[Current methods of treatment and prevention of pathologic scars].
ABSTRACT The aetiology of pathologic scarring is unknown today regarding the keloids. The authors have analyzed the literature and own experience retrospectively according to the evidence based treatments and prevention of the hypertrophic and keloid scars. The corticosteroids have been used intralesionally since the beginning of the 1960-ies. It was followed by the pressure garment therapy in order to treat the widespread burns scars in the early 1970-ies. The silicone gel sheeting is being used since the 1980-ies. The basic treatment of keloids changed, radiotherapy was combined with the above mentioned methods because of its high recurrence rate. Newer methods, cryosurgery as well as lasers were used to treat keloids. The number of effective topical agents was increased. The researchers have been looking for other, intralesionally usable medicine and genetic causes for more than ten years. The clinicians have had the standard protocols of the adjunct and alternative methods too. After having the standard and internationally accepted scar assessment system (Vancouver-scar scale and score), the controlled, randomized trials were practicable. The prospective evaluation of the efficacy of different protocols with adequate follow-up became performable. The comparison of different methods is difficult because of the lack of its standard outcome.
- British Journal of Plastic Surgery 07/1999; 52(4):323-4. · 1.29 Impact Factor
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ABSTRACT: Post surgical scars can be erythematous, raised, pruritic and painful. Numerous modalities are available to improve the appearance and symptomatology of these scars. A topical onion gel extract is the newest in the armamentarium of scar treatments. The active ingredient in this gel is allium cepa. Published studies evaluating the usefulness of this gel in the treatment of scars are not available. To evaluate the effectiveness of topical onion gel extract in improving the appearance and symptomatology of postsurgical scars and to compare the results of its use to those of a topical emollient ointment. Seventeen patients with surgical scars resulting from Mohs surgery were assigned to 1 of 2 groups on the day of suture removal. Each group applied a designated topical product 3 times a day for 1 month. Photographic documentation and questionnaires using a visual analog scale were completed for each scar enrolled in the study. Using the Fischer's exact test, no statistically significant difference between pre- and posttreatment evaluations of scar erythema and pruritus in patients using topical onion extract gel was found. A statistically significant reduction in scar erythema was found in patients using a petrolatum based ointment. Scar hydration is an important factor in wound healing and can be achieved with topical petrolatum-based ointment. Topical onion gel extract was ineffective in improving scar erythema and pruritus in our patients.Dermatologic Surgery 05/1999; 25(4):267-9. · 1.87 Impact Factor
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ABSTRACT: Vitamin E is a generic term for a group of tocol and tocotrienol derivatives. Since the discovery that vitamin E is the major lipid soluble antioxidant in skin, this substance has been tried for the treatment of almost every type of skin lesion imaginable. Anecdotal reports claim that vitamin E speeds wound healing and improves the cosmetic outcome of burns and other wounds. Many lay people use vitamin E on a regular basis to improve the outcome of scars and several physicians recommend topical vitamin E after skin surgery or resurfacing. We attempted to determine whether topically applied vitamin E has any effect on the cosmetic appearance of scars as suggested by multiple anectodal reports. Fifteen patients who had undergone skin cancer removal surgery were enrolled in the study. All wounds were primarily closed in 2 layers. After the surgery, the patients were given two ointments each labeled A or B. A was Aquaphor, a regular emollient, and the B was Aquaphor mixed with vitamin E. The scars were randomly divided into parts A and B. Patients were asked to put the A ointment on part A and the B ointment on part B twice daily for 4 weeks. The study was double blinded. The physicians and the patients independently evaluated the scars for cosmetic appearance on Weeks 1, 4, and 12. The criteria was simply to recognize which side of the scar looked better if there was any difference. The patients' and the physicians' opinions were recorded. A third blinded investigator was shown photographs of the outcomes and their opinion was also noted. The results of this study show that topically applied vitamin E does not help in improving the cosmetic appearance of scars and leads to a high incidence of contact dermatitis. This study shows that there is no benefit to the cosmetic outcome of scars by applying vitamin E after skin surgery and that the application of topical vitamin E may actually be detrimental to the cosmetic appearance of a scar. In 90% of the cases in this study, topical vitamin E either had no effect on, or actually worsened, the cosmetic appearance of scars. Of the patients studied, 33% developed a contact dermatitis to the vitamin E. Therefore we conclude that use of topical vitamin E on surgical wounds should be discouraged.Dermatologic Surgery 05/1999; 25(4):311-5. · 1.87 Impact Factor