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Yang et al. Plast Aesthet Res 2020;7:34 Plastic and
DOI: 10.20517/2347-9264.2020.24 Aesthetic Research

Opinion Open Access

Psychological stress enhances keloid development
via stress hormone-induced abnormal cytokine

profiles and inflammatory responses

Ya-Ting Yang, Xiao-Li Wu , Wei Liu #
#
Department of Plastic and Reconstructive Surgery, Shanghai Tissue Engineering Key Laboratory, Shanghai Research Institute of
Plastic and Reconstructive Surgery, Shanghai 9th People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai
200011, China.
# These authors contributed equally to this work.
Correspondence to: Dr. Wei Liu and Dr. Xiao-Li Wu, Department of Plastic and Reconstructive Surgery, Shanghai Tissue
Engineering Key Laboratory, Shanghai Research Institute of Plastic and Reconstructive Surgery, Shanghai 9th People’s Hospital,
Shanghai Jiao Tong University School of Medicine, 639 Zhi Zao Ju Rd, Shanghai 200011, China.
E-mail: liuwei_2000@yahoo.com; wuxiaoli528@icloud.com

How to cite this article: Yang YT, Wu XL, Liu W. Psychological stress enhances keloid development via stress hormone-induced
abnormal cytokine profiles and inflammatory responses. Plast Aesthet Res 2020;7:34.
http://dx.doi.org/10.20517/2347-9264.2020.24

Received: 17 Feb 2020 First Decision: 27 Apr 2020 Revised: 17 Jun 2020 Accepted: 20 Jun 2020 Available online: 12 Jul 2020

Academic Editor: Alexis Desmoulière, Jérôme Laloze Copy Editor: Cai-Hong Wang Production Editor: Jing Yu

Abstract
Keloid is a fibroproliferative disorder resulting from the abnormal wound healing process, and it causes both
cosmetic concerns and functional disabilities. Genetic predisposition, wound trauma, foreign body reaction,
mechanical stretch, and immune dysfunction are common risk factors, but there remain mechanisms unclarified,
leaving challenges in addressing the clinical concerns of recurrence and resistance. However, similar patterns of
growth and metabolism between keloids and cancers provide a unique insight into the future exploration of keloid
pathogenesis. Psychological stress has been demonstrated to be involved in the development and drug resistance
of multiple cancers, but this aspect remains less-explored in keloids. Clinical observations and published
investigations have noticed that persistent stress is common among keloid patients and their symptoms tend to
deteriorate under stressful conditions. Following a thorough review of the published literature, we have identified
three signaling pathways that might imply how stress hormones are likely to influence the keloid pathogenesis via
activating adrenergic receptors and dysregulating the immune system. Thus, we hypothesized that psychological
stress would be a key risk factor for keloid development via stimulating fibrosis, aggravating local hypoxia, and
inflammation.

© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0
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