drug delivery. Int J Pharm Pharm Sci. 2013;5(1):35–40.
49.
go back to reference Chung JH. The effects of sunlight on the skin of Asians. In 2001. p. 69–90. Chung JH. The effects of sunlight on the skin of Asians. In 2001. p. 69–90.
50.
go back to reference Zlowodzki M, Bhandari M. Outcome measures and implications for sample-size calculations. J Bone Jt Surg. 2009;91(SUPPL. 3):35–40.CrossRef Zlowodzki M, Bhandari M. Outcome measures and implications for sample-size calculations. J Bone Jt Surg. 2009;91(SUPPL. 3):35–40.CrossRef
54.
go back to reference Dahlan MS. Statistik Untuk Kedokteran Dan Kesehatan. 4th ed. Jakarta: Salemba Medika 2009. p. 27. Dahlan MS. Statistik Untuk Kedokteran Dan Kesehatan. 4th ed. Jakarta: Salemba Medika 2009. p. 27.
55.
go back to reference Dahlan MS. Komparatif-Kategorik-Tidak Berpasangan Lebih dari Satu Kali Pengukuran. In: Besar Sampel dalam Penelitian Kedokteran dan Kesehatan. 5th ed. Jakarta: Epidemiologi Indonesia; 2020. p. 124–31. Dahlan MS. Komparatif-Kategorik-Tidak Berpasangan Lebih dari Satu Kali Pengukuran. In: Besar Sampel dalam Penelitian Kedokteran dan Kesehatan. 5th ed. Jakarta: Epidemiologi Indonesia; 2020. p. 124–31.
56.
57.
go back to reference Draaijers LJ, Tempelman FRH, Botman YAM, Tuinebreijer WE, Middelkoop E, Kreis RW, et al. The Patient and Observer Scar Assessment Scale: a reliable and feasible tool for scar evaluation. Plast Reconstr Surg. 2004;113(7):1960–5.PubMedCrossRef Draaijers LJ, Tempelman FRH, Botman YAM, Tuinebreijer WE, Middelkoop E, Kreis RW, et al. The Patient and Observer Scar Assessment Scale: a reliable and feasible tool for scar evaluation. Plast Reconstr Surg. 2004;113(7):1960–5.PubMedCrossRef
58.
go back to reference Verhaegen PDHM, Van Der Wal MBA, Middelkoop E, Van Zuijlen PPM. Objective scar assessment tools: a clinimetric appraisal. Plast Reconstr Surg. 2011;127(4):1561–70.PubMedCrossRef Verhaegen PDHM, Van Der Wal MBA, Middelkoop E, Van Zuijlen PPM. Objective scar assessment tools: a clinimetric appraisal. Plast Reconstr Surg. 2011;127(4):1561–70.PubMedCrossRef
59.
go back to reference Van Der Wal M, Bloemen M, Verhaegen P, Tuinebreijer W, De Vet H, Van Zuijlen P, et al. Objective color measurements: clinimetric performance of three devices on normal skin and scar tissue. J Burn Care Res. 2013;34(3):187–94.CrossRef Van Der Wal M, Bloemen M, Verhaegen P, Tuinebreijer W, De Vet H, Van Zuijlen P, et al. Objective color measurements: clinimetric performance of three devices on normal skin and scar tissue. J Burn Care Res. 2013;34(3):187–94.CrossRef
60.
go back to reference Kim MS, Rodney WN, Cooper T, Kite C, Reece GP, Markey MK. Towards quantifying the aesthetic outcomes of breast cancer treatment: comparison of clinical photography and colorimetry. J Eval Clin Pract. 2009;15(1):20–31.PubMedPubMedCentralCrossRef Kim MS, Rodney WN, Cooper T, Kite C, Reece GP, Markey MK. Towards quantifying the aesthetic outcomes of breast cancer treatment: comparison of clinical photography and colorimetry. J Eval Clin Pract. 2009;15(1):20–31.PubMedPubMedCentralCrossRef
62.
go back to reference van Zuijlen PPM, Angeles AP, Suijker MH, Kreis RW, Middelkoop E. Reliability and accuracy of techniques for surface area measurements of wounds and scars. Int J Low Extrem Wounds. 2004;3(1):7–11.PubMedCrossRef van Zuijlen PPM, Angeles AP, Suijker MH, Kreis RW, Middelkoop E. Reliability and accuracy of techniques for surface area measurements of wounds and scars. Int J Low Extrem Wounds. 2004;3(1):7–11.PubMedCrossRef
63.
go back to reference Witmer WK, Lebovitz PJ. Clinical photography in the dermatology practice. Semin Cutan Med Surg. 2012;31(3):191–9.PubMedCrossRef Witmer WK, Lebovitz PJ. Clinical photography in the dermatology practice. Semin Cutan Med Surg. 2012;31(3):191–9.PubMedCrossRef
64.
go back to reference Aragón-Sánchez J, Quintana-Marrero Y, Aragón-Hernández C, Hernández-Herero MJ. ImageJ: a free, easy, and reliable method to measure leg ulcers using digital pictures. Int J Low Extrem Wounds. 2017;16(4):269–73.PubMedCrossRef Aragón-Sánchez J, Quintana-Marrero Y, Aragón-Hernández C, Hernández-Herero MJ. ImageJ: a free, easy, and reliable method to measure leg ulcers using digital pictures. Int J Low Extrem Wounds. 2017;16(4):269–73.PubMedCrossRef
65.
go back to reference Bessonart MN, Macedo N, Carmona C. High resolution B-scan ultrasound of hypertrophic scars. Ski Res Technol. 2005;11(3):185–8.CrossRef Bessonart MN, Macedo N, Carmona C. High resolution B-scan ultrasound of hypertrophic scars. Ski Res Technol. 2005;11(3):185–8.CrossRef
66.
go back to reference Lee KC, Dretzke J, Grover L, Logan A, Moiemen N. A systematic review of objective burn scar measurements. Burns Trauma. 2016;4:1–33. Lee KC, Dretzke J, Grover L, Logan A, Moiemen N. A systematic review of objective burn scar measurements. Burns Trauma. 2016;4:1–33.
67.
go back to reference Reinholz M, Schwaiger H, Poetschke J, Epple A, Ruzicka T, Von Braunmühl T, et al. Objective and subjective treatment evaluation of scars using optical coherence tomography, sonography, photography, and standardised questionnaires. Eur J Dermatol. 2016;26(6):599–608.PubMedCrossRef Reinholz M, Schwaiger H, Poetschke J, Epple A, Ruzicka T, Von Braunmühl T, et al. Objective and subjective treatment evaluation of scars using optical coherence tomography, sonography, photography, and standardised questionnaires. Eur J Dermatol. 2016;26(6):599–608.PubMedCrossRef
68.
go back to reference Poetschke J, Schwaiger H, Gauglitz GG. Current and emerging options for documenting scars and evaluating therapeutic progress. Dermatol Surg. 2017;43:S25–36.PubMedCrossRef Poetschke J, Schwaiger H, Gauglitz GG. Current and emerging options for documenting scars and evaluating therapeutic progress. Dermatol Surg. 2017;43:S25–36.PubMedCrossRef
69.
go back to reference Lye I, Edgar DW, Wood FM, Carroll S. Tissue tonometry is a simple, objective measure for pliability of burn scar: is it reliable? J Burn Care Res. 2006;27(1):82–5.PubMedCrossRef Lye I, Edgar DW, Wood FM, Carroll S. Tissue tonometry is a simple, objective measure for pliability of burn scar: is it reliable? J Burn Care Res. 2006;27(1):82–5.PubMedCrossRef
70.
go back to reference de Oliveira GV, de Morais Gambogi Alvarenga LR, de Oliveira Duarte Stuhr PM, Cantaruti TA, Ferreira ÁRS, Kitten GT. Treatment of median sternotomy scars using triamcinolone injections, silicone dressings and a combination group: a prospective randomized comparative study. Surg Cosmet Dermatol. 2020;12(1):34–41. de Oliveira GV, de Morais Gambogi Alvarenga LR, de Oliveira Duarte Stuhr PM, Cantaruti TA, Ferreira ÁRS, Kitten GT. Treatment of median sternotomy scars using triamcinolone injections, silicone dressings and a combination group: a prospective randomized comparative study. Surg Cosmet Dermatol. 2020;12(1):34–41.
71.
go back to reference Dolynchuk KN, Tredget EE. A Preliminary report of the biochemical and clinical effects of 1,4-diaminobutane on prevention of human hypertrophic scars. Plast Reconstr Surg. 2020;145(1):76e–84e.PubMedCrossRef Dolynchuk KN, Tredget EE. A Preliminary report of the biochemical and clinical effects of 1,4-diaminobutane on prevention of human hypertrophic scars. Plast Reconstr Surg. 2020;145(1):76e–84e.PubMedCrossRef
72.
go back to reference Zhao T, Zhao W, Meng W, Liu C, Chen Y, Sun Y. Vascular endothelial growth factor-C: its unrevealed role in fibrogenesis. Am J Physiol Hear Circ Physiol. 2014;306(6):789–96.CrossRef Zhao T, Zhao W, Meng W, Liu C, Chen Y, Sun Y. Vascular endothelial growth factor-C: its unrevealed role in fibrogenesis. Am J Physiol Hear Circ Physiol. 2014;306(6):789–96.CrossRef
73.
go back to reference Fang QQ, Wang XF, Zhao WY, Chen CY, Zhang MX, Shi BH, et al. The source of ACE during scar formation is from both bone marrow and skin tissue. FASEB J. 2018;32(9):5199–208.PubMedCrossRef Fang QQ, Wang XF, Zhao WY, Chen CY, Zhang MX, Shi BH, et al. The source of ACE during scar formation is from both bone marrow and skin tissue. FASEB J. 2018;32(9):5199–208.PubMedCrossRef
74.
go back to reference Pereira RM, Dos Santos RAS, Dias FLDC, Teixeira MM, Simões e Silva AC. Renin-angiotensin system in the pathogenesis of liver fibrosis. World J Gastroenterol. 2009;15(21):2579–86.PubMedPubMedCentralCrossRef Pereira RM, Dos Santos RAS, Dias FLDC, Teixeira MM, Simões e Silva AC. Renin-angiotensin system in the pathogenesis of liver fibrosis. World J Gastroenterol. 2009;15(21):2579–86.PubMedPubMedCentralCrossRef
75.
go back to reference Ren M, Hao S, Yang C, Zhu P, Chen L, Lin D, et al. Angiotensin II regulates collagen metabolism through modulating tissue inhibitor of metalloproteinase-1 in diabetic skin tissues. Diabetes Vasc Dis Res. 2013;10(5):426–35.CrossRef Ren M, Hao S, Yang C, Zhu P, Chen L, Lin D, et al. Angiotensin II regulates collagen metabolism through modulating tissue inhibitor of metalloproteinase-1 in diabetic skin tissues. Diabetes Vasc Dis Res. 2013;10(5):426–35.CrossRef
76.
go back to reference Colwell AS, Phan TT, Kong W, Longaker MT, Lorenz PH. Hypertrophic scar fibroblasts have increased connective tissue growth factor expression after transforming growth factor-β stimulation. Plast Reconstr Surg. 2005;116(5):1387–90.PubMedCrossRef Colwell AS, Phan TT, Kong W, Longaker MT, Lorenz PH. Hypertrophic scar fibroblasts have increased connective tissue growth factor expression after transforming growth factor-β stimulation. Plast Reconstr Surg. 2005;116(5):1387–90.PubMedCrossRef
77.
78.
go back to reference Kovács MG, Kovács ZZ, Varga Z, Szűcs G, Freiwan M, Farkas K, Kővári B, Cserni G, Kriston A, Kovács F, Horváth P. Investigation of the Antihypertrophic and antifibrotic effects of losartan in a rat model of radiation-induced heart disease. Int J Mol Sci. 2021;22(23):1–24. Kovács MG, Kovács ZZ, Varga Z, Szűcs G, Freiwan M, Farkas K, Kővári B, Cserni G, Kriston A, Kovács F, Horváth P. Investigation of the Antihypertrophic and antifibrotic effects of losartan in a rat model of radiation-induced heart disease. Int J Mol Sci. 2021;22(23):1–24.
79.
go back to reference Insel PA, Murray F, Yokoyama U, Romano S, Yun H, Brown L, et al. CAMP and Epac in the regulation of tissue fibrosis. Br J Pharmacol. 2012;166(2):447–56.PubMedPubMedCentralCrossRef Insel PA, Murray F, Yokoyama U, Romano S, Yun H, Brown L, et al. CAMP and Epac in the regulation of tissue fibrosis. Br J Pharmacol. 2012;166(2):447–56.PubMedPubMedCentralCrossRef
80.
go back to reference Yeh FL, Der SH, Lin MW, Chang CY, Tai HY, Huang MH. Keloid-derived fibroblasts have a diminished capacity to produce prostaglandin E2. Burns. 2006;32(3):299–304.PubMedCrossRef Yeh FL, Der SH, Lin MW, Chang CY, Tai HY, Huang MH. Keloid-derived fibroblasts have a diminished capacity to produce prostaglandin E2. Burns. 2006;32(3):299–304.PubMedCrossRef
81.
go back to reference Sandulache VC, Parekh A, Li-Korotky H, Dohar JE, Hebda PA. Prostaglandin E2 inhibition of keloid fibroblast migration, contraction, and transforming growth factor (TGF)-β1-induced collagen synthesis. Wound Repair Regen. 2007;15(1):122–33.PubMedCrossRef Sandulache VC, Parekh A, Li-Korotky H, Dohar JE, Hebda PA. Prostaglandin E2 inhibition of keloid fibroblast migration, contraction, and transforming growth factor (TGF)-β1-induced collagen synthesis. Wound Repair Regen. 2007;15(1):122–33.PubMedCrossRef
82.
go back to reference Zhao J, Shu B, Chen L, Tang J, Zhang L, Xie J, et al. Prostaglandin E2 inhibits collagen synthesis in dermal fibroblasts and prevents hypertrophic scar formation in vivo. Exp Dermatol. 2016;25(8):604–10.PubMedCrossRef Zhao J, Shu B, Chen L, Tang J, Zhang L, Xie J, et al. Prostaglandin E2 inhibits collagen synthesis in dermal fibroblasts and prevents hypertrophic scar formation in vivo. Exp Dermatol. 2016;25(8):604–10.PubMedCrossRef
83.
go back to reference Molina-Molina M, Serrano-Mollar A, Bulbena O, Fernandez-Zabalegui L, Closa D, Marin-Arguedas A, et al. Losartan attenuates bleomycin induced lung fibrosis by increasing prostaglandin E2 synthesis. Thorax. 2006;61(7):604–10.PubMedPubMedCentralCrossRef Molina-Molina M, Serrano-Mollar A, Bulbena O, Fernandez-Zabalegui L, Closa D, Marin-Arguedas A, et al. Losartan attenuates bleomycin induced lung fibrosis by increasing prostaglandin E2 synthesis. Thorax. 2006;61(7):604–10.PubMedPubMedCentralCrossRef
84.
go back to reference Mbah CC, Builders PF, Attama AA. Nanovesicular carriers as alternative drug delivery systems: ethosomes in focus. Expert Opin Drug Deliv. 2014;11(1):45–59.PubMedCrossRef Mbah CC, Builders PF, Attama AA. Nanovesicular carriers as alternative drug delivery systems: ethosomes in focus. Expert Opin Drug Deliv. 2014;11(1):45–59.PubMedCrossRef
85.
go back to reference Gabrijelčič V, Šentjurc M. Influence of hydrogels on liposome stability and on the transport of liposome entrapped substances into the skin. Int J Pharm. 1995;118(2):207–12.CrossRef Gabrijelčič V, Šentjurc M. Influence of hydrogels on liposome stability and on the transport of liposome entrapped substances into the skin. Int J Pharm. 1995;118(2):207–12.CrossRef
Metadata
Title
A randomised clinical trial study assessing the efficacy of 5% losartan potassium loaded in ethosomal gel to treat human keloids: a trial protocol
Authors
Yuni Eka Anggraini
Niken Trisnowati
Ronny Martien
Retno Danarti
Publication date
01-12-2024
Publisher
BioMed Central
Keywords
Keloid
Losartan
Published in
Trials / Issue 1/2024
Electronic ISSN: 1745-6215
DOI
https://doi.org/10.1186/s13063-023-07880-2

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