Hypertrophic Scars and Keloids: Advances in Treatment and Review of Established Therapies

Dioscin improves hypertrophic scars by inducing apoptosis and ferroptosis of scar fibroblasts through mitochondrial oxidative stress damage

Hypertrophic scar (HS) is a common fibrotic disease primarily caused by excessive activation and proliferation of fibroblasts. Dioscin, a steroidal saponin isolated from the roots of Dioscorea plants, has been shown to be effective in the management of metabolic disorders, regulation of inflammation, and inhibition of tumor growth. This study investigates the inhibitory effects of Dioscin on the proliferation and functionality of human scar fibroblasts (HSFs) and its therapeutic potential for HS, as well as the underlying mechanisms involved. The impact of Dioscin on collagen secretion and HSFs activation was assessed using Reverse transcription real-time quantitative polymerase chain reaction (RT-qPCR) and Western blot (WB). HSFs functionality was evaluated through EdU proliferation, wound healing, transwell migration, and contracture assays. RNA sequencing revealed that Dioscin triggers HSFs apoptosis and ferroptosis by compromising mitochondrial membrane potential. Immunofluorescence and WB were employed to examine the mechanisms of Dioscin-induced apoptosis and ferroptosis. The therapeutic efficacy of Dioscin was further assessed in vivo using a rabbit ear scar model. Results show that Dioscin suppresses HSFs proliferation, migration, and contraction, reduces collagen secretion, and deactivates HSFs by destabilizing mitochondrial membrane potential, leading to ROS accumulation. Local administration of Dioscin significantly mitigates scar formation in rabbit ears. In conclusion, Dioscin reduces HS progression by disrupting mitochondrial membrane potential, inducing oxidative stress, and promoting apoptosis and ferroptosis in HSFs, highlighting its potential as a therapeutic agent for HS.

Circadian Gene NPAS2 Relieves Hypertrophic Scar Formation via CDC25A-Mediated Fibroblasts Activity

Neuronal PAS domain protein 2 (NPAS2) is critical in tissue fibrosis. Hypertrophic scars (HTS), a form of skin fibrosis, are characterised by excessive myofibroblast proliferation and abnormal extracellular matrix (ECM) deposition. However, whether NPAS2 contributes to skin fibrosis and the development of HTS remains unclear. In this study, the expression of NPAS2 between normal skin and hypertrophic scars (HTS) was assessed using RT-qPCR and immunohistochemistry (IHC). Human dermal fibroblasts (HDFs) and HTS-derived fibroblasts (HTS-Fs) were isolated from normal skin and HTS, respectively. NPAS2 was knocked down in HTS-Fs and overexpressed in HDFs via gene transfection. Cell proliferation and migration of transfected HTS-Fs and HDFs were analysed using flow cytometry, CCK-8 and transwell assays. The expressions of NPAS2, CLOCK, BMAL1, COL I, COL III, α-SMA and CDC25A were evaluated by western blotting and RT-qPCR. Dual-luciferase reporter assays and chromatin immunoprecipitation (ChIP) identified the regulatory effect of NPAS2 on CDC25A. In vivo, an 8 × 8 mm full-thickness skin defect was created on the tail of SD rats, with viral particles (1 × 107) of r-plenR-sh-NPAS2 or r-plenR-NPAS2-NC injected subcutaneously at the wound edges weekly. Tissue samples, histopathological analyses and photographs were taken until the wound healed completely. The results indicated that NPAS2 was significantly upregulated in HTS. The proliferation, migration, and expression of COL I, COL III, and α-SMA were higher in HDFs overexpressing NPAS2 than those of HDFs themselves. In contrast, the behaviours mentioned above of HTS-Fs knocking down NPAS2 were lower than that of HTS-Fs. Mechanistically, the migration and proliferation promoting effect of NPAS2 was mediated by the binding of NPAS2 to the E-like-box of CDC25A. In vivo, compared with the r-plenR-NPAS2-NC group, the re-epithelialised regions of r-plenR-sh-NPAS2 were pink, flat and as large as the initial wound. In addition, their dermal structures were similar to skin and possessed loose and regular collagen arrangement which was parallel to the epidermis. Take together, these findings suggested that compared with HDFs, NPAS2 was upregulated in HTS-Fs. NPAS2 promoted the activation of HDFs, which is characterised by stronger proliferation and migration and the higher level of α-SMA, COL I and COL III. In which, the proliferation and migration effects of NPAS2 were mediated by CDC25A. Furthermore, NPAS2 knocked down in rat tail wounds inhibited the HTS formation. Therefore, NPAS2 may serve as a potential therapeutic target for HTS in the future.

Combining Steroid Plus 5-Fluorouracil Injection with Radiotherapy Versus Injection Alone for Keloids: A 4-Year Retrospective Study

BACKGROUND

Keloid management has been debated for decades due to unsatisfactory outcomes and high recurrence rates. Intralesional injection and radiotherapy are prominent nonsurgical interventions for keloids. However, monotherapies for keloids usually yield poor efficacy and cause patient burden due to additional treatment sessions and side effects, affecting adherence. The study aimed to evaluate the safety and efficacy of combining intralesional triamcinolone acetonide (TAC) + 5-fluorouracil (5-FU) injection with electron beam radiotherapy or brachytherapy compared to intralesional TAC+5-FU injection alone.

METHODS

We retrospectively reviewed patients who were initially treated between 2019 and 2022 and followed for more than 12 months. The baseline condition, the Vancouver Scar Scale (VSS), recurrence, symptoms, follow-up period, and patient self-assessment were recorded.

RESULTS

The study included a cohort of 100 eligible patients with a total of 111 keloids. Seventy-one of patients received the combined therapy and 29 received TAC+5-FU injection only. The results revealed that combining injection with radiotherapy reduced the recurrence rate and improved symptoms such as pruritus and pain while posing minimal extra risk of side effects. Moreover, patients receiving combined therapy assessed treatment outcomes more positively than those solely receiving injection therapy. Other factors that related to increased risk of recurrence included a higher VSS score at the end of treatment and the presence of keloid family history.

CONCLUSIONS

The combined schedule of intralesional TAC+5-FU injection with radiotherapy could effectively reduce the recurrence rate and alleviate symptoms of keloids.

LEVEL OF EVIDENCE IV

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 .

Orthogonal upconversion supramolecular microneedles promote endogenous ferroptosis in keloids

Background: Keloids represent a type of tumor-like fibroproliferative disease, which can not only cause aesthetic damage but also threaten health. Current therapies often lack precision and efficacy, necessitating minimally invasive and targeted strategies. Methods: This study developed orthogonal upconversion supramolecular microneedles (OUSMNs) integrated with surface-functionalized upconversion nanoparticles (UCNPs) for intelligent keloid therapy. The UCNPs were functionalized by the ferritin homing peptide (HKN15) and a photosensitizer (rose Bengal), which could target keloid fibroblast (KF) and generate singlet oxygen (1O2), thereby inducing endogenous ferroptosis. Mechanistic effects on PI3K-AKT, mTOR, and ferroptosis pathways were analyzed by transcriptome analysis and rescue experiments. Results: The OUSMNs are strong and tough to effectively penetrate the fibroproliferative tissue, and can rapidly dissolve in keloids within 60 s, which makes the UCNPs easy to target the KF by the ferritin-homing peptide HKN15 on the particle surface. The targeting process can be tracked by the red-color upconversion emission under 980 nm laser. On the other hand, upon 808 nm laser irradiation, the UCNPs can lead to the generation of 1O2. The 1O2 not only result in endogenous ferroptosis by destroying the ferritin, but also give rise to synergistic photodynamic therapy that can effectively combat keloids through inhibiting the PI3K-AKT and mTOR pathways while activating the ferroptosis pathway. Conclusions: The proposed OUSMNs promise practical applications for minimally invasive, precise and intelligent keloid therapy.

Exosome-Loaded GelMA Hydrogel as a Cell-Free Therapeutic Strategy for Hypertrophic Scar Inhibition

Purpose

Hypertrophic scar (HS) is a fibrotic proliferative disorder that arises from an abnormal wound healing process. It is a significant clinical challenge, primarily characterized by the excessive accumulation of extracellular matrix (ECM) and abnormal angiogenesis. This study introduces a novel injectable hydrogel system that integrates sustained-release Exosomes for targeted hypertrophic scar modulation. Exosomes (Exos) from adipose-derived stem cells (ASCs) are emerging as promising treatment for hypertrophic scar inhibition. But when treated independently, it must be applied regularly multiple times to maintain its optimal concentration. Gelatin Methacryloyl (GelMA) hydrogel is an ideal biomaterial candidate for engineering skin tissues because of its similarity to ECM, and importantly GelMA hydrogel can maintain drug concentrations via the encapsulation and sustained release of it, which enhances the potential of clinical applications.

Methods

The Exosome-Loaded GelMA Hydrogel (Exos-GelMA) hydrogel was fabricated and characterized for its pore size and biocompatibility. A rabbit ear HS model was established. Three skin defects on each ear were treated with GelMA hydrogel, Exos-GelMA hydrogel, or left untreated as a blank group. The effects of HS inhibition were assessed through Hematoxylin and Eosin (HE) staining, Masson's trichrome staining, and immunohistochemical staining of Collagen I (COL I), Collagen III (COL III), α-smooth muscle actin (α-SMA), as well as immunofluorescence staining of vascular endothelial growth factor (VEGF).

Results

The Exos-GelMA hydrogel demonstrated an appropriate pore size distribution, excellent biocompatibility, and enhanced fibroblast proliferation in vitro. In the rabbit ear HS model, the Exos-GelMA hydrogel significantly inhibited excessive collagen fiber deposition and the overexpression of the angiogenic factor VEGF. Quantitative analysis of immunohistochemical and immunofluorescence staining showed comparing to blank group the Exos-GelMA hydrogel significantly reduced COL I deposition by 43%, COL III deposition by 15%, α-SMA expression by 31%, and VEGF expression by 35% at 28 day.

Conclusion

In summary, the Exos-GelMA composite hydrogel exhibits significant potential for the prevention and treatment of HS. This study supports the feasibility of Exos-GelMA as a cell-free therapeutic approach for the management of HS.

LncRNA SNHG1/miR-320b/CTNNB1 axis regulating the collective migration of fibroblasts in the formation of keloid

BACKGROUND

To explore the regulatory molecular mechanism of long non-coding RNA (lncRNA) small nucleolar RNA host gene 1 (SNHG1) expression on keloid formation.

METHODS

The expression differences of SNHG1, miR-320b, and Catenin Beta 1 (CTNNB1) in keloid tissue and normal skin tissue of patients with keloid were detected. Normal cultured human fibroblasts were used as the Blank group (Blank) and then transfected with si-SNHG1 to silence SNHG1 expression. MTT assay, Transwell chamber assay, RT-qPCR, and Western blot (WB) were used. SNHG1 and miR-320b, as well as miR-320b and CTNNB1, were found to be targeted using the dual luciferase reporter gene (DLRG) strategy.

RESULTS

As against normal skin tissue, SNHG1 and CTNNB1 were increased, while miR-320b was decreased in keloid tissue (P < 0.05). As against the Blank, there was a drop in the number of transferring and attacking cells, a decrease in the proliferative activity, an increase in the expression of miR-320b, a decrease in CTNNB1, and the relative expression (RE) of Pro-Collagen I, Cyclin D1, VEGF, α-smooth muscle actin (α-SMA), matrix metallopeptidase-2 (MMP-2), and MMP-9 was decreased in the si-SNHG1 group (AG) (P < 0.05).

CONCLUSION

SNHG1 could target and regulate miR-320b, and miR-320b could target and regulate CTNNB1. Fibroblast transfer, attack, and multiplication may all be prevented by reducing SNHG1 expression.

Clinical observation of super tension-relieving suture for wound repair following resection of benign skin tumors in pediatric patients

OBJECTIVE

To examine the clinical effectiveness of super tension-relieving sutures in surgical wound repair among pediatric patients after surgery.

METHODS

The study included 100 patients with skin tumors who underwent surgical resection in the Hunan Children's Hospital outpatient department between January 2021 and December 2022. The experimental group (n ​= ​55) received super tension-relieving sutures, while the control group (n ​= ​45) received traditional tension-relieving sutures. The wound healing status, decompression duration, scar status, and effectiveness rates between the two groups were compared after 6 months of treatment.

RESULTS

The experimental group exhibited higher wound eversion height, wound healing grade, the Vancouver Scar Scale scores, and wound satisfaction (p ​< ​0.05) compared to the control group, while no significant difference was observed in wound infection and subcutaneous hematoma between the two groups (p ​> ​0.05).

CONCLUSIONS

Using super tension-relieving sutures effectively reduces wound tension, minimizes scar formation, and improves postoperative aesthetics with patient satisfaction in pediatric dermatological surgery.

Risk Factors for Scar Formation After Thyroidectomy and Advances in its Prevention and Treatment

An open thyroidectomy typically results in a "suicide" wound in the neck measuring approximately 4 to 6 cm in length. In the event that this wound develops into a hypertrophic scar, it can lead to significant psychological and quality-of-life challenges for the patient. The formation of proliferative scarring in surgical incisions is influenced by a multitude of risk factors, which can be broadly classified into intrinsic and extrinsic categories. Contemporary scar prevention and control strategies encompass a range of modalities, including postoperative rehabilitation physiotherapy, topical dressings, drug injections, laser therapy, combined therapy, and emerging therapeutic approaches. Among these, combined therapy has demonstrated superior efficacy in scar prevention and control. The objective of this article is to present a concise overview of the risk factors and interventions associated with proliferative scar formation following thyroid surgery. This is with a view to informing future research on the prevention of incisional scarring in thyroid surgery. Level of Evidence V 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 .

LINC01711 modulates proliferation, migration, and extracellular matrix deposition of hypertrophic scar fibroblasts by targeting miR-34a-5p

Hypertrophic scar (HS) is a proliferative disorder that occurs after skin injury and generally leads to disfigurement and impaired skin function in patients. This study aims to delve into the biological role of long intergenic non-protein coding RNA 1711 (LINC01711) in HS, thereby identifying novel therapeutic approaches for HS. HS tissues and corresponding normal tissues were obtained from 35 patients. The expression of LINC01711 was evaluated by qRT-PCR. The effect of LINC01711 knockdown on HS fibroblasts (HSFs) was measured by CCK-8 assay, migration assay, and apoptosis assay. The molecular mechanisms were investigated through bioinformatics analysis and dual-luciferase reporter assay. The impact of LINC01711 on the expression of extracellular matrix (ECM) deposition markers was measured using ELISA assay. LINC01711 was upregulated in HS tissues and positively correlated with disease severity. The silencing of LINC01711 induced the suppression of cell viability, migration, and the promotion of apoptosis in HSFs. LINC01711 negatively modulated microRNA-34a-5p (miR-34a-5p) expression. Suppression of miR-34a-5p reversed the biological function of LINC01711 knockdown in HSFs. Furthermore, LINC01711 modulated collagen type I alpha 1 chain (COL1A1), tissue inhibitor of metalloprotease-1 (TIMP1), and actin alpha 2 (Acta2) expression in HSFs mediated by miR-34a-5p. The results demonstrated that LINC01711 functioned as a regulatory factor in the proliferation, migration, apoptosis, and ECM deposition of HSFs mediated by miR-34a-5p.

Cepharantine prevents hypertrophic scarring by regulating the TGF-β/SMAD pathway

Hypertrophic scarring (HS) is a fibrotic skin disorder characterized by excessive deposition of extracellular matrix (ECM), leading to symptoms such as pain, itching, and skin contraction. HS can also result in restricted joint mobility and cosmetic deformities, imposing psychological and economic burdens on patients. Additionally, it increases wound care costs, and currently, no ideal treatment options exist. Therefore, HS is not only a clinical care issue but also a societal problem, with significant challenges related to its management and prevention. In this study, a custom-made cepharanthine ointment was applied to a rabbit ear scar model to investigate its effects on morphology, histology, and protein expression in HS. Additionally, the mechanism underlying the effect of cepharanthine on affected fibroblasts and the expression of ECM proteins was explored in vitro models of fibrosis. Animal experiments demonstrated that cepharanthine significantly reduced the tissue scar hypertrophy index and collagen content, improved the arrangement of fibroblasts, and inhibited ECM production. Cellular experiments indicated that cepharanthine effectively downregulated key proteins in the TGF-β/SMAD pathway, decreased ECM protein expression, and suppressed fibroblast proliferation and migration. Cepharanthine can prevent HS by reducing ECM deposition through the TGF-β/SMAD signalling pathway.

Scar Management in Pediatric Patients

Background and Objectives: Pediatric patients can acquire scars from both accidental injury and surgical procedures. While scars cannot be avoided if a full-thickness injury occurs, scar visibility may be minimized through a variety of approaches. In this narrative review, we evaluate the current evidence and propose an algorithm for scar management in pediatric patients. Materials and Methods: A review of the literature was performed for scar management techniques for pediatric patients. Management modalities based on the type of scar and dosing, treatment regimen, and safety profiles are described in this article and used to create a scar management algorithm. Results: The initial step to scar management in the pediatric population involves ensuring minimal wound tension, which can be achieved through making the incision along relaxed skin tension lines, and early, minimal tension wound closure. Subsequent treatments to optimize scar care should begin 2-3 weeks following wound closure and involve the application of silicone gel or sheets and scar massaging. When topical products are insufficient, laser therapy can be utilized for the management of immature erythematous or thick scars. When mature, pathological scars form such as atrophic scars, hyperpigmentation, hypertrophic scars, or keloids, a combination of modalities is recommended. These modalities vary by scar type and include retinoids and dermabrasion for atrophic scars; retinoids, hydroquinone, and laser therapy for hyperpigmentation; and pressure therapy, corticosteroids, and laser therapy for hypertrophic scars and keloids. When mature, pathological scars persist following 12 months of non-invasive therapies, surgical excision should be considered. Conclusions: Several treatment options are available to manage scars in the pediatric population depending on scar type.

Association and mediation between circulating inflammatory proteins and skin fibrosis

Objective

Skin fibrosis is a dermal lesion associated with inflammatory factors. However, the exact causal relationship between circulating inflammatory proteins (CIPs) and skin fibrosis remains unclear. To investigate this potential association and mediated effect, Mendelian randomization (MR) and two-step MR were used.

Methods

Summary statistics from genome-wide association studies (GWAS) were extracted from the GWAS Catalog for CIPs, blood metabolites (BMs), and skin fibrosis. Two-sample MR and reverse MR were conducted to determine the effect of CIPs on skin fibrosis. Two-step MR was then performed to investigate the role of BMs in mediating the effect of CIPs on skin fibrosis. Reverse MR analysis was performed to confirm the unidirectional causality between CIPs and BMs, as well as between BMs and skin fibrosis.

Results

Bidirectional Mendelian randomization revealed negative associations between skin fibrosis and the levels of T-cell surface glycoprotein CD6 isoform (odds ratio [OR] 0.670 [95% confidence interval [CI] 0.472, 0.951], p = 0.025), Delta and Notch-like epidermal growth factor-related receptor (OR 0.779 [95% CI 0.609, 0.998], p = 0.048), and Interleukin-10 receptor subunit beta (OR 0.541 [95% CI 0.332, 0.884], p = 0.014). There was a positive association between skin fibrosis and levels of Fibroblast growth factor 21 (OR 2.276 [95% CI 1.064, 4.870], p = 0.034). Two-step MR showed that Retinol (Vitamin A) to the linoleoyl-arachidonoyl-glycerol ratio (βM 0.108 [95% CI 0.006, 0.210], p = 0.004) and the Cholesterol to linoleoyl-arachidonoyl-glycerol ratio (βM 0.238 [95% CI 0.002, 0.474], p = 0.048) were identified as mediators, which showed evidence of the mediated effect of the levels of Fibroblast growth factor 21 on Keloid through these mediators.

Conclusion

The study presented credible evidence of a causal association between CIPs and skin fibrosis, with BMs potentially acting as a mediator in this association. These findings offer new insights into early screening and prevention of skin fibrosis.

Fractional carbon dioxide laser treatment of hypertrophic scar clinical and histopathological evaluation

Hypertrophic scar could be associated with several complications that interfere with patient daily activities, physical and psychological health and impact patient quality of life. Several therapeutics and maneuvers are used for treatment of hypertrophic scar with variable success and side effects. We aim to evaluate safety and efficacy of fractional carbon dioxide laser on treatment of hypertrophic scar both clinically and histopathologically. Hypertrophic scars in each patient of total thirty patients were subjected to random division with sealed envelope into two parts, part A treated with fractional carbon dioxide laser every month for 5 sessions, and part B lift without treatment for control. Hypertrophic scars in each patient were single or multiple, Single scar was more than 15 cm length. Clinical evaluation was done by two blinded dermatologists, using Vancouver Scar Scale (VSS) and Patient and Observer Scar Assessment Scale (POSAS) for each part before, 3 months and 6 months after treatment. Histopathological evaluation was done for each part before and 3 months after treatment by measuring epidermal thickness, collagen area percent, and elastin area percent. The upper significant clinical and histopathological improvement was shown in carbon dioxide laser treated parts than control parts without significant side effects for fractional carbon dioxide laser treatment. Treatment of hypertrophic scar with fractional carbon dioxide laser is beneficial and generally considered safe, with minimal risk of harm when performed with appropriate laser parameters for male and female patients with skin type III and IV, at different ages and different body regions.

Evaluating the combination and comparison of ablative fractional lasers (CO2, Erbium-YAG) with pulsed dye laser (PDL) for treating hypertrophic scars: a systematic review

The aim of this study is to compare pulsed dye laser (PDL) and ablative fractional lasers (CO2, Erbium-YAG) in the treatment of hypertrophic scars in a systematic review. Databases including Web of Science, Science Direct, Google Scholar and PubMed were searched for clinical trials up to December 1, 2022; focusing on the role of ablative fractional lasers and pulsed dye lasers in treating hypertrophic scars, using comprehensive keywords and search syntaxes. Key data extracted included type of scars, the assessment indexes, treatment modalities, side effects and the final conclusion of each article. We found no significant difference between the PDL and the ablative fractional laser in the treatment of hypertrophic scars, and both showed significant improvement. The average number of treatment sessions in the group receiving ablative fractional laser was 3.43 sessions, in the group receiving PDL, 3.68 sessions, and in the group receiving the combination of the two lasers, 1.5 sessions. Ablative fractional laser was 57.5% effective in VSS scoring and 40.4% effective in POSAS scoring, while PDL laser was 49.4% effective in VSS scoring and 35.5% effective in POSAS scoring, also the combination of both methods may lead to better results and higher efficacy with no severe adverse reactions noted. More high-quality trials are needed to fully confirm the effectiveness of laser therapy. Ablative fractional laser and PDL are both effective in treating hypertrophic scars and there was no significant difference between them. However, studies investigating the combination of these two lasers have reported greater effectiveness than each method alone.

Advancements in pharmacological interventions for atopic dermatitis current strategies and future directions

Atopic dermatitis (AD) is a complex chronic inflammatory skin disorder, with its incidence significantly increasing in recent years. The pathogenesis of AD is complex, involving multiple factors such as genetic susceptibility, dysbiosis of the skin microbiome, autoimmune abnormalities, impaired epidermal barrier function, and environmental factors. These factors collectively contribute to the high incidence of the disease and its significant socio-economic burden. This article reviews the pathogenesis of AD and analyzes the current traditional treatment approaches, including topical and systemic therapies, highlighting the issues they face. It focuses on the current status and treatment strategies. Specifically, as the significant heterogeneity of AD, treatment paradigms are gradually shifting from a "one-size-fits-all" approach to personalized treatments. The aim is to achieve more effective management of AD and address the issues arising from individual differences. Through these discussions, this article aims to provide new perspectives and strategies for the clinical treatment of AD, in order to reduce the disease burden on patients.

Efficacy of Combined 595-nm Pulsed Dye Laser and Intralesional Corticosteroids Versus Intralesional Corticosteroids Alone for Treating Postmastectomy Hypertrophic Scars and Keloids in Transgender Men: A Randomized Controlled Trial

BACKGROUND

Top surgery masculinizes the chest appearance for transgender men (TM); however, some individuals may experience hypertrophic scars (HTS) or keloids following the surgery.

OBJECTIVES

This study aimed to evaluate the efficacy of combined 595-nm pulsed dye laser (PDL) and intralesional triamcinolone acetonide injection (IL TAC) compared to IL TAC monotherapy for treating HTS and keloids.

METHODS

Twenty-five TM with 35 pairs of bilateral symmetric postmastectomy HTS or keloids were randomly allocated to receive the combined PDL and IL TAC on the scar(s) on one side of the chest and IL TAC monotherapy on the contralateral scar(s) in four monthly treatment sessions. Clinical improvement was evaluated using the Vancouver Scar Scale (VSS). Melanin index, hemoglobin index, and scar roughness were determined before each treatment session and at 1, 3, and 6 months after the last treatment. Participant-rated satisfaction and adverse events were documented.

RESULTS

After two treatment sessions, scars treated with combined PDL and IL TAC demonstrated significantly greater improvements in the VSS (p = 0.012) and melanin index (p = 0.004) compared to those treated with IL TAC alone. The superior outcomes of the combined therapy persisted for 3 and 6 months after the end of treatment sessions for the VSS (p = 0.001) and melanin index (p = 0.048), respectively. Participants reported higher satisfaction for combined PDL and IL TAC than IL TAC monotherapy (p = 0.005). No serious or permanent adverse event was reported.

CONCLUSION

The addition of 595-nm PDL to IL TAC may provide more favorable outcomes for treating postmastectomy HTS and keloids among TM.

An active shrinkage and antioxidative hydrogel with biomimetic mechanics functions modulates inflammation and fibrosis to promote skin regeneration

Achieving scar-free skin regeneration in clinical settings presents significant challenges. Key issues such as the imbalance in macrophage phenotype transition, delayed re-epithelialization, and excessive proliferation and differentiation of fibroblasts hinder wound healing and lead to fibrotic repair. To these, we developed an active shrinkage and antioxidative hydrogel with biomimetic mechanical functions (P&G@LMs) to reshape the healing microenvironment and effectively promote skin regeneration. The hydrogel's immediate hemostatic effect initiated sequential remodeling, the active shrinkage property sealed and contracted the wound at body temperature, and the antioxidative function eliminated ROS, promoting re-epithelialization. The spatiotemporal release of LMs (ACEI) during the inflammation phase regulated macrophage polarization towards the anti-inflammatory M2 phenotype, promoting progression to the proliferation phase. However, the profibrotic niche of macrophages induced a highly contractile α-SMA positive state in myofibroblasts, whereas the sustained LMs release could regulate this niche to control fibrosis and promote the correct biomechanical orientation of collagen. Notably, the biomimetic mechanics of the hydrogel mimicked the contraction characteristics of myofibroblasts, and the skin-like elastic modulus could accommodate the skin dynamic changes and restore the mechanical integrity of wound defect, partially substituting myofibroblasts' mechanical role in tissue repair. This study presents an innovative strategy for skin regeneration.

Pathological-microenvironment responsive injectable GelMA hydrogel with visualized biodegradation for pressure-assisted treatment of hypertrophic scars

Intralesional injection of 5-fluorouracil for the clinical treatment of hypertrophic scars (HS) remains challenging due to its short half-life, as well as the absence of evidence-based dosage and frequency injection guidelines. Herein, we developed a matrix metalloproteinases (MMPs)/reactive oxygen species (ROS)-responsive injectable prodrug hydrogel (GFP) that exhibits sustained drug release and fluorescence imaging capability, aiming to facilitate the optimization of injection dosage and frequency in HS treatment. The GFP hydrogel comprises gelatin methacryloyl and pendant methacryloyl-decorated tetrapeptide (PPPK) with 5-fluorouracil acetic acid/rhodamine B at the N-terminus. After intralesional injection and blue light irradiation, the crosslinked hydrogel in HS lesions exhibited long-term sustained drug release by consuming overexpressed MMPs and ROS, which could be visualized by fluorescence imaging to guide injection frequency for HS treatment. In addition, due to its exceptional swelling and mechanical properties, the GFP hydrogel exerts a certain pressure inside the HS tissues, functioning as an adjunctive therapy to inhibit HS. Our results demonstrate that the GFP hydrogel can promote fibroblast apoptosis, inhibit collagen synthesis, and remodel the microenvironment of HS. This study presents a promising visualized drug delivery platform that potentially guides the optimization of injection frequency and dosage in the treatment of HS.

LINC00525 promotes cell proliferation and collagen expression through feedforward regulation of TGF-β signaling in hypertrophic scar fibroblasts

The etiology of hypertrophic scar formation continues to elude researchers, despite advancements in the understanding of skin scarring. Several long non-coding RNAs (lncRNAs) have been implicated in the pathogenesis of hypertrophic scars, yet the role and molecular mechanisms of LINC00525 in this process remain unclear. This study demonstrates that LINC00525 enhances cell proliferation and collagen expression through knockdown and overexpression techniques. Further analysis, including nuclear and cytoplasmic localization studies, RNA pull-down assays, bioinformatics predictions, and PCR validation, reveals that LINC00525 interacts with miR-29a-5p. The downregulation of LINC00525 enhances the expression of miR-29a-5p and suppresses the TGF-β/Smad signaling pathway. Additionally, TGF-β1 induces the upregulation of LINC00525. Collectively, these findings indicate that LINC00525 operates through a feedforward mechanism to regulate TGF-β signaling in hypertrophic scar fibroblasts. This research offers novel insights for the prevention and treatment of scars.

Investigating the causal relationship between skin microbiota and hypertrophic scar using bidirectional mendelian randomization

BACKGROUND

Hypertrophic scar (HS) is acknowledged as a pathological fibro-proliferative disease of the dermis, resulting from excessive connective tissue growth. HS significantly impacts patient quality of life due to both social and functional issues. Despite various treatments, therapeutic effectiveness remains limited, necessitating further exploration of underlying factors and mechanisms.

OBJECTIVE

The current study was designed to determine the causal relationship between skin microbiota and HS employing a bidirectional Mendelian randomization (MR) approach.

METHODS

We utilized genome-wide association study (GWAS) data from the PopGen cohort and the FinnGen database. Independent single nucleotide polymorphisms (SNPs) linked to the skin microbiota were identified as instrumental variables (IVs) chosen for the two-sample MR analysis. Key analytical approaches included inverse variance weighting (IVW), MR-Egger, simple median, simple mode, and weighted mode, with MR-Egger intercept test and Cochrane's Q test used to detect potential horizontal pleiotropy and heterogeneity.

RESULTS

The two-sample MR analysis identified significant causal relationships between specific skin microbiota features and HS. Notably, Enhydrobacter, Micrococcus, and Acinetobacter on moist skin exhibited protective effects against HS, whereas Finegoldia and Lactobacillales on dry skin were linked to an increased risk of HS. Sensitivity analyses verified the strength of these results, revealing no notable horizontal pleiotropy or heterogeneity.

CONCLUSION

Our research reveals a unidirectional causal relationship between certain skin microbiota and HS, suggesting that modulation of skin microbiota could be a novel therapeutic approach for HS management. These results emphasize the significance of considering skin microbiota in the pathogenesis and treatment of HS.

Skin microincision technique to enhance drug penetration for the treatment of keloid and hypertrophic scars

The synergistic effect of corticosteroids and 5-fluorouracil (5-FU) for the treatment of pathological scarring is widely documented. While topical administration can be a painless, convenient way to convey the two active ingredients, physical enhancement techniques such as microneedling are required to deepen their skin penetration and achieve the therapeutic effect. A novel approach to keloid and scar treatment is given by microincision, i.e., micrometric-sized columnar perforations which allow the drugs to diffuse into the skin and promote tissue proliferation in a more physiological structure. Combining the delivery of triamcinolone acetonide (TAC) and 5-FU with microincision is an innovative approach that could improve the speed and efficacy of regenerative treatments. This study evaluated the effectiveness of the skin treatment with a device combining microincisions and photobiomodulation, in the skin permeation of a combination of TAC and 5-FU. Increasing treatment times (4, 6, and 8 min) led to higher drug penetration compared to intact skin, with a more noticeable effect for 5-FU compared to TAC. Specifically, all treatment durations were significantly more effective (p < 0.05) than the control for 5-FU, while TAC showed less variation between treatments. Moreover, it was shown that in-vitro, the permeation improvement given by the red-light treatment was mainly due to the mechanical massage, which pushed the actives into the microchannels created by the treatment. The application of prolonged skin microincision times ensured much higher skin permeation of both TAC and 5-FU compared to microneedling on healthy excised skin.

Microneedle-Based Approaches for Skin Disease Treatment

The use of microneedles (MNs) has been established as an effective transdermal drug delivery strategy that has been extensively deployed for treating various diseases, including skin diseases. MNs can surpass the constraints of conventional drug delivery methods by their superior safety and efficacy through precise targeting, while simultaneously enabling painless delivery. Currently, MNs are increasingly used as carriers for drug delivery, with the loading of insoluble drugs to improve their treatment efficiency or combining with bioactive substances for the construction of an efficient drug delivery system to maximize the effects of bioactive substances. The methods used for preparation MNs are diverse, enabling them to meet the requirements of most applications. The emergence of MNs has addressed the shortcomings associated with insoluble drugs, expanded the applications of bioactive substances, and improved their use in clinical practice. This review summarizes current information on the application of MNs in a variety of skin diseases, such as psoriasis, vitiligo, alopecia, hypertrophic scarring, atopic dermatitis, melanoma, acne, and skin infections. The current clinical applications and future opportunities for MNs in the treatment of skin diseases are also discussed. Despite substantial progress in the clinical application of MNs as delivery vectors, issues such as low drug loading and poor mechanical strength during MNs preparation remain the main challenges. Therefore, clinical implementation of MNs-based therapies remains limited, highlighting key opportunities for future research.

Silicone gel versus combination of silicone gel and a 577-nm diode laser in the treatment of post-surgery hypertrophic scar (comparative study)

BACKGROUND

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. The present study aim to compare the efficacy of silicone gel versus combination of a 577-nm pro- yellow laser and silicone gel in the treatment of post-surgery hypertrophic scar.

METHODS

This study is a randomized comparative study In the period from 14 January 2021 up to the end of January 2023. 30 patients with post-surgery hypertrophic scar divided into two groups: A: one half of scar was managed with 577 nm diode laser 3 sessions monthly combined with application of silicone gel at home. A + B: the entire scar was treated with silicone gel within six months who admitted to the Laser unit of the Dermatology and Andrology Department at Al-Azhar University Hospital, Assiut during the study period.

RESULTS

Significant improvement in pigmentation, pliability, height and total Vancouver score. By comparing between silicone gel and combination of silicone gel and a 577 nm diode laser, the combination shows significant improving than silicone gel alone. The scar in the lip and breast area showed a significant higher improvement rate with yellow laser plus silicone gel compared to the other site.

CONCLUSION

Combination of silicone gel and yellow laser has significant effect in making surgical scars less distinct.

Real-world effectiveness and safety of bleomycin in patients with keloids and hypertrophic scars: a systematic review and meta-analysis

Pathological scars are classified into hypertrophic scars and keloids, and currently have poor treatment outcomes and high recurrence rates. Bleomycin has received widespread attention in scar treatment in recent years, but there is currently no exploration on its real-world data. PubMed, Embase, and Cochrane databases were searched, and eight retrospective studies on the use of bleomycin for treatment were included, covering a total of 562 patients with keloids and hypertrophic scars. The meta-analysis results revealed that 90% of patients had significant flattening of scars after treatment with bleomycin, 5% had moderate flattening, and 4% had mild flattening. The recurrence rate after treatment was only 3%. The major adverse reaction was hyperpigmentation, with an incidence rate of 8%, and no significant ulcers or skin atrophy were reported. Subgroup analysis showed that the significant flattening rate treated with bleomycin alone was 91%, which was significantly different from the 79% treated with bleomycin in combined with triamcinolone acetonide, but the difference was not statistically significant. In addition, the significant flattening rate was 99% in Western patients and 57% in Asian patients, reflecting the impact of racial differences on treatment outcomes. There was no statistically significant difference in curative effects between males and females (RR: 0.95; P = 0.77). Overall, bleomycin has good curative effect in treating scars and has high safety, especially showing more significant effects in Western populations. However, racial differences, treatment plans, and other factors may affect the therapeutic effect of bleomycin. Future research can further explore the mechanisms of these factors and provide more personalized treatment plans for patients with scar.

Losartan in Situ Forming Gel as a New Treatment for Hypertrophic Scars

Hypertrophic scars are defined as visible lesions formed by excessive wound healing that cause cosmetic and, in some cases, functional challenges in patients. This study aimed to assess the efficacy of intralesional injections of losartan-loaded in situ forming gel and compare it with the common treatment (triamcinolone) in preventing scar formation. The formulation was prepared using a thermosensitive PLGA-PEG-PLGA triblock copolymer. Ear scar tissue in rabbits represented the hypertrophic scar, and the animals were treated with three treatments in three groups. Nine weeks following the single treatment, images of the scars were obtained and quantitatively analyzed using ImageJ and light microscopy was used to evaluate the fibroblast cell number, vascularization, inflammation and collagen deposition and fibrosis in H&E-stained sample tissue. According to the results based on the ImageJ and the Vancouver criteria, the losartan in situ forming gel (F-LG) indicated significantly higher improving effects on decreased vascularity and pigmentation in comparison with triamcinolone (F-TA) and placebo as a control (F-Ctl), although the effect F-LG was almost similar to F-TA on pliability and scar height, and they were better than the control. Histological findings showed F-LG and F-TA have less inflammatory and fibroblast cells compared to F-Ctl. Also, results indicated the dermal layers of the F-TA and F-LG groups' scar were thinner, and the deposition of collagens was reduced compared to the control. Consequently, F-LG was found to be an effective treatment in reducing scarring and promoting wound healing.No Level Assigned This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. 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 .

Single cell transcriptomics reveals the cellular heterogeneity of keloids and the mechanism of their aggressiveness

Keloid is a dermatofibrotic disease known for its aggressive nature and characterized by pathological scarring, which often leads to disfigurement and frequent recurrences. Effective therapies for keloids are still limited, presumably due to the inadequate comprehension of their aggressive mechanisms. In our study, we examined the unique scenario where both keloid and non-aggressive pathological scar originate from the same patient, providing a rare opportunity to explore the aggressive mechanisms of keloids through single-cell RNA sequencing. We found that the dominant fibroblast subgroup in keloids is mechanoresponsive group, which showed enhanced mechanotransduction and migration. This mechanoresponsive fibroblast subgroup is likely to be the key cell population and confer aggressive growth of keloids. The results also indicate that the endothelial cells and keratinocytes in keloid involve in endothelial-mesenchymal and epithelial-mesenchymal transitions. This study demonstrated the mechanoresponsive fibroblasts and multiple cellular mesenchymal processes could pave the way for further investigations into the keloid aggressiveness.

VR23 and Bisdemethoxycurcumin Enhanced Nanofiber Niche with Durable Bidirectional Functions for Promoting Wound Repair and Inhibiting Scar Formation

Chronic wounds pose a significant clinical challenge worldwide, which is characterized by impaired tissue regeneration and excessive scar formation due to over-repair. Most studies have focused on developing wound repair materials that either facilitate the healing process or control hyperplastic scars caused by over-repair, respectively. However, there are limited reports on wound materials that can both promote wound healing and prevent scar hyperplasia at the same time. In this study, VR23-loaded dendritic mesoporous bioglass nanoparticles (dMBG) are synthesized and electrospun in poly(ester-curcumin-urethane)urea (PECUU) random composite nanofibers (PCVM) through the synergistic effects of physical adsorption, hydrogen bond, and electrospinning. The physicochemical characterization reveals that PCVM presented matched mechanical properties, suitable porosity, and wettability, and enabled sustained and temporal release of VR23 and BDC with the degradation of PCVM. In vitro experiments demonstrated that PCVM can modulate the functions and polarization of macrophages under an inflammatory environment, and possess effective anti-scarring potential and reliable cytocompatibility. Animal studies further confirmed that PCVM can efficiently promote re-epithelialization and angiogenesis and reduce excessive inflammation, thereby remarkably accelerating wound healing while preventing potential scarring. These findings suggest that the prepared PCVM holds promise as a bidirectional regulatory dressing for effectively promoting scar-free healing of chronic wounds.

Exosomal miR‑194 from adipose‑derived stem cells impedes hypertrophic scar formation through targeting TGF‑β1

Hypertrophic scars, which result from aberrant fibrosis and disorganized collagen synthesis by skin fibroblasts, emerge due to disrupted wound healing processes. These scars present significant psychosocial and functional challenges to affected individuals. The current treatment limitations largely arise from an incomplete understanding of the underlying mechanisms of hypertrophic scar development. Recent studies, however, have shed light on the potential of exosomal non‑coding RNAs interventions to mitigate hypertrophic scar proliferation. The present study assessed the impact of exosomes derived from adipose‑derived stem cells (ADSCs‑Exos) on hypertrophic scar formation using a rabbit ear model. It employed hematoxylin and eosin staining, Masson's trichrome staining and immunohistochemical staining techniques to track scar progression. The comprehensive analysis of the present study encompassed the differential expression of non‑coding RNAs, enrichment analyses of functional pathways, protein‑protein interaction studies and micro (mi)RNA‑mRNA interaction investigations. The results revealed a marked alteration in the expression levels of long non‑coding RNAs and miRNAs following ADSCs‑Exos treatment, with little changes observed in circular RNAs. Notably, miRNA (miR)‑194 emerged as a critical regulator within the signaling pathways that govern hypertrophic scar formation. Dual‑luciferase assays indicated a significant reduction in the promoter activity of TGF‑β1 following miR‑194 overexpression. Reverse transcription‑quantitative PCR and immunoblotting assays further validated the decrease in TGF‑β1 expression in the treated samples. In addition, the treatment resulted in diminished levels of inflammatory markers IL‑1β, TNF‑α and IL‑10. In vivo evidence strongly supported the role of miR‑194 in attenuating hypertrophic scar formation through the suppression of TGF‑β1. The present study endorsed the strategic use of ADSCs‑Exos, particularly through miR‑194 modulation, as an effective strategy for reducing scar formation and lowering pro‑inflammatory and fibrotic indicators such as TGF‑β1. Therefore, the present study advocated the targeted application of ADSCs‑Exos, with an emphasis on miR‑194 modulation, as a promising approach to managing proliferative scarring.

Efficacy and safety of sequential treatment with botulinum toxin type A, fractional CO2 laser, and topical growth factor for hypertrophic scar management: a retrospective analysis

Hypertrophic scars arise from aberrant wound healing and can lead to functional and aesthetic impairments. One of the common interventions for treating hypertrophic scars is fractional carbon dioxide (CO2) laser, which employs narrow laser beams to stimulate dermal collagen deposition. Recent studies and reports have suggested that combining laser therapy with other interventions such as botulinum toxin type A (BTX-A) and topical growth factors may enhance treatment outcomes. Here, we examine the efficacy and safety of a sequential combination of BTX-A, fractional CO2 laser, and topical growth factors, referred to as combined therapy, for treating hypertrophic scars compared with only using fractional CO2 laser and topical growth factors, referred to as monotherapy. Our retrospective study includes 128 patients with hypertrophic scars (56 underwent monotherapy and 72 underwent combined therapy), which were followed-up for up to 15 months after the initiation of treatment to collect demographic and clinical data. Our analysis showed that the combined therapy significantly outperformed monotherapy in improving Vancouver scar scale scores (P < 0.05) and in the reduction of scar thickness (P < 0.05), without increasing adverse complications. Repeated treatments further augmented the efficacy of the combined therapy. Subgroup analysis revealed that combined therapy was notably more effective in reducing Vancouver scar scale scores and scar thickness in early-stage scars compared to late-stage (P = 0.023 and P = 0.045, respectively). Our study suggests that including BTX-A treatment before fractional CO2 laser and topical growth factors offers superior efficacy in reducing hypertrophic scars. We encourage early intervention and repeated treatments for optimal treatment outcomes.

Construction of ceRNA Network and Disease Diagnosis Model for Keloid Based on Tumor Suppressor ERRFI1

The aim of this study is to identify the key biomarker of keloid (KD) with significant diagnostic value and to construct the related competing endogenous RNA (ceRNA) network and disease diagnostic model to provide new ideas for the early diagnosis and prevention of KD. Public databases were used to identify the key gene of KD. Enrichment analysis and immune cell infiltration (ICI) analysis revealed its functional and immune characteristics. Then, a ceRNA network was constructed to explore the potential pathways of it. Random forest (RF) analysis was applied to construct a predictive model for the disease diagnosis of KD. Finally, immunohistochemistry (IHC) and RT-qPCR were used to verify the differential expression of key gene. ERRFI1 was identified as a key biomarker in KD and was lowly expressed in KD. The ceRNA network revealed that H0TAIRM1-has-miR-148a-3p-ERRFI1 may be a potential pathway in KD. Finally, a 2-gene diagnostic prediction model (ERRFI1, HSD3B7) was constructed and externally validated and the results suggested that the model had good diagnostic performance. ERRFI1 is a downregulated gene in KD and is expected to be a promising predictive marker and disease diagnostic gene. ICI may play a role in the progression of KD. The ceRNA network may provide new clues to the potential pathogenesis of KD. Finally, the new KD diagnostic model could be an effective tool for assessing the risk of KD development.

Activatable Near-Infrared Fluorescence Probe for Hypochlorous Acid Detection in Early Diagnosis of Keloids

Keloids represent pathologic conditions characterized by the presence of hyalinized collagen bundles and chronic inflammatory reactions. Recently, increased ROS production and disrupted apoptosis mechanisms in keloids have been reported, although the detailed mechanisms remain unclear. Herein, we developed a specific fluorescence probe, Pro-NBS, to investigate ClO- levels in keloids. The probe demonstrated high specificity for ClO- over other ROS and exhibited a strong linear detection relationship. Based on its performance, we focused on the TGF-β pathway in the development of keloids. ROS upregulation was observed in keloid-derived fibroblasts. Using ClO- as an intrinsic overexpression marker, our probe effectively distinguished between normal fibroblasts and keloid-derived fibroblasts both in vitro and in vivo. Furthermore, Pro-NBS showed potential for monitoring the progression and evaluating the systematic therapy of abnormal scarring or keloids.

Melatonin's Impact on Wound Healing

Melatonin (5-methoxy-N-acetyltryptamine) is an indoleamine compound that plays a critical role in the regulation of circadian rhythms. While melatonin is primarily synthesized from the amino acid tryptophan in the pineal gland of the brain, it can also be produced locally in various tissues, such as the skin and intestines. Melatonin's effects in target tissues can be mediated through receptor-dependent mechanisms. Additionally, melatonin exerts various actions via receptor-independent pathways. In biological systems, melatonin and its endogenous metabolites often produce similar effects. While injuries are common in daily life, promoting optimal wound healing is essential for patient well-being and healthcare outcomes. Beyond regulating circadian rhythms as a neuroendocrine hormone, melatonin may enhance wound healing through (1) potent antioxidant properties, (2) anti-inflammatory actions, (3) infection control, (4) regulation of vascular reactivity and angiogenesis, (5) analgesic (pain-relieving) effects, and (6) anti-pruritic (anti-itch) effects. This review aims to provide a comprehensive overview of scientific studies that demonstrate melatonin's potential roles in supporting effective wound healing.

The role of α7nAchR and PD-L1 in neuroimmune regulation of keloid treatment

Keloid formation, characterized by aberrant fibroproliferation and immune dysregulation, remains a challenging clinical concern. This study aims to elucidate the neuroimmune mechanisms underlying keloid pathogenesis and explores the efficacy of a combined treatment approach involving modulation of the α7 nicotinic acetylcholine receptor (α7nAchR), a key player in neural transmission, and programmed death ligand 1 (PD-L1), an immune checkpoint molecule, for keloid intervention. A key innovation lies in the identification of signal peptide-CUB-EGF-like domain-containing protein 3 (SCUBE3) as a potential target gene influenced by this dual treatment. We elucidate the underlying mechanism, wherein the hypoxic keloid microenvironment fosters an upsurge in SCUBE3 secretion. Subsequently, SCUBE3 forms complexes with TGF-β, initiating the activation of the PI3K/AKT/NF-κB signaling pathway. Notably, SCUBE3 is secreted in the form of exosomes, thereby exerting a profound influence on the differentiation of T cells and macrophages within the keloid milieu. This research not only provides a comprehensive understanding of the molecular mechanisms involved but also offers a promising avenue for the development of targeted therapies to address keloid-associated fibrosis and immune dysregulation. In conclusion, the combined inhibition of α7nAchR and PD-L1 represents a promising therapeutic strategy with SCUBE3 as a pivotal molecular target in the complex landscape of keloid pathophysiology.

Histone lactylation regulates autophagy of hyperplastic scar fibroblasts by inhibiting the transcriptional activity of phosphatase and tensin homologue

Hyperplastic scar (HS) is an overreaction of tissue to skin injury caused by local fibroblast proliferation and excessive collagen production. Histone posttranslational modification patterns are important epigenetic processes that control various biological activities. This study was designed to investigate the effects of histone lactylation on HS and the underlying mechanism. Western blot was used to analyse the lactylation level in HS patients and fibroblasts (HSFs). In vitro experiments, western blot, cell counting kit-8, and immunofluorescence staining were performed to detect the collagen level, cell viability, and autophagy, respectively. The relationship between snai2 (SLUG) and phosphatase and tensin homologue (PTEN) was assessed by RNA immunoprecipitation and dual-luciferase reporter assays. The results showed that the histone lactylation level was upregulated in HS tissues and HSFs. HSFs showed increased collagen production and cell viability, and decreased autophagy. Silencing of lactate dehydrogenase A (LDHA) promoted the transcription of PTEN by inhibiting SLUG, thus promoting autophagy. Knockdown of LDHA inhibited collagen deposition and cell viability, and increased autophagy in HSFs, and the results were reversed after PTEN inhibition. In summary, histone lactylation inhibited the transcription activity of PTEN by promoting SLUG, thereby suppressing autophagy and promoting collagen deposition and cell viability of HSFs, which might provide effective therapeutic strategies in HS.

Serum deprivation protein response intervenes in the proliferation, motility, and extracellular matrix production in keloid fibroblasts by blocking the amplification of TGF-β1/SMAD signal cascade via ERK1/2

Keloid formation has been linked to abnormal fibroblast function, such as excessive proliferation and extracellular matrix (ECM) production. Serum deprivation protein response (SDPR) is a crucial regulator of cellular function under diverse pathological conditions, yet its role in keloid formation remains unknown. The current work investigated the function of SDPR in regulating the proliferation, motility, and ECM production of keloid fibroblasts (KFs), as well as to decipher the mechanisms involved. Analysis of RNA sequencing data from the GEO database demonstrated significant down-regulation of SDPR in KF compared to normal fibroblasts (NFs). This down-regulation was also observed in clinical keloid specimens and isolated KFs. Overexpression of SDPR suppressed the proliferation, motility, and ECM production of KFs, while depletion of SDPR exacerbated the enhancing impact of TGF-β1 on the proliferation, motility, and ECM production of NFs. Mechanistic studies revealed that SDPR overexpression repressed TGF-β/Smad signal cascade activation in KFs along with decreased levels of phosphorylated Samd2/3, while SDPR depletion exacerbated TGF-β/Smad activation in TGF-β1-stimulated NFs. SDPR overexpression also repressed ERK1/2 activation in KFs, while SDPR depletion exacerbated ERK1/2 activation in TGF-β1-stimulated NFs. Inhibition of ERK1/2 abolished SDPR-depletion-induced TGF-β1/Smad activation, cell proliferation, motility, and ECM production in NFs. In conclusion, SDPR represses the proliferation, motility, and ECM production in KFs by blocking the TGF-β1/Smad pathway in an ERK1/2-dependent manner. The findings highlight the role of SDPR in regulating abnormal behaviors of fibroblasts associated with keloid formation and suggest it as a potential target for anti-keloid therapy development.

Isorhamnetin inhibits hypertrophic scar formation through TGF-β1/Smad and TGF-β1/CREB3L1 signaling pathways

Background

Hypertrophic scar (HS) is a common fibrotic skin disease that occurs secondary to burns or injuries. The activation of the TGF-β signaling pathway contributes immensely to HS formation. Isorhamnetin (ISO) is a type of flavonoid compound that exerts an antifibrotic effect via TGF-β signaling suppression. However, whether ISO can inhibit HS formation via TGF-β signaling is yet to be elucidated. This study aimed to examine the influence of ISO on HS pathogenesis and TGF-β signaling, especially the downstream molecules and networks of TGF-β signaling that facilitate HS formation.

Methods

Hypertrophic scar fibroblasts (HSFBs) were isolated from human HS tissues. The in vitro proliferation, migration, contractile ability, cell cycle, and apoptosis of HSFBs after ISO treatment were determined using cell viability assay, EdU staining, wound healing assay, collagen gel contraction assay, and flow cytometry. The expressions of genes and proteins involved in TGF-β signaling and its downstream molecules in ISO-treated HSFBs were determined using quantitative PCR (qPCR), immunofluorescence, and western blotting. In vivo, a rabbit HS model was established, and the effects of ISO on rabbit HS formation were investigated using histological analysis, immunohistochemical staining, and qPCR.

Results

In vitro studies indicated that ISO treatment suppressed the proliferation, migration, and contractile ability of HSFBs; attenuated the expressions of COL Ⅰ, COL Ⅲ, and α-SMA; and inhibited TGF-β1 signaling-induced activation of HSFBs by decreasing the levels of phosphorylated Smad2/3 and cleaved CREB3L1 in a dose-dependent manner. Furthermore, ISO augmented apoptosis and G2 phase cell cycle arrest of HSFBs by upregulating the expressions of the proapoptotic proteins Bax and cleaved caspase-3 and downregulating the expression of the antiapoptotic protein Bcl-2. In vivo studies revealed that ISO ameliorated HS formation in the rabbit ear by lowering the scar elevation index, attenuating the collagen density, facilitating the regular arrangement of collagen fibers, and downregulating the expressions of TGF-β1, CREB3L1, COL Ⅰ, COL Ⅲ, and α-SMA.

Conclusions

ISO suppressed HS pathogenesis by dampening TGF-β1/Smad and TGF-β1/CREB3L1 signaling pathways, which suggests that it may serve as a candidate inhibitor of TGF-β1 signaling and a promising anti-HS drug with a high therapeutic potential.

Dual-wavelength dye laser combined with betamethasone injection for treatment of keloids: protocol of a randomised controlled trial

INTRODUCTION

Keloids, benign fibroproliferative tumours characterised by excessive fibroblast proliferation and over-deposition of extracellular matrix, pose a therapeutic challenge with high recurrence rates. Betamethasone (diprospan) injection (BI) is one of the most common non-invasive therapies for keloids. Pulsed dye laser (PDL) has the function of closing microvessels, which may become one of the auxiliary treatment methods of BI and may enhance its curative effect. Some studies suggest that the combination of a dual-wavelength dye laser (DWL) and BI may offer superior efficacy. This randomised controlled trial aims to evaluate whether the combined therapy of DWL+BI outperforms BI alone in treating keloids.

METHODS AND ANALYSIS

This single-centre, parallel positive control, randomised trial evaluates the efficacy and safety of DWL (585 nm PDL+1064 nm neodymium-doped yttrium aluminium garnet) combined with BI for keloid treatment. Enrolling 66 adult patients, participants are randomised into DWL+BI or BI groups in a 1:1 ratio. Over 12 weeks, each group undergoes four treatment sessions, ensuring blinding for outcome assessors. Data collection occurs at multiple time points (4, 12, 24 and 52 weeks), with primary outcomes assessing the Vancouver Scar Scale (VSS) improvement rate 24 weeks after the last intervention. Secondary outcomes include VSS improvement rates, changes in keloid volume, changes in relative perfusion index measured by laser speckle contrast imaging, Patient and Observer Scar Assessment Scale results and patient satisfaction. Safety assessments include vital signs, laboratory tests, pregnancy tests and self-reports of adverse reactions.

ETHICS AND DISSEMINATION

The results will be presented in peer-reviewed journals and at international conferences. This study is approved by the Ethics Committee of Peking Union Medical College Hospital, Chinese Academy of Medical Sciences.

TRIAL REGISTRATION NUMBER

Chinese Clinical Trial Register (ChiCTR2400080148).

MALAT1 Knockdown Inhibits the Proliferation, Migration, and Collagen Deposition of Human Hypertrophic Scar Fibroblasts via Targeting miR-29a-3p/Smurf2 Axis

PURPOSE

Hypertrophic scarring (HS) is commonly described as an abnormal post-traumatic tissue repair characterized by excessive hypercellularity and extracellular matrix (ECM) deposition. Mounting evidence suggests that MALAT1 is maladjusted in many fibrotic diseases, but its contribution to HS progression remains poorly understood. Hence, we sought to elucidate the fundamental role of MALAT1 in HS.

METHODS

The expression of MALAT1, miR-29a-3p, and Smurf2 in skin tissues and fibroblasts was assessed by RT-qPCR and Western blotting. Furthermore, lentiviruses, RNAi, or plasmids were utilized to transfect hypertrophic scar fibroblasts (HSFs) for gene overexpression or downregulation. The biological behaviors of HSFs were quantified by the CCK-8 assay, wound healing assay, transwell assay, and flow cytometry. Mechanistically, bioinformatics analysis, dual-luciferase reporter assays, and rescue experiments were performed to verify the relationship between miR-29a-3p and MALAT1 or Smurf2.

RESULTS

Our data indicate that MALAT1, Smurf2 were overexpressed while miR-29a-3p was suppressed in HS tissues and fibroblasts. Downregulation of MALAT1 may lead to decreased proliferation, migration, and invasion of fibroblasts, accompanied by enhanced apoptosis, reduced TGF-β signal transduction, and ECM accumulation in HSFs, by enhancing miR-29a-3p and suppressing Smurf2 expression. Mechanistically, MALAT1 acted as a sponge for miR-29a-3p, while miR-29a-3p directly targeted Smurf2. More importantly, rescue experiments suggested that MALAT1 downregulation induced impact on the proliferation, migration, and invasion of HSFs could be partially overturned through miR-29a-3p knockdown or Smurf2 overexpression.

CONCLUSION

MALAT1 knockdown inhibits the proliferation, migration, invasion, and collagen deposition of HSFs via targeting the miR-29a-3p/Smurf2 axis, which may reveal a promising therapeutic exploitable vulnerability to HS.

Preparation of Compound Salvia miltiorrhiza-Blumea balsamifera Nanoemulsion Gel and Its Effect on Hypertrophic Scars in the Rabbit Ear Model

Hypertrophic scars (HS) still remain an urgent challenge in the medical community. Traditional Chinese medicine (TCM) has unique advantages in the treatment of HS. However, due to the natural barrier of the skin, it is difficult for the natural active components of TCM to more effectively penetrate the skin and exert therapeutic effects. Therefore, the development of an efficient drug delivery system to facilitate enhanced transdermal absorption of TCM becomes imperative for its clinical application. In this study, we designed a compound Salvia miltiorrhiza-Blumea balsamifera nanoemulsion gel (CSB-NEG) and investigated its therapeutic effects on rabbit HS models. The prescription of CSB-NEG was optimized by single-factor, pseudoternary phase diagram, and central composite design experiments. The results showed that the average particle size and PDI of the optimized CSB-NE were 46.0 ± 0.2 nm and 0.222 ± 0.004, respectively, and the encapsulation efficiency of total phenolic acid was 93.37 ± 2.56%. CSB-NEG demonstrated excellent stability and skin permeation in vitro and displayed a significantly enhanced ability to inhibit scar formation compared to the CSB physical mixture in vivo. After 3 weeks of CSB-NEG treatment, the scar appeared to be flat, pink, and flexible. Furthermore, this treatment also resulted in a decrease in the levels of the collagen I/III ratio and TGF-β1 and Smad2 proteins while simultaneously promoting the growth and remodeling of microvessels. These findings suggest that CSB-NEG has the potential to effectively address the barrier properties of the skin and provide therapeutic benefits for HS, offering a new perspective for the prevention and treatment of HS.

Application and effect of tension-reducing suture in surgical treatment of hypertrophic scar

PURPOSE

To investigate the application and effectiveness of tension-reducing suture in the repair of hypertrophic scars.

METHODS

A retrospective analysis of clinical data was conducted on 82 patients with hypertrophic scars treated at the Department of Burns and Plastic Surgery of Nanjing Drum Tower Hospital from September 2021 to December 2022. Patients were operated with combination of heart-shaped tension-reducing suturing technique and looped, broad, and deep buried (LBD) suturing technique or conventional suture method. Outcomes of surgical treatment were assessed before and 6 months after surgery using the Patient and Observer Scar Assessment Scale (POSAS) and the Vancouver Scar Scale (VSS).

RESULTS

Improvements were achieved on scar quality compared to that preoperatively, with a reduction in scar width (1.7 ± 0.6 cm vs. 0.7 ± 0.2 cm, P < 0.001). Assessment using the POSAS and VSS scales showed significant improvements in each single parameter and total score compared to preoperative values (P < 0.05). The Combination method group achieved better score in total score of VSS scale, in color, stiffness, thickness and overall opinion of PSAS scale, and in vascularity, thickness, pliability and overall opinion of OSAS scale.

CONCLUSION

The amalgamation of the heart-shaped tension-reducing suturing technique and the LBD suturing technique has shown promising outcomes, garnering notably high levels of patient satisfaction in the context of hypertrophic scar repair. Patients have exhibited favorable postoperative recoveries, underscoring the clinical merit and the prospective broader applicability of this approach in the realm of hypertrophic scar management.

Impact of the gut microbiome on skin fibrosis: a Mendelian randomization study

Objective

Skin fibrosis is a lesion in the dermis causing to itching, pain, and psychological stress. The gut microbiome plays as an essential role in skin diseases developments. We conducted a Mendelian randomization study to determine the causal association between the gut microbiome and skin fibrosis.

Methods

We retrieved valid instrumental variables from the genome-wide association study (GWAS) files of the gut microbiome (n = 18,340) conducted by the MiBioGen consortium. Skin fibrosis-associated data were downloaded from the GWAS Catalog. Subsequently, a two-sample Mendelian randomization (MR) analysis was performed to determine whether the gut microbiome was related to skin fibrosis. A reverse MR analysis was also performed on the bacterial traits which were causally associated with skin fibrosis in the forward MR analysis. In addition, we performed an MR-Pleiotropy Residual Sum and Outlier analysis to remove outliers and a sensitivity analysis to verify our results.

Results

According to the inverse variance-weighted estimation, we identified that ten bacterial traits (Class Actinobacteria, Class Bacteroidia, family Bifidobacteriaceae, family Rikenellaceae, genus Lachnospiraceae (UCG004 group), genus Ruminococcaceae (UCG013 group), order Bacteroidales, order Bifidobacteriales, genus Peptococcus and genus Victivallis) were negatively correlated with skin fibrosis while five bacterial traits (genus Olsenella, genus Oscillospira, genus Turicibacter, genus Lachnospiraceae (NK4A136group), and genus Sellimonas) were positively correlated. No results were obtained from reverse MR analysis. No significant heterogeneity or horizontal pleiotropy was observed in MR analysis.

Objective conclusion

There is a causal association between the gut microbiome and skin fibrosis, indicating the existence of a gut-skin axis. This provides a new breakthrough point for mechanistic and clinical studies of skin fibrosis.

Effective keloid management using a combinatorial continuous-wave and repeat fractionated ablative CO2 laser regimen

BACKGROUND

Keloids are benign proliferative scars that form as a result of dysregulated growth and collagen deposition in response to cutaneous injury. Laser therapies have emerged as promising options for the treatment of keloids, with performance varying by laser type and lesion characteristics.

PURPOSE

To assess the combined continuous wave and repetitive fractionated CO2 laser treatment of keloids.

METHODS

A retrospective chart review of 22 cases of keloid scars treated with combined CO2 laser modes. A single session of continuous wave followed by five sessions of fractional delivery. Efficacy was assessed using the Patient and Observer Scar Assessment Scale (POSAS) and the Vancouver Scar Scale. The Numeric Rating Scale was used to assess patient satisfaction and pain.

RESULTS

Most patients were female (77.3%) with skin type IV (72.7%), age was 24.3 ± 9.3 years, most keloids were located on the earlobe (56.5%) or arm or hand (17.4%), size ranged from 5 to 10 cm, and time since injury ranged from 3 months to 35 years. No serious adverse events were reported. At 6 months, significant improvements from baseline occurred in all characteristics, scar color (4.8 ± 2.8 to 1.9 ± 1.1), rigidity (5.0 ± 2.8 vs. 5.4 ± 2.8), thickness (5.4 ± 2.8 vs. 2.0 ± 1.1), and irregularity (5.9 ± 2.4 vs. 1.9 ± 0.9). The Vancouver scores followed a similar trend. Patient-rated overall improvement from 37 ± 17.6 at baseline to 16.1 ± 8.5 at 6 months, and improvement in associated pain and pruritus.

CONCLUSION

Combination of two ablative laser delivery modes within a single laser platform provided for effective and safe keloid management and left patients highly satisfied.

Revisiting roles of mast cells and neural cells in keloid: exploring their connection to disease activity

Background

Mast cells (MCs) and neural cells (NCs) are important in a keloid microenvironment. They might contribute to fibrosis and pain sensation within the keloid. However, their involvement in pathological excessive scarring has not been adequately explored.

Objectives

To elucidate roles of MCs and NCs in keloid pathogenesis and their correlation with disease activity.

Methods

Keloid samples from chest and back regions were analyzed. Single-cell RNA sequencing (scRNA-seq) was conducted for six active keloids (AK) samples, four inactive keloids (IK) samples, and three mature scar (MS) samples from patients with keloids.

Results

The scRNA-seq analysis demonstrated notable enrichment of MCs, lymphocytes, and macrophages in AKs, which exhibited continuous growth at the excision site when compared to IK and MS samples (P = 0.042). Expression levels of marker genes associated with activated and degranulated MCs, including FCER1G, BTK, and GATA2, were specifically elevated in keloid lesions. Notably, MCs within AK lesions exhibited elevated expression of genes such as NTRK1, S1PR1, and S1PR2 associated with neuropeptide receptors. Neural progenitor cell and non-myelinating Schwann cell (nmSC) genes were highly expressed in keloids, whereas myelinating Schwann cell (mSC) genes were specific to MS samples.

Conclusions

scRNA-seq analyses of AK, IK, and MS samples unveiled substantial microenvironmental heterogeneity. Such heterogeneity might be linked to disease activity. These findings suggest the potential contribution of MCs and NCs to keloid pathogenesis. Histopathological and molecular features observed in AK and IK samples provide valuable insights into the mechanisms underlying pain and pruritus in keloid lesions.

Endogenous stimuli-responsive separating microneedles to inhibit hypertrophic scar through remodeling the pathological microenvironment

Hypertrophic scar (HS) considerably affects the appearance and causes tissue dysfunction in patients. The low bioavailability of 5-fluorouracil poses a challenge for HS treatment. Here we show a separating microneedle (MN) consisting of photo-crosslinked GelMA and 5-FuA-Pep-MA prodrug in response to high reactive oxygen species (ROS) levels and overexpression of matrix metalloproteinases (MMPs) in the HS pathological microenvironment. In vivo experiments in female mice demonstrate that the retention of MN tips in the tissue provides a slowly sustained drug release manner. Importantly, drug-loaded MNs could remodel the pathological microenvironment of female rabbit ear HS tissues by ROS scavenging and MMPs consumption. Bulk and single cell RNA sequencing analyses confirm that drug-loaded MNs could reverse skin fibrosis through down-regulation of BCL-2-associated death promoter (BAD), insulin-like growth factor 1 receptor (IGF1R) pathways, simultaneously regulate inflammatory response and keratinocyte differentiation via up-regulation of toll-like receptors (TOLL), interleukin-1 receptor (IL1R) and keratinocyte pathways, and promote the interactions between fibroblasts and keratinocytes via ligand-receptor pair of proteoglycans 2 (HSPG2)-dystroglycan 1(DAG1). This study reveals the potential therapeutic mechanism of drug-loaded MNs in HS treatment and presents a broad prospect for clinical application.

Identification of Collagen-Suppressive Agents in Keloidal Fibroblasts Using a High-Content, Phenotype-Based Drug Screen

Keloids are characterized by excessive extracellular collagen and exaggerated scarring. Large-volume lesions can be functionally debilitating, therapeutically intractable, and psychologically devastating. A key barrier to translational momentum for novel antikeloid agents is the lack of a faithful high-content screen. We devised, to our knowledge, a previously unreported phenotype-based assay that measures secreted collagen by keloidal fibroblasts in tissue hypoxic conditions (1% oxygen). Four keloidal fibroblasts and 1 normal dermal fibroblast line were exposed to 199 kinase inhibitors. Of 199 kinase inhibitors, 41 (21%) and 71 (36%) increased and decreased the CI ¯ norm (mean collagen inhibition normalized to viability) by more than 10%, respectively. The most collagen suppressive agents were CGP60474 (CI ¯ norm = 0.36), KIN001-244 (CI ¯ norm = 0.55), and RAF265 (CI ¯ norm = 0.58). The top candidate, CGP60474, consistently abolished collagens I and VII production, exhibited minimal global toxicity, and induced a fivefold increase in phosphorylated extracellular signal-regulated kinase. This proof-of-concept high-content screen can identify drugs that appear to target critical keloidal pathophysiology-collagen secretion.

Benzbromarone Induces Targeted Degradation of HSP47 Protein and Improves Hypertrophic Scar Formation

Fibrotic diseases are characterized by the abnormal accumulation of collagen in the extracellular matrix, leading to the functional impairment of various organs. In the skin, excessive collagen deposition manifests as hypertrophic scars and keloids, placing a substantial burden on patients and the healthcare system worldwide. HSP47 is essential for proper collagen assembly and contributes to fibrosis. However, identifying clinically applicable HSP47 inhibitors has been a major pharmaceutical challenge. In this study, we identified benzbromarone (BBR) as an HSP47 inhibitor for hypertrophic scarring treatment. BBR inhibited collagen production and secretion in fibroblasts from patients with keloid by binding to HSP47 and inhibiting the interaction between HSP47 and collagen. Interestingly, BBR not only inhibits HSP47 but also acts as a molecular glue degrader that promotes its proteasome-dependent degradation. Through these molecular mechanisms, BBR effectively reduced hypertrophic scarring in mini pigs and rats with burns and/or excisional skin damage. Thus, these findings suggest that BBR can be used to clinically treat hypertrophic scars and, more generally, fibrotic diseases.

Expression of macrophage activation‑specific factors in hyperplastic scar tissue during hyperplasia phase by antibody array blotting membrane assay and its clinical significance

The expression of macrophage activation-specific factors in hyperplastic scar (HS) tissues during hyperplasia phase was detected by antibody array imprinted membrane method and the role of macrophage activation in the natural evolution of HS was explored. A total of 83 patients with HS admitted to the Affiliated Hospital of Beihua University (Jilin, China) between February 2021 and July 2021 were enrolled. The clinical data of the patients were retrospectively analyzed. These patients were divided into the hyperplasia HS group (n=26) and the decline HS group (the HS tissues ceased to grow and were in regression periods; n=57) according to the time of scar formation and clinical characteristics. The HS tissues were collected from patients in both groups. The contents of IL-12, IL-10, VEGF and basic fibroblast growth factor (bFGF) were detected by antibody array imprinted membrane method and the contents of IL-12, IL-10, VEGF and bFGF in tissues with various groups of tissues and clinical features were compared. The connection between macrophage activation-specific factors with VEGF and bFGF was analyzed using Pearson correlation analysis. The contents of IL-10 (9.48±1.06), VEGF (24.15±2.64) and bFGF (37.48±2.56) were much lower and IL-12 levels (16.45±0.85) were strongly higher in hyperplasia HS group compared with those in the decline HS group (14.56±1.26 for IL-10, 27.85±2.63 for VEGF, 43.15±3.16 for bFGF and 10.46±0.75 for IL-12, P<0.001). In the hyperplasia HS group, the contents of IL-10, VEGF and bFGF were obviously higher and the IL-12 levels were markedly lower in patients with age ≥30 years, protuberance height <2 mm, soft flexibility, low hyperemia degree and no concomitant symptoms than those in the patients with age <30 years, protuberance height ≥2 mm, hard flexibility, high hyperemia degree and concomitant symptoms (P<0.001). Pearson correlation analysis showed that IL-12 was negatively correlated with VEGF and bFGF (r=-0.328, 0.600, P<0.01). IL-10 was positively correlated with VEGF and bFGF (r=0.486, 0.684, respectively, P<0.001). In conclusion, macrophage activation-specific factors were abnormally expressed in hyperplasia HS, mainly M1 macrophages, accompanied by severe inflammatory reaction. The transformation of M1 macrophage into M2 macrophage usually occurred during the declining HS phase, which accelerated scar formation by promoting the formation of fibroblasts and angiogenesis. Detection of macrophage activation-specific factors may contribute to evaluate the clinical stage of HS.

Indocyanine green based photodynamic therapy for keloids: Fundamental investigation and clinical improvement

BACKGROUND

Keloid, a prevalent pathological skin lesion, presents significant challenges in terms of treatment efficacy. Photodynamic therapy (PDT), an increasingly popular adjuvant treatment, has shown significant potential in the management of various disorders, including cancer. However, the therapeutic potential of indocyanine green-mediated photodynamic therapy (ICG-PDT) for keloids has not yet been demonstrated.

METHODS

In this study, we divided the experimental groups into control group, Photothermal Therapy group, Photodynamic Therapy group, and Combined Therapy group. The in vitro investigation aimed to optimize the clinical application of PDT for keloid treatment by elucidating its underlying mechanism. Subsequently, on this basis, we endeavored to manage a clinical case of keloid by employing surgical intervention in conjunction with modified ICG-PDT.

RESULTS

Our investigation revealed an unexpected outcome that ICG-PDT maximally inhibited the cellular activity and migration of keloid fibroblasts only when photodynamic mechanism took effect. Additionally, the induction of autophagy and apoptosis, as well as the inhibition of collagen synthesis, were particularly evident in this experimental group. Furthermore, the above therapeutic effect could be achieved at remarkably low drug concentrations. Building upon the aforementioned experimental findings, we successfully optimized the treatment modality for the latest case and obtained a more favorable treatment outcome.

CONCLUSIONS

This study investigated the mechanism of ICG-PDT treatment and optimized the in vivo treatment regimen, demonstrating the significant therapeutic potential of ICG-PDT treatment in clinical keloid treatment.

Hydrogel Loaded with Components for Therapeutic Applications in Hypertrophic Scars and Keloids

Hypertrophic scars and keloids are common fibroproliferative diseases following injury. Patients with pathologic scars suffer from impaired quality of life and psychological health due to appearance disfiguration, itch, pain, and movement disorders. Recently, the advancement of hydrogels in biomedical fields has brought a variety of novel materials, methods and therapeutic targets for treating hypertrophic scars and keloids, which exhibit broad prospects. This review has summarized current research on hydrogels and loaded components used in preventing and treating hypertrophic scars and keloids. These hydrogels attenuate keloid and hypertrophic scar formation and progression by loading organic chemicals, drugs, or bioactive molecules (such as growth factors, genes, proteins/peptides, and stem cells/exosomes). Among them, smart hydrogels (a very promising method for loading many types of bioactive components) are currently favoured by researchers. In addition, combining hydrogels and current therapy (such as laser or radiation therapy, etc.) could improve the treatment of hypertrophic scars and keloids. Then, the difficulties and limitations of the current research and possible suggestions for improvement are listed. Moreover, we also propose novel strategies for facilitating the construction of target multifunctional hydrogels in the future.

Osteopathic Approach for Keloids and Hypertrophic Scars

The skin is a complex organ, a system that influences and is influenced by the body system, with different skin layers always mechano-biologically active. In the presence of a lesion that damages the dermis, the skin undergoes sensory, morphological, and functional alterations. The subsequent adaptation is the formation of scar tissue, following distinct and overlapping biological phases. For reasons not yet fully elucidated, some healing processes lead to pathological scars, from which symptoms such as pain, itching, and functional limitations are derived. Currently, there is no gold standard treatment that fully meets the needs of different scars and can eliminate any symptoms that the patient suffers. One such treatment is manual medicine, which involves direct manual approaches to the site of injury. Reviewing the phases that allow the skin to be remodeled following an injury, this article reflects on the usefulness of resorting to these procedures, highlighting erroneous concepts on which the manual approach is based, compared to what the current literature highlights the cicatricial processes. Considering pathological scar adaptations, it would be better to follow a gentle manual approach.