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TREATMENT GUIDE |


treatment guide Scar removal


MA Trelles and J Alcolea discuss the effectiveness of a range of treatment options available for the removal of scar tissue


on the depth within the skin layers, scars can endure subtle changes during repair depending on the involvement of the epidermis or superficial dermis. However, a wound can be deeper, reaching the reticular dermis and occasionally, muscles or even the bone. In these cases, inflammation together with formation of reactive granulation, is of significance in the healing process as the lesion can cause destruction of the surrounding tissue, including hair follicles and sweat and sebaceous glands. Wounds in these cases re-epithelize from the edges, incurring a remodulation phenomena which can lead to hypertrophic scars or keloids1


S . Wound healing


goes through three phases. The inf lammat o ry phase, in which blood vessels break as a result of injury leading to collagen formation and p la t el et degranulation, with involvement of neutrophils and monocytes which cleanse the wound. At the same time, proinflammatory cytokines stimulate fibroblast activity. In the proliferative phase, fibroblasts,


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CARS CAN BE DEFINED AS fibrotic tissue formed to replace the skin following a lesion, and occurs during wound repair and the healing process. Depending


and glycosaminoglycans that, together


with new cytokines, activate keratinocytes and fibroblasts to initiate collagen formation, contracting the wound. An angiogenesis process maintains the temporary matrix for the re-epithelization of the wound2


. The remodelling phase, is the most


important phase in the treatment of scars. Here, collagen production and the matrix are equalised with the involvement of fibroblasts, mastocytes, endothelial cells and macrophages, as well as matrix metalloproteinases and interferons. This phase can last 6–12 months depending on the wound. A normal lesion of the dermis will scar


A normal lesion of the


dermis will scar in the first 7–10 days; however, there are lesions that,


hypertrophic scar or keloid.


irrespective of their depth, heal abnormally, transforming into a


in the first 7–10 days; however there are lesions that, irrespective of their depth, heal abnormally, transforming into a hypertrophic scar or keloid. In both cases fibroblasts produce large amounts of collagen owing to a loss of equilibrium of cytokine regulators3 Hypertrophic scars


.


grow respecting the edges of the wound area and can decrease to a normal size with practically no


symptoms.


Keloids share many characteristics of a hypertrophic scar and some authors


believe them to be part of the same proliferative process4


increased in number, build an extracellular matrix of fibrin, fibronectin


. Keloids grow


outside the wound invading surrounding tissue, and can be itchy, sensitive to touch and sometimes painful. Their presence is associated with high levels of


June 2012 | prime-journal.com


melanocyte-stimulating hormone (MSH) and an increase in mastocytes and their chemical transmitters. Atrophic scars show a sunken and


wrinkled aspect. They are usually associated with acne or chickenpox and their importance depends on the level of inflammation that occurs in the skin when formed. The damage to the connective tissue causes atrophy and dermal fibrosis.


Figure 1 (A) Before treatment and (B) 6 months after three sessions, spaced 2 weeks apart, for treatment of scar tissue.


Treatment A number of approaches can be adopted such as occlusion with silicon or polyurethane gel, with or without pressure dressings, as well as steroid or other injections. The most commonly recommended are triamcinolone and bleomycin. Both substances can be mixed and diluted and, administered regularly and directly to the fibrotic tissue, have proved effective. Currently, a range of lasers are used to . However, depending on the


treat scars5,6


interaction of their wavelengths, dosage and treatment techniques, related to the type of scar involved, a different epidermal or dermal response will be observed.


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