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| TREATING SCARS | ARTICLE


results. None of the patients showed failure of therapy. Regression from the periphery was noted in all of the patients next to flattening of the lesions. Within the follow-up period of 1 year, no signs of recurrence were noted in any of the patients. Xiao and colleagues studied 19 patients suffering from


hypertrophic scars who received intralesional injections of botulinum toxin (2.5 u/cm3 intervals) for 3 months104


per lesion at 1-month . At 6-month follow-up, all of the


patients showed acceptable improvement of the scars and therapeutic satisfaction was very high. Erythema, pruritus, and pliability score after injection were significantly decreased compared with baseline104


. The


author’s group treated a total of five patients suffering from therapy-resistant keloids with repeated injections of botulinum toxin A (50 u/ml, with a total dose varying from 25–70 u per session) and have achieved contradicting results to date (unpublished data).


Conclusions Scarring following surgery or trauma is difficult to predict, and both physicians and patients are highly concerned with minimising the appearance of scars, and value even small improvements in scarring as clinically meaningful.


Interferon


therapy has a potential therapeutic benefit in the treatment of abnormal scars based on the idea that it can decrease the synthesis of collagen types I and III.


Existing prophylactic and therapeutic strategies include pressure therapy, silicone gel, onion extract-containing creams, intralesional TAC, cryotherapy, radiotherapy, and surgical excision, as well as a multitude of topical agents. Many of these therapies have been proven through extensive use, but few have been supported by well-designed prospective studies with adequate control groups. Recent techniques such as lasers, intralesional 5-FU and INF, imiquimod and botulinum toxin currently extend the spectrum of excessive scar treatment. Today, fractional lasers are successfully used for the treatment of atrophic scars. Emerging therapies support 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.


 Declaration of interest Dr Gerd G Gauglitz has served as an advisor and speaker for Merz Pharma, MEDA Pharma and Sinclair Pharma


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