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Dmytrzak A, Lewandowska K, Boroń A, Łoniewska B, Grzesch N, Brodkiewicz A, Clark JSC, Ciechanowicz A, Kostrzewa-Nowak D. No Association of Polymorphisms in the Genes Encoding Interleukin-6 and Interleukin-6 Receptor Subunit Alpha with the Risk of Keloids in Polish Patients. Int J Mol Sci 2024; 25:5284. [PMID: 38791322 PMCID: PMC11121548 DOI: 10.3390/ijms25105284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 05/09/2024] [Accepted: 05/11/2024] [Indexed: 05/26/2024] Open
Abstract
A keloid is a benign fibroproliferative hypertrophy of scar tissue that extends outside the original wound and invades adjacent healthy skin. Keloid formation is thought to be a complex process including overactivity of the interleukin-6 signaling pathway and genetic susceptibility. The aim of the study was to investigate possible associations between rs1800797, rs1800796, and rs1800795 polymorphisms in the promoter of the IL6 gene encoding interleukin-6 and the rs2228145 polymorphism in the IL6R gene encoding the interleukin-6 receptor subunit alpha with the predisposition to keloids in Polish patients. The genetic polymorphisms were identified either using Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP) or sequencing of samples of genomic DNA extracted from blood leukocytes of 86 adult patients with keloids and 100 newborns comprising a control group. No significant differences in the distributions of IL6 or IL6R alleles or genotypes were found between keloid patients and newborn controls. There were also no significant differences between both groups in the distribution of IL6 haplotypes. The IL6 rs1800797, rs1800796 and rs1800795 and IL6R rs2228145 polymorphisms were not found to predispose individuals in the study group to keloids. IL6 promoter haplotypes were not found to be associated with a higher risk of keloids in the studied group.
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Affiliation(s)
| | - Klaudyna Lewandowska
- Department of Clinical and Molecular Biochemistry, Pomeranian Medical University, 70-111 Szczecin, Poland; (K.L.); (A.B.); (N.G.); (J.S.C.C.); (A.C.)
| | - Agnieszka Boroń
- Department of Clinical and Molecular Biochemistry, Pomeranian Medical University, 70-111 Szczecin, Poland; (K.L.); (A.B.); (N.G.); (J.S.C.C.); (A.C.)
| | - Beata Łoniewska
- Department of Neonatal Diseases, Pomeranian Medical University, 70-111 Szczecin, Poland;
| | - Natalie Grzesch
- Department of Clinical and Molecular Biochemistry, Pomeranian Medical University, 70-111 Szczecin, Poland; (K.L.); (A.B.); (N.G.); (J.S.C.C.); (A.C.)
| | - Andrzej Brodkiewicz
- Department of Pediatrics, Child Nephrology, Dialysotherapy and Management of Acute Poisoning, Pomeranian Medical University, 70-780 Szczecin, Poland;
| | - Jeremy S. C. Clark
- Department of Clinical and Molecular Biochemistry, Pomeranian Medical University, 70-111 Szczecin, Poland; (K.L.); (A.B.); (N.G.); (J.S.C.C.); (A.C.)
| | - Andrzej Ciechanowicz
- Department of Clinical and Molecular Biochemistry, Pomeranian Medical University, 70-111 Szczecin, Poland; (K.L.); (A.B.); (N.G.); (J.S.C.C.); (A.C.)
| | - Dorota Kostrzewa-Nowak
- Department of Clinical and Molecular Biochemistry, Pomeranian Medical University, 70-111 Szczecin, Poland; (K.L.); (A.B.); (N.G.); (J.S.C.C.); (A.C.)
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Franzetti J, Durante S, Mastroleo F, Volpe S, De Lorenzi F, Rotondi M, Lorubbio C, Vitullo A, Frassoni S, Bagnardi V, Cambria R, Cattani F, Vavassori A, Jereczek-Fossa BA. Post-operative KEloids iRradiation (POKER): does the surgery/high-dose interventional radiotherapy association make a winning hand? LA RADIOLOGIA MEDICA 2024; 129:328-334. [PMID: 38280971 PMCID: PMC10879234 DOI: 10.1007/s11547-024-01756-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 01/02/2024] [Indexed: 01/29/2024]
Abstract
PURPOSE To report the results involving post-operative interventional radiotherapy (POIRT) in a homogenous cohort of patients affected by keloid and treated at a single institution with the same fractionation schedule. PATIENTS AND METHODS Inclusion criteria were: surgery with a histopathological diagnosis of keloid, subsequent high-dose rate interventional radiotherapy (HDR-IRT)-12 Gy in 4 fractions (3 Gy/fr) twice a day-and follow-up period ≥ 24 months. RESULTS One-hundred and two patients and a total of 135 keloids were eligible for the analyses. Median follow-up was 64 [IQR: 25-103] months. Thirty-six (26.7%) recurrences were observed, 12-months and 36-months cumulative incidence of recurrence were 20.7% (95% CI 12.2-28.5) and 23.8% (95% CI 14.9-31.7) respectively. History of spontaneous keloids (HR = 7.00, 95% CI 2.79-17.6, p < 0.001), spontaneous cheloid as keloid cause (HR = 6.97, 95% CI 2.05-23.7, p = 0.002) and sternal (HR = 10.6, 95% CI 3.08-36.8, p < 0.001), ear (HR = 6.03, 95% CI 1.71-21.3, p = 0.005) or limb (HR = 18.8, 95% CI 5.14-68.7, p < 0.001) keloid sites were significantly associated to a higher risk of recurrence. CONCLUSIONS The findings support the use of surgery and POIRT as an effective strategy for controlling keloid relapses. Further studies should focus on determining the optimal Biologically Effective Dose and on establishing a scoring system for patient selection.
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Affiliation(s)
- Jessica Franzetti
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Via Ripamonti, 435, 20141, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20122, Milan, Italy
| | - Stefano Durante
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Via Ripamonti, 435, 20141, Milan, Italy
| | - Federico Mastroleo
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Via Ripamonti, 435, 20141, Milan, Italy.
- Department of Translational Medicine, University of Piemonte Orientale (UPO), 28100, Novara, Italy.
| | - Stefania Volpe
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Via Ripamonti, 435, 20141, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20122, Milan, Italy
| | - Francesca De Lorenzi
- Department of Plastic and Reconstructive Surgery, European Institute of Oncology, IRCCS, Via Ripamonti, 435, 20141, Milan, Italy
| | - Marco Rotondi
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Via Ripamonti, 435, 20141, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20122, Milan, Italy
| | - Chiara Lorubbio
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Via Ripamonti, 435, 20141, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20122, Milan, Italy
| | - Angelo Vitullo
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Via Ripamonti, 435, 20141, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20122, Milan, Italy
| | - Samuele Frassoni
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - Vincenzo Bagnardi
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - Raffaella Cambria
- Unit of Medical Physics, European Institute of Oncology IRCCS, Milan, Italy
| | - Federica Cattani
- Unit of Medical Physics, European Institute of Oncology IRCCS, Milan, Italy
| | - Andrea Vavassori
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Via Ripamonti, 435, 20141, Milan, Italy
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Via Ripamonti, 435, 20141, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20122, Milan, Italy
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Liu AH, Sun XL, Liu DZ, Xu F, Feng SJ, Zhang SY, Li LZ, Zhou JL, Wang YT, Zhang L, Lin X, Gao SB, Yue X, Liu XM, Jin GH, Xu B. Epidemiological and clinical features of hypertrophic scar and keloid in Chinese college students: A university-based cross-sectional survey. Heliyon 2023; 9:e15345. [PMID: 37123979 PMCID: PMC10130857 DOI: 10.1016/j.heliyon.2023.e15345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 04/03/2023] [Accepted: 04/04/2023] [Indexed: 04/08/2023] Open
Abstract
Background Hypertrophic scar (HS) and keloid (KD) are common dermal fibroproliferative growth caused by pathological wound healing. HS's prevalence is currently undetermined in China. Though it primarily occurs in dark-skinned individuals, KD can develop in all races, and its prevalence among Chinese people is poorly documented. Objective To explore the present epidemiological status of them in Chinese college students. Methods We conducted a university-based cross-sectional study at one university in Fujian, China. A total of 1785 participants aged 16-34 years (mean age, 20.0 ± 2.0; 58.7% female) were enrolled and statistical analyses were performed. Results HS and KD were observed in 5.2% (95% confidence interval [CI]: 4.2-6.2) and 0.6% (95% CI: 0.3-1.0) of the population respectively. There was a significant difference by sex in HS (P < 0.05), but not in KD. The prevalence of HS and KD both showed a significant difference by age (P < 0.05), but not in ethnic and native place distribution. The occurrence of HS and KD were both concentrated in individuals 9-20 years old (HS: 77.2%; KD: 81.8%). They were mainly distributed in the upper limbs (52.1%; 64.3%), and the main cause was trauma (51.0%; 35.7%). In addition, male sex was a risk factor for HS (adjusted P < 0.001), and KD was associated with age ≥22 years and family history (adjusted P < 0.050). Conclusion HS and KD are common in Chinese college students, and more attention and research is warranted.
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Zhang W, Li X, Li X. Efficacy and Safety of Verapamil Versus Triamcinolone Acetonide in Treating Keloids and Hypertrophic Scars: A Systematic Review and Meta-Analysis. Aesthetic Plast Surg 2023; 47:473-482. [PMID: 36562775 DOI: 10.1007/s00266-022-03229-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 12/11/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Keloids and hypertrophic scars can affect the appearance and normal function of patients, and may severely affect patients' physical and mental health. Many methods have been used for the treatment of keloids and hypertrophic scars, there is no standardized method so far. The aim of this study was to compare the efficacy and safety of verapamil and triamcinolone acetonide (TAC) in treating keloids and hypertrophic scars. METHODS All studies from their inception date up to August 2022 were searched using four databases (PubMed, Cochrane Library, MEDLINE, and EMBASE). The weighted mean differences and the risk ratio were calculated for comparing continuous variables and dichotomous variables, respectively. RESULTS A total of nine randomized controlled trials involving 567 patients were identified. This meta-analysis indicated that TAC group showed significantly better effects compared with verapamil group in the reduction of height at 3 and 9 weeks, pliability at 3, 9, and 18 weeks, vascularity at 3, 6, 9, 12, 18, and 24 weeks, whereas verapamil group showed significantly better effects compared with TAC group in the reduction of pliability at 21 and 24 weeks. Verapamil group showed a significantly lower incidence of skin atrophy, telangiectasia, and hypopigmentation compared with TAC group. However, the incidence of burning sensation in verapamil group was higher than that in TAC group. CONCLUSION Concerning the treatment of keloids and hypertrophic scars, TAC was more effective than verapamil for improving vascularity; TAC was superior to verapamil in improving height within 9 weeks of treatment; TAC produced superior result for improving pliability within 18 weeks of treatment, whereas verapamil produced superior result between 18 and 24 weeks of treatment. Verapamil had fewer adverse events than TAC and can be used as a safer alternative for the treatment of keloids and hypertrophic scars. LEVEL OF EVIDENCE II This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Wei Zhang
- Department of Plastic Surgery, The First Affiliated Hospital of Anhui Medical University, 218# Ji-Xi Road, Hefei, 230022, Anhui, China
| | - Xiaojing Li
- Department of Plastic Surgery, The First Affiliated Hospital of Anhui Medical University, 218# Ji-Xi Road, Hefei, 230022, Anhui, China
| | - Xinyi Li
- Department of Plastic Surgery, The First Affiliated Hospital of Anhui Medical University, 218# Ji-Xi Road, Hefei, 230022, Anhui, China.
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He X, Lee B, Jiang Y. Extracellular matrix in cancer progression and therapy. MEDICAL REVIEW (2021) 2022; 2:125-139. [PMID: 37724245 PMCID: PMC10471113 DOI: 10.1515/mr-2021-0028] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 03/31/2022] [Indexed: 09/20/2023]
Abstract
The tumor ecosystem with heterogeneous cellular compositions and the tumor microenvironment has increasingly become the focus of cancer research in recent years. The extracellular matrix (ECM), the major component of the tumor microenvironment, and its interactions with the tumor cells and stromal cells have also enjoyed tremendously increased attention. Like the other components of the tumor microenvironment, the ECM in solid tumors differs significantly from that in normal organs and tissues. We review recent studies of the complex roles the tumor ECM plays in cancer progression, from tumor initiation, growth to angiogenesis and invasion. We highlight that the biomolecular, biophysical, and mechanochemical interactions between the ECM and cells not only regulate the steps of cancer progression, but also affect the efficacy of systemic cancer treatment. We further discuss the strategies to target and modify the tumor ECM to improve cancer therapy.
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Affiliation(s)
- Xiuxiu He
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Byoungkoo Lee
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, USA
| | - Yi Jiang
- Department of Mathematics and Statistics, Georgia State University, Atlanta, GA, USA
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Barone N, Safran T, Vorstenbosch J, Davison PG, Cugno S, Murphy AM. Current Advances in Hypertrophic Scar and Keloid Management. Semin Plast Surg 2021; 35:145-152. [PMID: 34526861 PMCID: PMC8432993 DOI: 10.1055/s-0041-1731461] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Hypertrophic scars and keloids are caused by excessive tissue response to dermal injury due to local fibroblast proliferation and collagen overproduction. This response occurs because of pathologic wound healing due to dysregulation in the inflammatory, proliferative, and/or remodeling phase. Patients with hypertrophic scars or keloids report reduced quality of life, physical status, and psychological health. Hypertrophic scars or keloids will develop in 30 to 90% of individuals, and despite their prevalence, treatment remains a challenge. Of the treatments currently available for hypertrophic scars and keloids few have been adequately supported by studies with appropriate experimental design. Here, we aim to review the available literature to provide up-to-date information on the etiology, epidemiology, histology, pathophysiology, prevention, and management options available for the treatment of hypertrophic scars and keloids and highlight areas where further research is required.
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Affiliation(s)
- Natasha Barone
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Tyler Safran
- Division of Plastic and Reconstructive Surgery, McGill University Health Centre, Montreal, Canada
| | - Joshua Vorstenbosch
- Division of Plastic and Reconstructive Surgery, McGill University Health Centre, Montreal, Canada
| | - Peter G. Davison
- Division of Plastic and Reconstructive Surgery, McGill University Health Centre, Montreal, Canada
| | - Sabrina Cugno
- Division of Plastic and Reconstructive Surgery, McGill University Health Centre, Montreal, Canada
| | - Amanda M. Murphy
- Division of Plastic and Reconstructive Surgery, McGill University Health Centre, Montreal, Canada
- Division of Plastic and Reconstructive Surgery, Jewish General Hospital, Montreal, Canada
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Mascharak S, desJardins-Park HE, Longaker MT. Fibroblast Heterogeneity in Wound Healing: Hurdles to Clinical Translation. Trends Mol Med 2020; 26:1101-1106. [PMID: 32800679 DOI: 10.1016/j.molmed.2020.07.008] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/06/2020] [Accepted: 07/10/2020] [Indexed: 12/21/2022]
Abstract
Recent work has revealed that fibroblasts are remarkably heterogeneous cells, but the appropriate lens through which to study this variation (lineage, phenotype, and plasticity) and its relevance to human biology remain unclear. In this opinion article, we comment on recent breakthroughs in our understanding of fibroblast heterogeneity during skin wound healing, and on open questions that must be addressed to clinically translate these findings in order to minimize scarring in patients. We emphasize the need for experimental models of wound healing that better approximate human biology, as well as comparison of scarring and regenerative phenotypes to uncover master regulators of fibrosis.
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Affiliation(s)
- Shamik Mascharak
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA; Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Heather E desJardins-Park
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA; Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Michael T Longaker
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA; Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA.
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Nonsurgical Management of Hypertrophic Scars: Evidence-Based Therapies, Standard Practices, and Emerging Methods. Aesthetic Plast Surg 2020; 44:1320-1344. [PMID: 32766921 DOI: 10.1007/s00266-020-01820-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2006] [Accepted: 01/05/2007] [Indexed: 12/12/2022]
Abstract
Hypertrophic scars, resulting from alterations in the normal processes of cutaneous wound healing, are characterized by proliferation of dermal tissue with excessive deposition of fibroblast-derived extracellular matrix proteins, especially collagen, over long periods, and by persistent inflammation and fibrosis. Hypertrophic scars are among the most common and frustrating problems after injury. As current aesthetic surgical techniques become more standardized and results more predictable, a fine scar may be the demarcating line between acceptable and unacceptable aesthetic results. However, hypertrophic scars remain notoriously difficult to eradicate because of the high recurrence rates and the incidence of side effects associated with available treatment methods. This review explores the various treatment methods for hypertrophic scarring described in the literature including evidence-based therapies, standard practices, and emerging methods, attempting to distinguish those with clearly proven efficiency from anecdotal reports about therapies of doubtful benefits while trying to differentiate between prophylactic measures and actual treatment methods. Unfortunately, the distinction between hypertrophic scar treatments and keloid treatments is not obvious in most reports, making it difficult to assess the efficacy of hypertrophic scar treatment.
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Bao Y, Xu S, Pan Z, Deng J, Li X, Pan F, Li X. Comparative Efficacy and Safety of Common Therapies in Keloids and Hypertrophic Scars: A Systematic Review and Meta-analysis. Aesthetic Plast Surg 2020; 44:207-218. [PMID: 31637502 DOI: 10.1007/s00266-019-01518-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 10/05/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES At present, there are many therapies for treating keloids and hypertrophic scars, but there is still a lack of treatments that are relatively balanced in efficacy and safety. The study aims to evaluate comprehensively efficacy and safety of common therapies in keloids and hypertrophic scars. METHODS The literature search was conducted up to May 2019. The traditional meta-analysis was performed on 17 therapies. Bayesian network meta-analysis was conducted on the four most common treatments. The outcome indicators were the numbers of patients with good-to-excellent effect, Vancouver Scar Scale (VSS) and adverse events. RESULTS There was no significant difference in the efficacy of triamcinolone acetonide (TAC) compared with other monotherapies except for silicone gel sheet and neodymium-yttrium-aluminum-garnet in primary indicator. The combination therapies were superior to TAC, and the results were consistent after the pooled analysis (RR = 0.522, 95% CI 0.332-0.823). The level of VSS in TAC group was higher than that in 5-flurouracil (5-FU) and TAC + 5-FU group, but lower than that in verapamil (VER) group. And the patients treated with TAC were less safe than those treated with verapamil (P = 0.013). Surface under cumulative ranking ranked verapamil and TAC + 5-FU as the favorable efficacy therapies in terms of primary indicator and ranked TAC + 5-FU as the best therapy for VSS, while VER was ranked as the worst. CONCLUSION This meta-analysis showed that TAC + 5-FU may be the most effective therapy, while verapamil may be a better therapeutic strategy for safety. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Tawfik AA, Fathy M, Badawi A, Abdallah N, Shokeir H. Topical 5 fluorouracil cream vs combined 5 fluorouracil and fractional erbium YAG laser for treatment of severe hypertrophic scars. Clin Cosmet Investig Dermatol 2019; 12:173-180. [PMID: 30936735 PMCID: PMC6421878 DOI: 10.2147/ccid.s191137] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Topical 5 fluorouracil (5-FU) has been reported as one of the standard treatments for hypertrophic scars (HTS). Ablative fractional laser was found to have promising results in the delivery of topical drugs into the skin by creating vertical channels through which the drugs can penetrate the skin. So far there have been no comparative studies performed to compare both modalities in the same patient and same anatomical region, especially in severe HTS. Objective The aim of this study was to compare the effectiveness of topical 5-FU and combined topical 5-FU and laser in treating severe HTS. Patients and methods Twenty-four severe HTS lesions were treated by 5-FU monotherapy and 5-FU combined with ablative fractional erbium YAG laser. Each lesion was divided into two parts. One part was treated with topical 5-FU twice weekly for 8 months. The other part was treated with combined topical 5-FU and ablative fractional erbium YAG laser once per month for 8 months. The scars’ improvement was evaluated by Vancouver scar scale (VSS) and skin analysis camera. Results The assessment by VSS showed a significant reduction in the mean height, pliability, and vascularity of the lesions which were treated with combined approaches compared to 5-FU monotherapy. Pain and ulceration occurred at a higher rate in the combination therapy group. Conclusion Treatment of severe HTS with combined 5-FU and ablative fractional erbium YAG laser is more effective than 5-FU alone.
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Affiliation(s)
- Abeer Attia Tawfik
- Dermatology Unit, Department of Medical Applications of Lasers (MAL), National Institute of Laser Enhanced Sciences, Cairo University, Giza, Egypt,
| | - Maha Fathy
- Al-Houd Al Marsoud Hospital, Cairo, Egypt,
| | - Ashraf Badawi
- Dermatology Unit, Department of Medical Applications of Lasers (MAL), National Institute of Laser Enhanced Sciences, Cairo University, Giza, Egypt, .,Dermatology and Allergology Department, University of Szeged, Szeged, Hungary
| | - Noha Abdallah
- Dermatology Unit, Department of Medical Applications of Lasers (MAL), National Institute of Laser Enhanced Sciences, Cairo University, Giza, Egypt,
| | - Hisham Shokeir
- Dermatology Unit, Department of Medical Applications of Lasers (MAL), National Institute of Laser Enhanced Sciences, Cairo University, Giza, Egypt,
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Ogawa R. Keloid and Hypertrophic Scars Are the Result of Chronic Inflammation in the Reticular Dermis. Int J Mol Sci 2017; 18:ijms18030606. [PMID: 28287424 PMCID: PMC5372622 DOI: 10.3390/ijms18030606] [Citation(s) in RCA: 455] [Impact Index Per Article: 65.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Revised: 02/23/2017] [Accepted: 03/06/2017] [Indexed: 01/08/2023] Open
Abstract
Keloids and hypertrophic scars are caused by cutaneous injury and irritation, including trauma, insect bite, burn, surgery, vaccination, skin piercing, acne, folliculitis, chicken pox, and herpes zoster infection. Notably, superficial injuries that do not reach the reticular dermis never cause keloidal and hypertrophic scarring. This suggests that these pathological scars are due to injury to this skin layer and the subsequent aberrant wound healing therein. The latter is characterized by continuous and histologically localized inflammation. As a result, the reticular layer of keloids and hypertrophic scars contains inflammatory cells, increased numbers of fibroblasts, newly formed blood vessels, and collagen deposits. Moreover, proinflammatory factors, such as interleukin (IL)-1α, IL-1β, IL-6, and tumor necrosis factor-α are upregulated in keloid tissues, which suggests that, in patients with keloids, proinflammatory genes in the skin are sensitive to trauma. This may promote chronic inflammation, which in turn may cause the invasive growth of keloids. In addition, the upregulation of proinflammatory factors in pathological scars suggests that, rather than being skin tumors, keloids and hypertrophic scars are inflammatory disorders of skin, specifically inflammatory disorders of the reticular dermis. Various external and internal post-wounding stimuli may promote reticular inflammation. The nature of these stimuli most likely shapes the characteristics, quantity, and course of keloids and hypertrophic scars. Specifically, it is likely that the intensity, frequency, and duration of these stimuli determine how quickly the scars appear, the direction and speed of growth, and the intensity of symptoms. These proinflammatory stimuli include a variety of local, systemic, and genetic factors. These observations together suggest that the clinical differences between keloids and hypertrophic scars merely reflect differences in the intensity, frequency, and duration of the inflammation of the reticular dermis. At present, physicians cannot (or at least find it very difficult to) control systemic and genetic risk factors of keloids and hypertrophic scars. However, they can use a number of treatment modalities that all, interestingly, act by reducing inflammation. They include corticosteroid injection/tape/ointment, radiotherapy, cryotherapy, compression therapy, stabilization therapy, 5-fluorouracil (5-FU) therapy, and surgical methods that reduce skin tension.
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Affiliation(s)
- Rei Ogawa
- Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School Hospital, Tokyo 113-8603, Japan.
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Ogawa R, Akaishi S. Endothelial dysfunction may play a key role in keloid and hypertrophic scar pathogenesis – Keloids and hypertrophic scars may be vascular disorders. Med Hypotheses 2016; 96:51-60. [DOI: 10.1016/j.mehy.2016.09.024] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 08/26/2016] [Accepted: 09/27/2016] [Indexed: 11/17/2022]
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Żądkowski T, Nachulewicz P, Mazgaj M, Woźniak M, Cielecki C, Wieczorek AP, Beń-Skowronek I. A new CO2 laser technique for the treatment of pediatric hypertrophic burn scars: An observational study. Medicine (Baltimore) 2016; 95:e5168. [PMID: 27759650 PMCID: PMC5079334 DOI: 10.1097/md.0000000000005168] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Treatment of hypertrophic scars arising as a result of thermal burns in children is still a big problem. The results of the treatment are not satisfactory for patients and parents, and new methods of treatment are still investigated.We present the use of one of the most modern carbon dioxide (CO2) lasers (Lumenis Encore laser equipped with a Synergistic Coagulation and Ablation for Advanced Resurfacing module) in the treatment of hypertrophic scars in children after burns.From March to April of 2013, a group of 47 patients aged 6 to 16 years underwent 57 laser surgery treatments. The average time from accident was 7.5 years. The results of treatment were investigated in 114 areas. The assessed areas were divided into 2 groups: 9-cm area 1, where the thickness of the scar measured by physician was the lowest and 9-cm area 2, where the thickness of the scar was the biggest. The results were considered on the Vancouver Scar Scale (VSS) independently by the surgeon and by parents 1, 4, and 8 months after the procedure. In addition, ultrasound evaluation of the scar thickness before and after laser procedure was made.VSS total score improved in all areas assessed by both the physician and parents. The biggest change in total VSS score in area 1 in the evaluation of the investigator was obtained at follow-up after the 1st month of treatment (average 7.23 points before and 5.18 points after the 1st month after surgery-a difference of 2.05 points). Scar ratings by parents and the physician did not differ statistically (P < 0.05). In the ultrasound assessment, the improvement was statistically significant, more frequently for both minimum and maximum thickness of the scars (B-mode measures) (P < 0.05).The use of a CO2 laser in the treatment of hypertrophic scars in children is an effective and safe method. The use of a CO2 laser improves the appearance and morphology of scarring assessed using the VSS by both the parents and the physician. The treatment also reduced the thickness of scars evaluated by ultrasound.
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Affiliation(s)
- Tomasz Żądkowski
- Department of Paediatric Surgery
- Correspondence: Tomasz Żądkowski, Medical University of Poland, Lublin, Poland (e-mail: )
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Ren Y, Zhou X, Wei Z, Lin W, Fan B, Feng S. Efficacy and safety of triamcinolone acetonide alone and in combination with 5-fluorouracil for treating hypertrophic scars and keloids: a systematic review and meta-analysis. Int Wound J 2016; 14:480-487. [PMID: 27427423 DOI: 10.1111/iwj.12629] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 06/10/2016] [Indexed: 12/23/2022] Open
Abstract
Pathological scars, such as keloids and hypertrophic scars, readily cause physical and psychological problems. Combination 5-fluorouracil (5-FU) with triamcinolone acetonide (TAC) is presumed to enhance the treatment of pathological scars, although supportive evidence is lacking. We aimed to compare the efficacy and safety of TAC alone and in combination with 5-FU for the treatment of hypertrophic scars and keloids. Five databases (PubMed, Medline, Cochrane databases, Embase and CNKI) were searched with the limitations of human subjects and English-language text. Mean differences (MDs), odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. The Cochrane Collaboration's Risk of Bias Tool was used to assess the risk of bias. The control group received intralesional TAC alone, and the experimental group received TAC combined with 5-FU injection. A pooled analysis of the effectiveness based on patient self-assessment after treatment showed that the experimental group achieved better results than the control group (OR = 2·92, 95% CI = 1·63-5·22, P = 0·0003). Similarly, a pooled analysis of the effectiveness based on observer assessment following treatment produced the same conclusion (OR = 4·03, 95% CI = 1·40-11·61, P = 0·010). A meta-analysis of scar height after treatment showed that the experimental group performed better than the control group (MD = -0·14, 95% CI = -0·23-0·05, P = 0·002). The erythema score of the experimental group after treatment was superior (MD = -0·20, 95% CI = -0·34-0·06, P = 0·004). The heterogeneity test showed no heterogeneity among the studies (P > 0·1, I2 = 0%). TAC combined with 5-FU is more suitable for the treatment and prevention of hypertrophic scars and keloids, with greater improvement in scar height and patient satisfaction as well as fewer side effects.
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Affiliation(s)
- YiMing Ren
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, China
| | - XianHu Zhou
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, China
| | - ZhiJian Wei
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, China
| | - Wei Lin
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, China
| | - BaoYou Fan
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, China
| | - ShiQing Feng
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, China
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Walliczek U, Engel S, Weiss C, Aderhold C, Lippert C, Wenzel A, Hörmann K, Schultz JD. Clinical Outcome and Quality of Life After a Multimodal Therapy Approach to Ear Keloids. JAMA FACIAL PLAST SU 2015; 17:333-9. [DOI: 10.1001/jamafacial.2015.0881] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Ute Walliczek
- Department of Otorhinolaryngology–Head and Neck Surgery, University Hospital of Marburg, University of Giessen, Marburg, Germany
- Department of Otorhinolaryngology–Head and Neck Surgery, University Hospital of Mannheim, University of Heidelberg, Mannheim, Germany
| | - Stephan Engel
- Department of Otorhinolaryngology–Head and Neck Surgery, University Hospital of Mannheim, University of Heidelberg, Mannheim, Germany
| | - Christel Weiss
- Department of Medical Statistics and Biomathematics, University of Heidelberg, Mannheim, Germany
| | - Christoph Aderhold
- Department of Otorhinolaryngology–Head and Neck Surgery, University Hospital of Mannheim, University of Heidelberg, Mannheim, Germany
| | - Christiane Lippert
- Department of Pathology, University Hospital of Mannheim, University of Heidelberg, Mannheim, Germany
| | - Angela Wenzel
- Department of Otorhinolaryngology–Head and Neck Surgery, University Hospital of Mannheim, University of Heidelberg, Mannheim, Germany
| | - Karl Hörmann
- Department of Otorhinolaryngology–Head and Neck Surgery, University Hospital of Mannheim, University of Heidelberg, Mannheim, Germany
| | - Johannes David Schultz
- Department of Otorhinolaryngology–Head and Neck Surgery, University Hospital of Mannheim, University of Heidelberg, Mannheim, Germany
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Wang R, Mao Y, Zhang Z, Li Z, Chen J, Cen Y. Role of verapamil in preventing and treating hypertrophic scars and keloids. Int Wound J 2015; 13:461-8. [PMID: 25968157 DOI: 10.1111/iwj.12455] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 03/30/2015] [Accepted: 04/07/2015] [Indexed: 02/05/2023] Open
Abstract
Keloid and hypertrophic scars are difficult to manage and remain a therapeutic challenge. Verapamil has shown a great potential in the management of keloid and hypertrophic scars. Comparing with conventional corticosteroid injections, verapamil could improve the appearance of keloid and hypertrophic scars, and is associated with a lower incidence of adverse effects. Is verapamil an effective alternative modality in the prevention and treatment of keloid and hypertrophic scars? The aim of this study was to assess the effectiveness of verapamil in preventing and treating keloid and hypertrophic scars. Searches were conducted in Medline, EMbase and Cochrane databases from 1974 to January 2015. The selection of articles was limited to human subjects. Five randomised controlled trials (RCTs) or cluster-randomised trials or controlled clinical trials (CCTs) comparing the efficacy of verapamil with conventional treatments were identified. The results showed that verapamil could improve keloid and hypertrophic scars, and was not significantly different from conventional corticosteroid injections. Few adverse effects were observed. However, this result should be considered carefully, as most of the included studies have a high risk of bias because of issues with randomization, allocation concealment, blinding, incomplete outcomes and selective reporting. In conclusion, verapamil could act as an effective alternative modality in the prevention and treatment of keloid and hypertrophic scars. More high-quality, multiple-centre, large-sample (RCTs) are required to define the role of verapamil in preventing and treating keloid and hypertrophic scars.
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Affiliation(s)
- Ru Wang
- Department of Burn and Plastic Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Yu Mao
- Pediatric Department, The People's Hospital of Sichuan Province, Chengdu, China
| | - Zhenyu Zhang
- Department of Burn and Plastic Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Zhengyong Li
- Department of Burn and Plastic Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Junjie Chen
- Department of Burn and Plastic Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Ying Cen
- Department of Burn and Plastic Surgery, West China Hospital of Sichuan University, Chengdu, China
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Xue M, Jackson CJ. Extracellular Matrix Reorganization During Wound Healing and Its Impact on Abnormal Scarring. Adv Wound Care (New Rochelle) 2015; 4:119-136. [PMID: 25785236 DOI: 10.1089/wound.2013.0485] [Citation(s) in RCA: 776] [Impact Index Per Article: 86.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Indexed: 12/18/2022] Open
Abstract
Significance: When a cutaneous injury occurs, the wound heals via a dynamic series of physiological events, including coagulation, granulation tissue formation, re-epithelialization, and extracellular matrix (ECM) remodeling. The final stage can take many months, yet the new ECM forms a scar that never achieves the flexibility or strength of the original tissue. In certain circumstances, the normal scar is replaced by pathological fibrotic tissue, which results in hypertrophic or keloid scars. These scars cause significant morbidity through physical dysfunction and psychological stress. Recent Advances and Critical Issues: The cutaneous ECM comprises a complex assortment of proteins that was traditionally thought to simply provide structural integrity and scaffolding characteristics. However, recent findings show that the ECM has multiple functions, including, storage and delivery of growth factors and cytokines, tissue repair and various physiological functions. Abnormal ECM reconstruction during wound healing contributes to the formation of hypertrophic and keloid scars. Whereas adult wounds heal with scarring, the developing foetus has the ability to heal wounds in a scarless fashion by regenerating skin and restoring the normal ECM architecture, strength, and function. Recent studies show that the lack of inflammation in fetal wounds contributes to this perfect healing. Future Directions: Better understanding of the exact roles of ECM components in scarring will allow us to produce therapeutic agents to prevent hypertrophic and keloid scars. This review will focus on the components of the ECM and their role in both physiological and pathological (hypertrophic and keloid) cutaneous scar formation.
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Affiliation(s)
- Meilang Xue
- Sutton Research Laboratories, Institute of Bone and Joint Research, Kolling Institute of Medical Research, The University of Sydney at Royal North Shore Hospital, St. Leonards, Australia
| | - Christopher J. Jackson
- Sutton Research Laboratories, Institute of Bone and Joint Research, Kolling Institute of Medical Research, The University of Sydney at Royal North Shore Hospital, St. Leonards, Australia
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Riedel M, Brinckmann J, Steffen A, Nitsch S, Wollenberg B, Frenzel H. Influence of silicone gel on standardized postoperative scars. J Dtsch Dermatol Ges 2013; 11:412-9. [PMID: 23384111 DOI: 10.1111/ddg.12011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Accepted: 11/06/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND Silicone gel is one therapeutic approach in the treatment and prevention of excessive scarring. The likely mechanism of action is the hydration of the tissue. This should lead to reduced angiogenesis and capillary blood flow. The efficacy is still controversial and the evidence base, insufficient. The aim of this prospective and standardized study is to investigate silicone gel in the preventive treatment of scars. PATIENTS AND METHODS Included in the study were 20 patients with costal cartilage harvest. Half of a standard chest scar was treated for three months with a silicone gel. The other half served as an internal control. After three months both scar sides were compared subjectively by visual analog scale and objectively by elasticity, moisture and color measurements. RESULTS Of 19 patients 8 had a better subjective result in the treated half. In one subject, no difference was seen. A worse subjective result in the treated half was seen in 10 out of 19. The objective measurements showed no significant difference. A correlation between the different results was not seen. CONCLUSIONS The use of silicone gel caused subjective differences within the same scar (worsening as well as improvement of the appearance). Positive effects were not detectable in the investigated parameters.
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Affiliation(s)
- Mareen Riedel
- Department of General Surgery, Sana Clinics Eastern Holstein, Clinic Eutin, Germany
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Gauglitz G, Kunte C. Empfehlungen zur Prävention und Therapie hypertropher Narben und Keloide. Hautarzt 2011; 62:337-46. [DOI: 10.1007/s00105-010-2087-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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A review of the effectiveness of antimitotic drug injections for hypertrophic scars and keloids. Ann Plast Surg 2010; 63:688-92. [PMID: 19887927 DOI: 10.1097/sap.0b013e3181978753] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Hypertrophic scars and keloids are common problems after injury and cause functional and cosmetic deformities. A wide variety of treatments have been advocated for hypertrophic scars and keloids regression. Unfortunately, the reported efficacy has been variable. This article explores antimitotic drugs described in the literature such as steroid injection, 5-FU, mitomycin C, and bleomycin, which mainly target the fibroblasts in scar tissue, have been proposed as the effective modalities for scar treatment and scar prevention after surgery, but restricted due to possible side effects. The current accepted treatment for hypertrophic scar and keloid are combination therapy and the early treatment which could achieve better efficacy and less adverse effect.
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Prevention and management of hypertrophic scars and keloids after burns in children. J Craniofac Surg 2008; 19:989-1006. [PMID: 18650721 DOI: 10.1097/scs.0b013e318175f3a7] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Hypertrophic scars and keloids are challenging to manage, particularly as sequelae of burns in children in whom the psychologic burden and skin characteristics differ substantially from adults. Prevention of hypertrophic scars and keloids after burns is currently the best strategy in their management to avoid permanent functional and aesthetical alterations. Several actions can be taken to prevent their occurrence, including parental and children education regarding handling sources of fire and flammable materials, among others. Combination of therapies is the mainstay of current burn scar management, including surgical reconstruction, pressure therapy, silicon gels and sheets, and temporary garments. Other adjuvant therapies such as topical imiquimod, tacrolimus, and retinoids, as well as intralesional corticosteroids, 5-fluorouracil, interferons, and bleomycin, have been used with relative success. Cryosurgery and lasers have also been reported as alternatives. Newer treatments aimed at molecular targets such as cytokines, growth factors, and gene therapy, currently in developing stages, are considered the future of the treatment of postburn hypertrophic scars and keloids in children.
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Atiyeh BS. Nonsurgical management of hypertrophic scars: evidence-based therapies, standard practices, and emerging methods. Aesthetic Plast Surg 2007; 31:468-92; discussion 493-4. [PMID: 17576505 DOI: 10.1007/s00266-006-0253-y] [Citation(s) in RCA: 166] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2006] [Accepted: 01/05/2007] [Indexed: 01/10/2023]
Abstract
Hypertrophic scars, resulting from alterations in the normal processes of cutaneous wound healing, are characterized by proliferation of dermal tissue with excessive deposition of fibroblast-derived extracellular matrix proteins, especially collagen, over long periods, and by persistent inflammation and fibrosis. Hypertrophic scars are among the most common and frustrating problems after injury. As current aesthetic surgical techniques become more standardized and results more predictable, a fine scar may be the demarcating line between acceptable and unacceptable aesthetic results. However, hypertrophic scars remain notoriously difficult to eradicate because of the high recurrence rates and the incidence of side effects associated with available treatment methods. This review explores the various treatment methods for hypertrophic scarring described in the literature including evidence-based therapies, standard practices, and emerging methods, attempting to distinguish those with clearly proven efficiency from anecdotal reports about therapies of doubtful benefits while trying to differentiate between prophylactic measures and actual treatment methods. Unfortunately, the distinction between hypertrophic scar treatments and keloid treatments is not obvious in most reports, making it difficult to assess the efficacy of hypertrophic scar treatment.
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Affiliation(s)
- Bishara S Atiyeh
- Division Plastic and Reconstructive Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
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