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Recombinant TGF- β3 A milestone study by Ferguson and colleagues50


on the


prophylactic effects of TGF-β3 on skin scarring has further increased the current interest in the TGF-β family. In three double-blind, placebo-controlled studies, intradermal avotermin (recombinant, active, human TGF-β3, concentrations ranging from 0.25 to 500 ng/100 µL per linear cm wound margin) was administered in healthy subjects to both margins of 1 cm full-thickness skin incisions, before wounding and 24 hours later. In both young and old participants, only one dose regimen, 50 ng per 100 µL per linear cm, achieved more than 10% scar improvement in nearly two thirds of wounds. However, in the final phase II study, each of three doses was judged to be effective by both lay observers and clinicians3


. Although the investigators


acknowledged their commercial interests in TGF-β3, adherence to established standards in this translational investigation and the rigorous nature of the statistical analysis in a well-powered series of studies provided strong evidence for the benefits of Justiva (avotermin) in this setting. However, in spring 2011, Juvista failed to hit its primary and secondary endpoints in a pivotal phase III trial. In light of these findings, the company regrettably concluded that the efficacy of Juvista may be insufficient to demonstrate significant benefit when tested in a broad population of scar revision patients.


Current treatment strategies Importantly, most of the following therapeutic approaches are usually applied for both the therapy of hypertrophic scars and keloids. Nevertheless, clinical differentiation between hypertrophic and keloid scars is central before the initiation of any treatment, particularly before starting any surgical or laser-related manipulations as specified below.


Intralesional corticosteroid Injections Intralesional steroid injections have gained popularity as one of the most common approaches to attenuate hypertrophic scar and keloid formation since the mid-1960s51


. Effects of corticosteroids result primarily


from its suppressive effects on the inflammatory process in the wound20


, and secondly, from reduced collagen and


glycosaminoglycan synthesis, inhibition of fibroblast growth52


degeneration53


, and enhanced collagen and fibroblast . Three to four injections of TAC (10–40 mg/


ml) are generally sufficient, although occasionally injections continue for 6 months or more51


rates are highly variable, with figures ranging from 50–100%, and a recurrence rate of 9–50%54


. When used


alone, intralesional corticosteroid injections have the greatest effect on younger keloids and can provide symptomatic relief. For older hypertrophic scars and keloids, combination with cryotherapy may reap more effective results55, 56


and represents the most widely used


modality in daily practice. Indeed, the combination of cryotherapy with


intralesional TAC injections seems to yield marked improvement of hypertrophic scars and keloids57–59


. . Response


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