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| TREATING SCARS | ARTICLE


SCARS A


THERAPEUTIC STRATEGIES FOR THE IMPROVEMENT OF


Gerd G. Gauglitz reviews the literature pertaining to the range of treatments available to treat scar tissue, as well as discussing issues of anatomy, efficacy and potential side-effect profiles


ABSTRACT Scars form as a result of the physiologic wound healing process and may arise following any insult to the deep dermis. Genetic susceptibility, specific anatomic locations, prolonged inflammation, and delayed epithelialisation significantly increase the risk of developing excessive or atrophic scarring. Existing prophylactic and therapeutic strategies for keloid and hypertrophic scars include pressure therapy, silicone gel (sheeting), onion extract-containing scar creams, intralesional triamcinolone acetonide (TAC), cryotherapy, radiation, and surgical excision. Many of these have been proven through extensive use, but few have been supported by well-designed prospective studies with adequate control groups. Recent approaches, such as lasers, intralesional 5-fluorouracil (FU) and interferon (INF), imiquimod, and botulinum toxin A currently extend the spectrum of excessive scar treatment. Today, fractional lasers are successfully used for the treatment of atrophic scars. Emerging therapies support combined applications of two or more treatment modalities and earlier interventions in excessive scar-prone patients by modulating single cytokines or signalling receptors, showing encouraging results in some preliminary cases. Nevertheless, based on existing data, excessive scars remain difficult to treat.


TOTAL OF 100 MILLION PATIENTS develop scars every year in the developed world alone, as a result of 55 million elective operations and 25 million operations following trauma1


. As demonstrated in this survey, many


annum (independent research for Renovo: MedTech Insights and TforG) that could benefit from scar reduction therapy3


. Scars form as a result of the complex physiologic


wound healing cascade and may arise following any insult to the deep dermis. Genetic susceptibility, specific anatomic locations, prolonged inflammation, and delayed epithelialisation significantly contribute to increased risks of developing different types of non-physiological scars (i.e. excessive scars and atrophic scars).


Excessive scarring Excessive scars were first described in the Smith papyrus in around 1700 BC4 Peacock (1970)6


. Many years later Mancini (1962)5 differentiated excessive scarring into


and


hypertrophic and keloid scar formation. As per their definitions, both scar types rise above skin level, but while hypertrophic scars do not extend beyond the initial site of injury, keloids typically project beyond the original wound margins5, 6


(Figures 1a and 1b). Both lesions . A recent survey performed in


the USA confirmed that many patients are disappointed with their resulting scars, irrespective of gender, age or ethnicity2


patients would value any opportunity to improve or minimise scarring following surgery or trauma2


.


Indeed, it was estimated that there are approximately 44 million procedures performed in the US (independent research: Mattson Jack Group, Inc.) and approximately 42 million procedures performed in the EU per


represent aberrations in the fundamental processes of wound healing, where there is an obvious imbalance between the anabolic and catabolic phases. Keloids, however, appear to be a more sustained and aggressive fibrotic disorder than hypertrophic scars7


. Evidence to date strongly implies a more prolonged


inflammatory period with immune cell infiltration present in the scar tissue of keloids, the consequence of which may contribute to increased fibroblast activity with greater and more sustained extracellular matrix deposition7


. This, in turn, may help to explain why keloid


scars spread beyond the margins of the original wound, while hypertrophic scars, in which the immune cell


GERD G. GAUGLITZ is Clinical Head, Scar Clinic; Assistant Chief, Department of Aesthetics; Clinical Head, Department of Infectiology and Sexually Transmitted Diseases, Department of Dermatology and Allergology, Ludwig Maximilian University, Munich, Germany


email: gerd.gauglitz@med.uni- muenchen.de


KEYWORDS hypertrophic scars, keloids, atrophic scars, lasers, triamcinolone acetonide, TGF-β


prime-journal.com | January/February 2012 ❚ 17


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