Treatment innovations in hypertrophic and keloid scars


The amount of time required for a burn to heal was reported to be the most important indicator of whether problems would occur. It was demonstrated that one-third of the anatomic sites became hypertrophic when burn wounds re-epithelialised between 14 and 21 days post injury; however, if the burn wound healed after 21 days then 78% of the burn sites developed hypertrophic scars[13]


. While this


study investigated burn scars only, it is clear that delayed epithelialisation of any acute wound dramatically increases the incidence of hypertrophic scarring.


TOP TIPS The main focus for clinicians is to achieve rapid epithelialisation as a first measure of wound care to prevent abnormal scar formation. This is particularly important for wounds subjected to tension due to motion, body location or loss of tissue[11]


. Adequate debridement of


contaminated wounds, good haemostasis and gentle handling of tissues are also crucial factors in achieving re-epithelialisation[12] In terms of choosing treatments, no consensus


.


has been reached as yet, mainly due to the limited evidence-based information found in the literature. However, most therapeutic options have potential effectiveness as both monotherapy and as combination therapy[14]


Page points


1. The main focus for clinicians is to achieve rapid epithelialisation as a first measure of wound care to prevent abnormal scar formation


2. Adequate debridement of contaminated wounds, good haemostasis and gentle handling of tissues are crucial factors in achieving re-epithelialisation


3. The fast healing of acute wounds is the key to minimising abnormal scar formation 4. Research into the mechanism behind the action of scar treatments is also required


. References


THE FUTURE The fast healing of acute wounds is clearly the key to minimising abnormal scar formation. In the future research needs to focus on further understanding the mechanism of hypertrophic and keloid scar development. Furthermore, research into the mechanism behind the action of scar treatments is also required. By understanding these aspects, clinicians and researchers will be more able to develop effective and preventative treatment options for hypertrophic and keloid scars.


AUTHOR DETAILS Professor Zee Upton is Leader, Cell and Molecular Biosciences Discipline, Faculty of Science and Technology; Leader, Cells and Tissue Domain, Tissue Repair and Regeneration Program, Institute of Health and Biomedical Innovation, Queensland University of Technology


Emily Lynam is a PhD Candidate, Tissue Repair and Regeneration Program, Institute of Health


www.woundsinternational.com 8


5.Meier K, Nanney LB. Emerging new drugs for scar reduction. Expert Opin Emerg Drugs 2006; 11(1): 39–47.


6. Bock O, Yu H, Zitron S, Bayat A, Ferguson MW, Mrowietz U. Studies of transforming growth factors beta 1–3 and their receptors I and II in fibroblast of keloids and hypertrophic scars. Acta Derm Venereol 2005; 85(3): 216–20.


7. Shah M, Foreman DM, Ferguson MW. Neutralisation of TGF-beta 1 and TGF-beta 2 or exogenous addition of TGF-beta 3 to cutaneous rat wounds reduces scarring. J Cell Sci 1995; 108(3): 985–1002.


8. Perkins K, Davey RB, Wallis KA. Silicone gel: a new treatment for burn scars and contractures. Burns Incl Therm Inj 1983; 9(3): 201–4.


9. Lynam EC, Xie Y, Loli B, Dargaville TR, Leavesley DI, George GA, Upton Z. The effect of amphiphilic siloxane oligomers on fibroblast and keratinocyte proliferation and apoptosis. J Biomed Mater Res 2010; A. 95(2): 620–31.


10. Atiyeh BS. Nonsurgical Management of Hypertrophic Scars: Evidence-Based Therapies, Standard Practices, and Emerging Methods. Aesthetic Plast Surg. 2007; 31(5): 468–92.


11. Gauglitz GG, Korting HC, Pavicic T, Ruzicka T, Jeschke MG. Hypertrophic Scarring and Keloids: Pathomechanisms, Current and Emerging Treatment Strategies. Mol Med 2010; Available at: http://www.molmed.org/pdfstore/09_153_Gauglitz.pdf (accessed: January 4, 2011)


12. Slemp AE, Kirschner RE. Keloids and scars: a review of keloids and scars, their pathogenesis, risk factors, and management. Curr Opin Pediatr 2006; 18(4): 396–402.


13. Deitch EA, Wheelahan TM, Rose MP, Clothier J, Cotter J. Hypertrophic burn scars: analysis of variables. J Trauma 1983; 23(10): 895–8.


14. Viera MH, Amini S, Valins W, Berman B. Innovative therapies in the treatment of keloids and hypertrophic scars. J Clin Aesthet Dermatol 2010; 3(5): 20–6.


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