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Update on the Treatment of Scars
Abstract
Background: Treatment of scars continues to be a persisting challenge. Scar classification is paramount in determining an appropriate treatment strategy. They can be classified into hypertrophic, keloid, or atrophic scars. With the increasing demand for less invasive procedures that result in equal or greater outcomes, there has been an increase in the variety of procedures for the management of scarring.
Methods: A Pubmed search was performed for the most recent papers on scar treatments. Findings and applications are discussed in this review.
Results: Studies evaluating the efficacy and safety of microneedling, filler agents, toxins, silicone gels, and laser devices such as ablative, non-ablative, fractional, SRT, and radiofrequency are discussed.
Conclusion: Review of the literature revealed a myriad of options for the treatment of different scar types. Although there is not vast evidence in the literature in regard to combination treatments, these are becoming more popular, and it is the author’s opinion that combination treatments yield better overall results.
J Drugs Dermatol. 2019;18(6):550-555.
... Atrophic scars lie beneath the surface of healthy peripheral skin, usually quite small in area. They are commonly found on the face, often as a result of acne or chickenpox [32]. ...
... Among them, the ISCS presented in the 2002 publication in PRS was endorsed as a consensus by a renowned international expert panel and gained worldwide acceptance and recognition [41]. Clinicians and researchers have since acknowledged the robustness of the PRS ISCS, leading to its official adoption into the textbook on scar management in 2020 [32]. Table 1 shows the current ISCS. ...
... Aesthetic concerns and societal beauty standards can create preoccupation, negatively impacting body confidence and image. Additionally, anxiety related to scars is experienced by approximately 20% of patients and more than 50% of patients feel that their privacy is affected by their presence, necessitating coping strategies for mental well-being [32]. ...
Burn injuries are a significant public health concern, marked by substantial mortality and morbidity. The repercussions of burns extend beyond immediate trauma, often resulting in persistent challenges such as abnormal scar formation. Addressing the complexities of preventing and treating hypertrophic scarring requires innovative approaches that transcend mere survival, emphasizing the importance of enhancing the quality of survival of burn patients. Efficient prevention and treatment of hypertrophic scarring present considerable challenges, constituting a multifaceted endeavor to improve existing approaches and formulate novel strategies for optimal outcomes.
The research demonstrates the positive impact of combining laser Doppler imaging and NexoBrid® on the eventual scar quality of burn victims resulting from improved burn depth evaluation and reduced reliance on burn surgery. The effectiveness of Glyaderm®, a human-derived collagen-elastin dermal substitute, in enhancing scar quality in a cost-effective single-stage procedure is highlighted. Dissolving microneedles emerge as a promising, minimally painful alternative for hypertrophic scar treatment, with potential for personalized treatment techniques. A comprehensive systematic review affirms the efficacy of pressure therapy in scar prevention and treatment, emphasizing specific requirements for effectiveness. Scar hydration studies reveal that while costly silicone gels offer benefits compared to no therapy, more economical and patient-friendly moisturizers may be as effective. Moisturizers can replace silicone gels, with an impact on blood flow and the importance of reevaluating compositions for scar treatment. The exploration of anti-AGE enzymatic compounds for deglycation and decrosslinking in damaged skin shows promise for improving skin elasticity. In conclusion, this doctoral work signifies the progress made in scar management, emphasizing the anticipation of a more scarless future despite the long road traveled.
... The topical treatments such as creams, gels, and silicone sheets can help to improve the appearance of scars by reducing redness, flattening the scar, and improving its texture [51]. Injections of corticosteroids can treat both the hypertrophic and keloid scars by reducing inflammation, and by flattening the scar [57]. The surgical excision is also a standard treatment for the hypertrophic and keloid scars, while the laser therapy can improve the scars' appearance, and can stimulate the collagen production [37]. ...
... The potential for NPs to cause allergic reactions is another concern [115] since NPs can induce allergic reactions in some individuals, leading to inflammation, and tissue damage. Therefore, it is essential to consider the potential for NPs to cause allergic reactions when developing a nanotechnology-based approach for wound healing, and scar removal [57,106]. The long-term effects of NPs on the environment are also another concern since NPs can enter the environment through wastewater, leading to potential ecological damage. ...
Nanotechnology has emerged as a promising approach for wound healing and scar removal, offering unique solutions to promote tissue regeneration and reduce scarring. Electrospun nanofibers have gained significant attention due to their ability to mimic the extracellular matrix and provide an ideal environment for cell adhesion, proliferation, and differentiation. This comprehensive review explores the recent advances in electrospinning-related/-based nanotechnology for scar management, focusing on the fabrication techniques, therapeutic applications, and safety considerations. Various electrospinning methods, including needle-based, needleless, melt, emulsion, and solution electrospinning, are discussed via highlighting their advantages and limitations. The incorporation of therapeutic agents, such as drugs, growth factors, and stem cells, into electrospun nanofibers has shown promise in promoting wound healing, and reducing scar formation. However, the biocompatibility and safety of these nanomaterials remain a concern, necessitating rigorous research to ensure their long-term safety, and efficacy. The potential toxicity, biodistribution, immune response, and the regulatory aspects of nanotechnology-based scar treatments are critically examined. Despite the challenges, the future perspectives of electrospun nanotechnology in scar management are promising, with the potential to revolutionize wound care and improve patient outcomes. Further research and development in this field are essential to transform these innovative approaches into clinical practice.
... 2 There are a variety of treatment approaches for atrophic scars, including dermabrasion, chemical peeling, fractional lasers (FL), microneedling, radiofrequency, subcision, and dermal fillers. 5,7 Ablative fractional laser (AFL) and nonablative fractional laser (NAFL) are widely used to treat atrophic scars. 8,9 According to the fractional photothermal theory, fractional lasers stimulate the regeneration of neocollagen and the remodeling of the dermis by acting on the microscopic treatment area of the epidermis and dermis (AFL) or the dermis (NAFL). ...
... Two patients complained of edema that disappeared within 5 days. One patient experienced crusting and skin sensitivity, which were individually relieved within 1 week and 2 weeks.There was no hypopigmentation, hypertrophic scar, blister, or pruritus.Atrophic scars can be treated with several modalities, among which AFL and NAFL are widely utilized.3,5,[7][8][9] Both treatments carry the risk of PIH and obvious pain, and AFL has a longer recovery period.9,11,12 . ...
Background
Fractional picosecond lasers (FPL) are reported to be effective and safe for atrophic acne scars and post‐acne erythema. However, there is no evidence regarding the effectiveness and safety of FPL treatment for non‐acne atrophic scars and scar erythema among Chinese patients.
Methods
In this retrospective study, 12 Chinese patients with non‐acne atrophic scars, including nine with scar erythema, were treated with one to three sessions of 1064 nm FPL treatment. Clinical improvement was objectively assessed through blinded evaluations by external physicians. A modified Manchester Scar Scale (mMSS) and the Clinician Erythema Assessment Scale (CEAS) were individually used to evaluate atrophic scars and scar erythema based on photographs. Physician‐assessed and subject‐assessed Global Aesthetic Improvement Scale (GAIS) were used to assess changes before and after FPL treatment. Patient satisfaction and adverse events were also documented.
Results
Total mMSS scores, as well as three parameters (color, distortion, and texture), were significantly decreased after FPL treatment, with a mean reduction of 3.18 ± 1.60 in total scores (p < 0.05). The CEAS scores were significantly reduced from 2.41 ± 0.98 before treatment to 0.41 ± 0.40 at the final visit (p < 0.05). Based on physician‐assessed and subject‐assessed GAIS scores, 11 (91.7%) patients were improved after FPL treatment. 33.3% of patients were very satisfied, and 41.7% were satisfied. No serious, prolonged (> 3 weeks) adverse events were observed.
Conclusion
Our study suggests that 1064 nm FPL treatment may be a promising option for non‐acne atrophic scars, especially with scar erythema. Further studies are needed to confirm our results.
... Topical treatments such as creams, gels, and silicone sheets can help improve the appearance of scars by reducing redness, flattening the scar, and improving texture [47]. Injections of corticosteroids can treat hypertrophic and keloid scars by reducing inflammation and flattening the scar [53]. Surgical excision is a standard treatment for hypertrophic and keloid scars, while laser therapy can improve the scars' appearance and stimulate collagen production [35]. ...
... NPs can induce allergic reactions in some individuals, 9 leading to inflammation and tissue damage. Therefore, it is essential to consider the potential for NPs to cause allergic reactions when developing nanotechnology-based approaches for wound healing and scar removal [53]. The long-term effects of NPs on the environment are also a concern. ...
Nanotechnology has become an increasingly promising medical field, particularly scar removal. Scar removal is a complex process involving regenerating damaged skin tissue, and nanotechnology presents unique solutions to this issue. One potential application of nanotechnology is using nanofibers as scaffolds to support the growth of new skin tissue. These fibres can also be loaded with drugs or growth factors to promote tissue regeneration and reduce scarring. Another potential application is nanocarriers for drug delivery to specific body areas, which can promote tissue regeneration and reduce scarring.Additionally, nanotechnology has been utilized to create new materials for skin regeneration, such as "nano skin" that mimics the structure of natural skin. Nanoprobes have also been developed for the detection of scar tissue and the monitoring of its progression. These potential nanotechnology applications offer exciting possibilities for the future of scar removal and skin repair. With further research and development, nanotechnology has the potential to revolutionize scar removal and provide more effective solutions for tissue regeneration.
... When the cause of a patient's abnormal posture, resulting from the presence of scar tissue, is not properly diagnosed and then addressed, damage on a structural level, known as a chain of leisings, can occur. The management of such cases, that is, the treatment of diseases and pain syndromes, is based primarily on understanding the functioning of the fascial system in the context of adhesions and taking therapeutic measures that involve more than just the area of the body where the complaints occur [58][59][60]. Therefore, the collaboration of a group of specialists such as a cosmetologist, dermatologist, surgeon, vascular surgeon, plastic surgeon, physiotherapist, psychologist and psychiatrist in scar reduction therapy is invaluable. ...
The skin serves not just a protective function, but also significantly influences body image and social relationships. Consequently, dermatological issues, including acne, eczema, psoriasis, and atopic dermatitis, can yield substantial psychological repercussions for individuals impacted. This study aimed to investigate the correlation between dermatological issues and mental health, emphasising the influence of emotions, stress, and body image on the psychological well-being of individuals. The significance of a comprehensive strategy in the management of dermatological patients was underscored. Findings indicate that people with chronic dermatological conditions are more likely to experience anxiety disorders, depression and reduced self-esteem. Skin problems can lead to social isolation and exacerbate negative emotions such as shame and frustration. Stress, as a reaction to these challenges, can further exacerbate skin symptoms, creating a vicious cycle between physical and psychological conditions. The results indicate a necessity for enhanced cooperation between dermatologists and psychologists in the management of patients with persistent skin disorders.
... This study aims to fill this gap by evaluating the efficacy of laser treatment in enhancing both the physical and psychological dimensions of scars, employing the DLQI as a metric. Previous investigations into laser therapy have primarily concentrated on severe burn scars and their influence on specific issues like sleep, often without directly linking treatment outcomes to overall QoL improvements [20]. In contrast, our research broadens the scope to include various types of scars and examines comprehensive treatment effects. ...
Introduction
The physical and emotional burden that scars impose on people's lives has been the concern of dermatological research for quite some time. Usually, the available literature on the topic draws a grim image containing solely dry medical facts. The present study deviates from this approach by reflecting a solution‐centered study which has also touched on the quotidian life of an average person. The overall intention of the present experiment was to inspect how a holistic approach to scars in dermatology can be crucial for the patient's quality of life.
Methods
This pilot study compiles data collected through the Patient and Observer Scar Assessment Scale (POSAS) and the Dermatology Life Quality Index (DLQI) from the same set of patients within the span of a year. Sixty patients with diverse scar profiles were asked to rate POSAS and DLQI in every session. A combination of EBDs was used based on the scar examination. Student's t‐test was run to validate the data.
Results
The evaluations by POSAS and DLQI indicate significant improvement in the physical aspect of the scar as well as the patient quality of life a year after the first treatment. According to mean values collected from POSAS, there is a direct correlation between average patient evaluations and physician assessments. Thus, EBDs prove to be efficient in improving the QoL of scar patient. The 20 patients who had reported mild side effects after treatments recovered fully within a few days after the sessions. No patient reported severe side effects.
Discussion
Apart from the physical indications that scars bring about into patients' lives, the psychological repercussions caused by scars have a major effect on the QoL of the patients. These repercussions can be divided into individual and social. At the individual level, scars have a profoundly negative effect on the image of the self which leads to several different psychological complications by time. At the social level, scars affect the radius of physical movement besides the quality of the patient's activities. Therefore, EBDs as effective treatment methods can improve itchiness, pain, and so forth, of the patient, and can also improve the psychological aspect.
Conclusion
All in all, the present study aims to produce a more panoramic perspective on the concern of scars in the field of dermatology, centering around EBDs as a solution for improving scar patient QoL. With a focus on the efficacy of EBDs in the scar treatment, and with reference to studies on the topic, it is safe to assume that the earlier the scar treatment initiates, the better the outcomes. Departing from this point, in the future of cosmetic dermatology, prepping the skin by EBD treatments before surgery is imaginable.
... These pathological conditions are not just physical manifestations; they also lead to pain, redness, itching, and contracture, adversely affecting a patient's quality of life and causing severe psychological distress. Despite several treatment options such as surgery, radiation, and laser therapy, current treatments have not demonstrated high e cacy (González and Goldberg, 2019) . ...
Hypertrophic scar (HS) is a sequela of abnormal dermal repair, marked by the excessive proliferation of fibroblasts and dermal fibrosis. While long-non-coding RNAs (LncRNAs) have emerged as crucial modulators in HS, the underlying mechanisms are yet to be fully elucidated. Our study employed DNA Microarrays to analyze differentially expressed LncRNAs in HS and identified significant upregulation of TUG1. Further analysis based on the TargetScan database revealed that TUG1 has binding sites for miR-627 and its target gene IGFR1. Quantitative Real-Time PCR (qRT-PCR) confirmed the upregulation of TUG1 and IGFR1, and downregulation of miR-627 in HS samples. Subsequent assays, including qRT-PCR, luciferase reporter gene, and Western Blot, were conducted to explore the interactions between TUG1, miR-627, and IGFR1. MTT and Transwell assays assessed the proliferative and migratory abilities of hypertrophic scar fibroblasts (HSFs). Furthermore, the rabbit ear scar model supported our findings. We discovered that upregulation of TUG1 or downregulation of miR-627 facilitated HSF proliferation and migration, elucidating a negative regulatory relationship between TUG1 and miR-627. Mechanically, TUG1 competitively binds to miR-627, thus freeing IGFR1 for upregulation. In conclusion, TUG1 knockout can inhibit HSF proliferation and migration by upregulating miR-627, which subsequently downregulates IGFR1. These findings offer novel insights for the effective treatment of HS.
... Scars result from a natural healing process that leads to the formation of fibrous tissue that replaces normal tissue destroyed by injury or disease [1]. Scar formation can result in keloid scarring due to increased fibrous tissue formation, but more commonly, atrophic scars are formed due to tissue loss or reduction at the site of injury [2]. Atrophic scars are common in patients with acne, chickenpox, trauma, and other skin diseases. ...
Background: Atrophic scars are the result of natural healing leading to the formation of replacement fibrous tissue. The atrophic scar is a common undesirable complication of acne, chickenpox, herpes, trauma, etc. Although the disease does not cause dangerous complications, due to the location of the lesions on the face, it causes great aesthetic and psychological obstacles, and the patient is less confident in communication, profoundly affecting the patient's quality of life. and labor productivity. The combination of subcision and platelet-rich plasma (PRP) in the treatment of atrophic scars is a new method applied in recent years. The morphological characteristics and causes of them may affect the results of subcision and platelet-rich plasma treatment. Objectives: To describe the clinical characteristics and causes of atrophic scars in patients at Can Tho Dermato-Venereology Hospital from 4/2021 to 6/2023. Materials and methods: A cross-sectional descriptive study was carried out on 30 patients with atrophic scars who were treated with subcision and platelet-rich plasma at Can Tho Dermato-Venereology Hospital in 2021 –2023. Results: the average age of onset of atrophic scars was 21.27 ± 4.085 years old, and the average duration of atrophic scars was 6.33 ± 4.31 years. The majority of patients had acne scars, accounting for 90%; only 6.7% had post-varicella scars; and 3.3% had traumatic scars. 70% with mixed scars, and the common rate of boxscar (83.3%). Scars on the cheek were 100%, and 80% of patients appear to have atrophic scars in multiple locations. Scars color as normal skin accounted for 66.7%. The most atrophic scar patients classified as grade 3 accounted for 66.7%, grade 4 accounted for 23.3%, and at least level 2 accounted for 10%. Conclusions: Facial atrophic scars are mainly the result of acne. Most of them have mixed scars, boxscar are common. Atrophic scars are mainly distributed on the cheeks and in multiple locations. And grade 3 accounts for the majority.
... Proteases are also used in detergents formulations [54] and in cosmetic, as whitening agents [66] or to remodel scar tissue [58]. In particular, gel formulations have been developed to maintain the active agents in the desired site of action for prolonged time and to fine-tune their delivery [66,67]. ...
Hydrolases are enzymes that have found numerous applications in various industrial sectors spanning from pharmaceuticals to foodstuff and beverages, consumers’ products such as detergents and personal care, textiles, and even for biodiesel production and environmental bioremediation. Self-assembling and gelling short peptides have been designed for their mimicry so that their supramolecular organization leads to the creation of hydrophobic pockets for catalysis to occur. Catalytic gels of this kind can also find numerous industrial applications to address important global challenges of our time. This concise review focuses on the last 5 years of progress in this fast-paced, popular field of research with an eye towards the future.
... For the treatment of abnormal scars and the improvement of the healing process, numerous investigations have been conducted on intervention or revision methods, and there are clinical management recommendations based on the available evidence. These include topical applications, intralesional medication (such as hyaluronic acid, corticosteroids, antimitotics), cryotherapy, laser applications, make-up camouflage, micro needling, radiofrequency, or oral agents [11][12][13][14][15]. ...
The development of abnormal scars has a great impact on people’s well-being, and improving scarring outcomes after surgery is a field that currently lacks consensus. This review aims to identify newly researched approaches to improving the quality of surgical scars. A systematic search of PubMed, Scopus, Web of Science, and ScienceDirect was conducted between 13 May 2023 and 17 May 2023, in accordance with the recommendations of the PRISMA Statement. Study selection and analysis of methodological quality were performed in parts, independently and blindly, based on eligibility criteria. The 21 prospective, comparative, and randomized studies reviewed included 1057 subjects and studied approaches such as topical applications of creams with herbal extracts and silicone gels, growth factors, negative pressure dressings, oligonucleotides, intralesional injection of compounds such as botulinum toxin, skin closure techniques such as suturing and tissue adhesive, and laser treatments. There are recent research techniques that generate good results and are really promising to improve the results of surgical scars; however, the available evidence is extremely limited in some cases, and it is necessary to deepen its analysis to obtain reliable action protocols in each type of surgery.
... This dysfunction causes itching and pain in most patients for long periods of time [11]. In addition, from a psychological point of view, these pathologies generate a negative cosmetic and emotional impact on patients, which can even limit their social interaction and affect their self-esteem [12]. ...
Citation: Hernández-Bule, M.L.; Toledano-Macías, E.; Pérez-González, L.A.; Martínez-Pascual, M.A.; Fernández-Guarino, M. Anti-Fibrotic Effects of RF Electric Currents. Int. J. Mol. Sci. 2023, 24, 10986. https:// Abstract: Hypertrophic scars and keloids are two different manifestations of excessive dermal fibrosis and are caused by an alteration in the normal wound-healing process. Treatment with radiofrequency (RF)-based therapies has proven to be useful in reducing hypertrophic scars. In this study, the effect of one of these radiofrequency therapies, Capacitive Resistive Electrical Transfer Therapy (CRET) on biomarkers of skin fibrosis was investigated. For this, in cultures of human myofibroblasts treated with CRET therapy or sham-treated, proliferation (XTT Assay), apoptosis (TUNEL Assay), and cell migration (Wound Closure Assay) were analyzed. Furthermore, in these cultures the expression and/or localization of extracellular matrix proteins such as α-SMA, Col I, Col III (immunofluorescence), metalloproteinases MMP1 and MMP9, MAP kinase ERK1/2, and the transcription factor NFκB were also investigated (immunoblot). The results have revealed that CRET decreases the expression of extracellular matrix proteins, modifies the expression of the metalloproteinase MMP9, and reduces the activation of NFκB with respect to controls, suggesting that this therapy could be useful for the treatment of fibrotic pathologies.
... В случае с атрофическими рубцами терапевтические усилия должны быть направлены на восполнение потерянного объема и структуры измененных тканей. С этой задачей весьма эффективно справляются фракционная лазерная и радиочастотная терапия, волюметрическая коррекция филлерами на основе гиалуроновой кислоты и аутологичного жира, реструктурирующая терапия препаратами на основе гидроксиапатита кальция и коллагена и другие методы [29]. ...
Scars are an urgent issue for many areas of practical medicine, especially for dermatovenerologists, cosmetologists and plastic surgeons. Every year, 100 million patients develop new scars and about 11 million of them are keloid. The issue of differential diagnosis of keloid and hypertrophic scars is still the subject of discussion among specialists. Despite the wide variety of available methods of treatment of keloid and hypertrophic – surgical excision, injections of glucocorticosteroids, laser therapy, cryotherapy, compression therapy and silicone bandages are the most effective and pathogenically rationalised methods for the correction of pathological scars. Promising methods of therapy are: injections of interferon, recombinant human TGF-β3 polypeptide, platelet-rich plasma, calcium channel blockers, lipofilling, the use of angiotensin-converting enzyme inhibitors, creams based on imiquimod and resiquimod, growth factors, stem cells. The article presents an up-to-date view on the processes of physiological and pathological scarring, the most important aspects of the differential diagnosis of keloid and hypertrophic scars, the understanding of which is important for choosing the right therapeutic strategy. Particular attention is paid to the pathophysiological mechanisms of action, the advantages and features of the use of silicone dressings. The authors present the clinical experience of successful two-stage correction of keloid scar – post-acne with the use of injection therapy with hyaluronidase and silicone dressings.
... However, patients with HS due to surgery, acne, or other skin damages (degloving injury, puncture, and knife trauma…) were excluded. And patients with keloid and atrophic scars were also ruled out [27]. What is particularly noteworthy is that all enrolled patients denied any history of psychological/mental illness or use of psychoactive drugs. ...
PurposeThis study assessed sleep quality in patients with burn scars and investigated risk factors of sleep disorders to guide clinical therapy. From the strategy of predictive, preventive, and personalized medicine (PPPM/3PM), we proposed that risk assessment based on clinical indicators could prompt primary prediction, targeted prevention, and personalized interventions to improve the management of sleep disorders present in patients with burn scars.Methods
This retrospective study recruited patients with burn scars and healthy volunteers from the Shanghai Burn Treatment Center between 2017 and 2022. Relevant information and data, including demographic characteristics, scar evaluation, and sleep quality, were obtained through the hospital information system, classical scar scale, and self-report questionnaires. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) and monitored using a cardiopulmonary-coupled electrocardiograph. Pain and pruritus were assessed using the visual analog scale (VAS). Scar appearance was assessed using the modified Vancouver scar scale (mVSS).ResultsThe sample was comprised of 128 hypertrophic scar (HS) patients, with 61.7% males, a mean age of 41.1 ± 11.6 years, and burn area of 46.2 ± 27.9% total body surface area (TBSA). Patients with PSQI ≥ 7 accounted for 76.6%, and the global PSQI score was 9.4 ± 4.1. Objective sleep data showed that initial enter deep sleep time, light sleep time, awakening time, light sleep efficiency, and sleep apnea index were higher but deep sleep time, sleep efficiency, and deep sleep efficiency were lower in HS patients than that in healthy controls. Preliminary univariate analysis showed that age, hyperplasia time of scar, narrow airway, microstomia, VAS for pain and pruritus, and mVSS total (comprised of pigmentation, vascularity, height and pliability) were associated with the PSQI score (p < 0.1). Multivariable linear regression showed narrow airway, VAS for pain and pruritus, and mVSS specifically height, were the risk factors for PSQI score (p < 0.1).Conclusions
This study model identified that narrow airway, pain, pruritus and scar appearance specifically height may provide excellent predictors for sleep disorders in HS patients. Our results provided a basis for the predictive diagnostics, targeted prevention, and individualized therapy of somnipathy predisposition and progression of HS patients in the setting of PPPM/3PM health care system, which contributed to a paradigm shift from reactive cure to advanced therapy.
... A traumatic scar is a complex, disfiguring and limiting soft tissue injury caused by a burn, trauma, and/or surgery which may require multiple therapy interventions [1,2]. People affected by a traumatic scar may experience both functional and psychological impairment [3]. ...
Objectives
To experimentally compare two fractional ablative CO2 laser handpieces intended for the treatment of large area burn scars. Each handpiece coverage rate, depth of penetration and application time were measured and compared in a simulation model of large area burns scars using a dynamic/roller handpiece (small footprint) and a stationary/stamping handpiece (large footprint).
Methods
A 30 W fractional ablative CO2 laser was applied using 2 different handpieces and footprints on a A4 size paper stack. The handpieces were a stationary (stamping) handpiece with 7×7 (49 pixels/square shape) and dynamic (roller) handpiece with 7×1 (7 pixels/single row shape). For both handpieces the laser settings were fixed at "High" power (30 W), providing an energy level of 100mJ/pixel. Both handpieces were applied perpendicular to the surface, with the process repeated for the dynamic handpiece with an angled operation. The depth of laser penetration was assessed by the number of pages of paper having visible holes and burn area coverage time measured under each handpiece/condition.
Results
The application time was faster and the penetration deeper for the dynamic handpiece compared to the stationary handpiece in both the perpendicular and angled conditions. This study has practical implications for lasers operators to improve time efficacy in large area scars with improved clinical endpoints.
Conclusion
The fractional ablative dynamic handpiece demonstrated superior application efficiency compared to the stationary handpiece in the simulated treatment of large surface area burn scars, reducing treatment time with improved depth of penetration.
... Abnormal scarring is a complication of aberrant wound healing caused by excessive proliferation of fibrous tissue. Abnormal scars are divided into three types: hypertrophic, keloid, and atrophic [1]. e wound healing process occurs in three stages: inflammation, proliferation, and remodelling. ...
Hypertrophic scarring (HS), caused by excessive fibrosis of injured skin, imposes a psychological burden and creates a source of distress that impairs the quality of life of affected individuals. However, the gold standard for HS treatment has not yet been determined due to the complicated and difficult nature of the routines and procedures involved. Previous studies have indicated that the topical application of certain active components found in traditional Chinese medicines shows potential as a therapeutic alternative for scars. Here, single-cell RNA-sequencing was performed to determine cellular heterogeneity and identify marker genes and mechanisms associated with HS. It was found that fibroblasts comprise the largest proportion of HS cell types. The marker genes that were highly expressed in fibroblasts were extracellular matrix (ECM)-related, whereas ECM-receptor interactions and the transforming growth factor (TGF)-β signalling pathway were also found to be active. Ultra-high-performance liquid chromatography-quadrupole time-of-flight mass spectrometry, which was applied to identify the molecular compounds of Dispel-Scar Ointment (DSO), revealed 74 effective chemical components belonging to 14 types of constituents, such as flavonoids, tanshinones, salvianolic acids, glycosides, and phthalides. Furthermore, in vivo studies using rat scar models showed that the topical application of Salvia miltiorrhiza, Ligusticum chuanxiong, peach kernel, safflower, and motherwort exerted beneficial effects on fibroblasts. DSO promoted scar maturation and reduced scar areas, its efficacy being similar to that of topically applied silicone. Functional studies using immunofluorescence staining, western blotting, and quantitative real-time polymerase chain reaction demonstrated that DSO may target the TGF-β/Smad pathway to inhibit collagen synthesis and promote ECM remodelling. However, further in vitro mechanistic research and single-drug prescription studies may be required to identify the specific effective compound or active ingredient of DSO, which would provide more substantial evidence regarding the potential therapeutic value of traditional herbs in HS.
... 6 Additionally, current treatments in reversing HSs are also minimally effective. 7 Therefore, hypertrophic scarring is a major concern in DPT burn injuries, and effective prevention and treatment strategies are needed. ...
Hypertrophic scars are a common negative outcome of deep partial-thickness burn wounds resulting in increased dermal thickness, wound area contracture, and inflammation of the affected area. The red Duroc and Yorkshire porcine breeds are common large animal models for studying dermal wounds due to their structural similarities to human skin; however, the porcine transcriptomic profiles of dermal burn wounds and healing process are not well known. In response, a longitudinal transcriptomic comparative study was conducted comparing red Duroc and Yorkshire superficial and DPT burn wounds to their respective control uninjured tissue. Using next-generation RNA-sequencing, total RNAs were isolated from burn wound tissue harvested at 0, 3, 7, 15, 30, and 60 days post-burn and mRNA-seq and gene expression read counts were generated. Significant differentially expressed genes relative to uninjured tissue were defined and active biological processes were determined using gene set enrichment analyses. Additionally, collagen deposition, α-SMA protein concentration, epidermal and dermal thickness measurements, and wound area changes in response to burn injury were characterized. Overall, the red Duroc pigs, in response to both burn wound types, elicited a more robust and prolonged inflammatory immune response, fibroblast migration and proliferation as well as heightened levels of extracellular matrix modulation relative to respective burn types in the Yorkshire pigs. Collectively, the red Duroc deep partial-thickness burn wounds produce a greater degree of hypertrohic scar like response compared to Yorkshire DPT burn wounds. These findings will facilitate future porcine burn studies down-selecting treatment targets and determining effects of novel therapeutic strategies.
... Применяемые в настоящее время косметологические процедуры (пилинги, мезотерапия, дермабразия) направлены на эстетическую коррекцию рубцов небольших размеров, но не имеют какого-либо терапевтического эффекта [9]. В то же время с увеличением спектра разнообразных процедур для лечения рубцов, которые приводят к сходным или более высоким результатам, увеличился спрос на менее инвазивные вмешательства [10]. Одним из них является воздействие факторов роста, содержащихся в богатой тромбоцитами плазме (БоТП). ...
Purpose : to evaluate the effectiveness of platelet-rich plasma lysate (PRP) in the treatment of patients with post-traumatic eyelid scarring by clinical examples. Material and methods . Patients with post-traumatic scarring changes in eyelid tissues causing a damage in the functional and cosmetic state of the auxiliary apparatus of the eye were treated in the Department of Plastic Surgery and Eye Prosthetics at the Helmholtz National Medical Research Center of Eye Diseases. Two of the patients, who had been traumatized shortly before the examination and one patient who had rejected surgery were offered treatment by PRP lysate manufactured at the Sklifosovsky Medical Research Institute of Emergency Medicine. After local infiltration anesthesia, each patient received a single injection of PRP lysate (2 ml) into the scar tissue. The result was evaluated at a follow-up that took place 3 months after the injection. Results . The clinical picture of the three patients showed a pronounced positive dynamic of the functional and cosmetic state of the auxiliary eye apparatus, which made the patients reject subsequent (additional) surgical treatment. Conclusion . An improvement tissue repair and regeneration processes after PRP lysate injection allows us to assess this method as an applicable alternative of reconstructive operations in certain cases.
... The mean age of subjects was 24.86 ± 6.98 years (range: 19-41); the subjects had Fitzpatrick skin types III-V. The mean scar surface area was 5.95 ± 3.94 cm 2 (range: [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15], and the average duration of scars was 2.5 ± 2.45 years (range: ...
Background
Hypertrophic scars (HS) are a challenging disorder that mostly develops during wound healing process following skin injuries.
Methods
A split‐scar, double‐blind randomized controlled trial was held to assess the safety and efficacy of botulinum toxin type A (BTA) injection in hypertrophic scars (HS). Thirty patients with old scars (range 1‐15years) were treated, with sides randomized to receive treatment with either BTA or 0.9% normal saline once monthly for three consecutive months. Scars were assessed using the Vancouver scar scale (VSS) along with digital photograph standardization
Results
Twenty one subjects completed the study. The mean VSS score for the BTA‐treated half of the scars decreased from 7.29±2.327 before injection to 5.33±2.41 following injection which was highly significant (p = 0.01). For the control half, the mean VSS decreased insignificantly from 7.29±2.327 before injection to 7.10±2.234 following injection (p = 0.104).
Conclusion
Clinical and cosmetic improvement was demonstrated significantly among the BTA treated group. BTA can be an additional and useful tool for improving scar outcomes.
... Hypertrophic scars and adjacent normal skin tissues were harvested from three female patients (aged 6, 20 and 26 years) who were admitted to the First Affiliated Hospital of Nanchang University from April to October 2018. A typical manifestation of hypertrophic scar is a bulging, erythematous, itching and thickened scar restricted to the site of injury (19,20). Samples were obtained from patients with hypertrophic scars following perineal burns that had not been treated with drugs or radiotherapy prior to sample collection. ...
tRNA‑derived small RNAs (tsRNAs) have been shown to play regulatory roles in many physiological and pathological processes. However, their roles in hypertrophic scars remain unclear. The present study investigated differentially expressed tsRNAs in human hypertrophic scar fibroblasts and normal skin fibroblasts via high‑throughput sequencing. Several dysregulated tsRNAs were validated by reverse transcription‑quantitative polymerase chain reaction (RT‑qPCR). Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment, target prediction, coexpression networks and competing endogenous RNA (ceRNA) networks were evaluated to discover the principal functions of significantly differentially expressed tsRNAs. In total, 67 differentially expressed tsRNAs were detected, of which 27 were upregulated and 40 downregulated in hypertrophic scar fibroblasts. The GO analysis indicated that the dysregulated tsRNAs are associated with numerous biological functions, including 'nervous system development', 'cell adhesion', 'focal adhesion', 'protein binding', 'angiogenesis' and 'actin binding'. KEGG pathway analysis revealed that the most altered pathways include 'Ras signaling pathway', 'Rap1 signaling pathway' and 'cGMP‑PKG signaling pathway'. The target genes of the differentially expressed tsRNAs participate in several signaling pathways important for scar formation. The results of RT‑qPCR were consistent with those of sequencing. MicroRNA (miR)‑29b‑1‑5p was identified as a target of tsRNA‑23678 and was downregulated in hypertrophic scar fibroblasts, constituting a negative regulatory factor for scar formation. Furthermore, tsRNA‑23761 acted as a ceRNA and bound to miR‑3135b to regulate the expression of miR‑3135b targets, including angiotensin‑converting enzyme. Collectively, these findings reveal that tsRNAs are differentially expressed in human hypertrophic scar fibroblasts, and may contribute to the molecular mechanism and treatment of hypertrophic scars.
... Despite increasing knowledge of the pathomechanisms of fibrotic diseases, there is no uniformly effective treatment, and a myriad of approaches have been reported, with variable success (González and Goldberg, 2019). Monotherapy with a variety of approaches, including surgical excision, intralesional steroid injections, brachytherapy, and silicone sheath application, has resulted in a high degree of recurrence (Tirgan, 2019b). ...
Wound management and acceleration of the healing process is influenced by a complex and coordinated set of cells and molecules. Disturbance in this process leads to longer treatment time, scar formation, and chronic wound which causes several complications. Therefore, it is necessary to understand and apply the appropriate treatment to different types of wounds. Exosomes can be mentioned as an effective novel cell-free strategy for the treatment of wounds. Exosomes as a population of extracellular vesicles have the characteristics of their parental cells and carry various components including functional protein and RNA factors. Exosomal factors specially depend on the type of cell that produced them. In this regard, stem cells, especially mesenchymal stem cell-derived exosomes have shown potentials in regenerative medicine and wound healing. Although MSC-derived exosomes are efficient in treatment of wounds that is comparable to other traditional treatment methods, they also have some innate limitations. Currently, scientists have the tendency to develop designed or engineered exosomes for overcoming some of the limitations. In this review, we explained the process of wound healing and exosomes from a molecular and cellular point of view. In addition, we reviewed the latest research of the application of natural and engineered exosomes in the wound healing process.
Hypertrophic scars are contained within the site of injury and may regress over time, while keloids spread beyond the borders of the initial injury and do not regress. On histologic examination, hypertrophic scars tend to have collagen in a wavy, regular pattern, whereas keloids have no distinct pattern of collagen.
To retrospectively analyze improvement in keloid and hypertrophic scars characteristics following treatment with Ablative 10600 nm and a non-Ablative 1570 nm Hybrid Laser Device.
Treatment parameters with the ProScan Hybrid Mode were 40 W/1.3–1.5 ms for the CO2 and 12 W/4 ms for the 1570 nm in a 1:1 ratio. Outcomes were assessed based on physician scar grading as measured by the Vancouver Scar Scale and patient-reported satisfaction. Excel was used for data analysis, and a p value < 0.05 was considered statistically significant. Adverse events and patient pain were also recorded.
A total of 31 hypertrophic scars and 30 keloid scars were treated. There was a significant reduction in Vancouver Scar Scale scores for both hypertrophic and keloid scars (62% ± 8% and 58% ± 7%; p = 2.6E-17 and p = 8.29E-26, respectively). In a scar-based comparison, a statistically significant difference was observed for all measures reflecting favorable outcomes for hypertrophic scars (VSS, p = 1.1E-05; satisfaction, p = 0.0112; pain, p = 0.00081). Only one adverse event was reported, a superficial burn treated with topical antibiotics.
The device was found to be safe and effective, with promising results for the treatment of hypertrophic and keloid scars.
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
Objective
A systematic review and meta‐analysis were conducted to evaluate the efficacy and safety of ablative laser combined with pulsed dye laser to treat pathological scars.
Methods
A systematic literature review was conducted to identify all blind, randomized, controlled trials of ablative laser and pulsed dye laser for treating pathological scars. The databases PubMed, Embase, and Cochrane were used. All research on ablative laser combined with PDL in treating pathological scars with ablative laser or no treatment as controls were included in the meta‐analysis. The retrieved studies' reference lists were thoroughly examined.
Results
POSAS and VSS were used as evaluation criteria in seven studies involving 189 patients. Effect of combined laser group therapy (−1.259 95% confidence interval, −1.515 to −1.003; p < 0.0001). The difference between the combined treatment and control groups was (−1.375; 95% CI, −1.727 to −1.023; p < 0.0001) and (−1.150; 95% CI, −1.523 to −0.777; p < 0.0001).
Conclusions
Ablative laser combined with PDL is more effective and safer than ablative laser or PDL alone in the treatment of pathological scars.
Резюме. Лікування післяопераційного рубця тісно пов’язане з етапами загоєння рани. Ведення пацієнта із плановою операцією починається з ретельного збору анамнезу, під час якого його інформують про особисті та клінічні показники, на які неможливо вплинути, наприклад, вік, етнічне походження, наявність супутніх захворювань. Мета дослідження – провести аналіз та узагальнення літературних джерел із вивченням сучасних відомостей про етіологічні та патофізіологічні аспекти утворення рубцевої тканини. Матеріали і методи. У дослідженні використано аналітичний та бібліосемантичний методи. Пошук наукової інформації щодо дослідної медичної тематики проводили у базах даних пошукових систем. Результати досліджень та їх обговорення. Утворення рубцевої тканини є фізіологічною реакцією на травму тканин й охоплює широкий спектр – від нормотрофічних рубців до атрофічних, гіпертрофічних і келоїдних. Порушення цілісності шкіри змінює клітинне середовище та може впливати на процеси каскаду загоєння ран. Коли цілісність шкіри відновлюється, механічні сили можуть впливати на ремоделювання шкіри, що призводить до ускладненого та тривалого відновлення. Механізми, за допомогою яких відбуваються ці процеси в нормальній шкірі під час загоєння ран, залишаються повністю не вивченими. При загоєнні ран може відбуватися як надмірний фіброз та патологічне рубцювання, так і сповільнене загоєння ран, що клінічно характеризується хронічними виразками, які не загоюються. Обидва варіанти аномального загоєння та відновлення ран становлять значну проблему для лікарів-хірургів. Утворення надмірного об’єму рубцевої тканини, спричинене патологічно надлишковим відкладенням колагену, є проблемою, відомою усім хірургам. Ускладнення при загоєнні ран, такі, як утворення гіпертрофічних рубців та келоїдів, можуть призвести до естетично неприйнятного результату, втрати функції, обмеження руху та/або росту тканин і несприятливих психологічних наслідків. Розвиток рубців – це тривалий процес, де формуваня та дозрівання рубцевої тканини може тривати декілька років. Тому і лікування часто є тривалим і вимагає комплексного підходу. Висновки. Завдяки глибшому розумінню фізіології загоєння ран і фізико-хімічних принципів утворення рубців, медична наука сприяє розробці нових стратегій лікування та профілактики патологічних рубців. Важливо бути максимально обізнаними у питанні утворення рубцевої тканини. Це дасть змогу планувати будь-яке хірургічне втручання таким чином, щоби мінімізувати або уникнути можливі ускладнення в післяопераційному періоді.
More than 12 decades have passed since the first clinical application of fat grafting. Because fat grafting is associated with an unpredictable survival/retention rate and potential complications, such as fibrosis, abscess/cyst formation, nodulation irregularity, and neurovascular injury, autologous fat grafting has become a popular procedure due to the ease of harvesting, an abundance of graft material (autologous adipose tissue), and lack of transplantation rejection. Lin introduced the concept of micro-autologous fat transplantation (MAFT) in 2007. The dogma of MAFT focused on the theme that each transplanted fat parcel should be less than <1/100 mL (0.01 mL) to avoid central necrosis, which is the main cause of most complications after fat grafting. The innovative instrument, the MAFT-GUN, has been developed and certified. This innovative instrument has a patented mechanism that facilitates and ensures that surgeons deliver fat parcels flexibly and consistently at volumes of 1/60, 1/90, 1/120, 1/150, 1/180, or 1/240 mL. This chapter discusses the history of fat grafting and parcel size, focusing on the prevention of central necrosis. The key points of the MAFT technique and its clinical results for facial and body contouring are illustrated to demonstrate its feasibility and indispensability in aesthetic, reconstructive, and regenerative surgeries.
This chapter highlights the importance of a comprehensive burn scar treatment plan in approaching a burn survivor. General concepts of burn scar physiology and a practical system to describe burn scars based on cause, biology, and symptoms are presented. Common scar management modalities including nonsurgical, surgical, and adjuvant therapies are further discussed.
Importance
Keloids and hypertrophic scars (excessive scarring) are relatively understudied disfiguring chronic skin conditions with high treatment resistance.
Objective
To evaluate established comorbidities of excessive scarring in European individuals, with comparisons across ethnic groups, and to identify novel comorbidities via a phenome-wide association study (PheWAS).
Design, Setting, and Participants
This multicenter cross-sectional population-based cohort study used UK Biobank (UKB) data and fitted logistic regression models for testing associations between excessive scarring and a variety of outcomes, including previously studied comorbidities and 1518 systematically defined disease categories. Additional modeling was performed within subgroups of participants defined by self-reported ethnicity (as defined in UK Biobank). Of 502 701 UKB participants, analyses were restricted to 230078 individuals with linked primary care records.
Exposures
Keloid or hypertrophic scar diagnoses.
Main Outcomes and Measures
Previously studied disease associations (hypertension, uterine leiomyoma, vitamin D deficiency, atopic eczema) and phenotypes defined in the PheWAS Catalog.
Results
Of the 972 people with excessive scarring, there was a higher proportion of female participants compared with the 229 106 controls (65% vs 55%) and a lower proportion of White ethnicity (86% vs 95%); mean (SD) age of the total cohort was 64 (8) years. Associations were identified with hypertension and atopic eczema in models accounting for age, sex, and ethnicity, and the association with atopic eczema (odds ratio [OR], 1.68; 95% CI, 1.36-2.07; P < .001) remained statistically significant after accounting for additional potential confounders. Fully adjusted analyses within ethnic groups revealed associations with hypertension in Black participants (OR, 2.05; 95% CI, 1.13-3.72; P = .02) and with vitamin D deficiency in Asian participants (OR, 2.24; 95% CI, 1.26-3.97; P = .006). The association with uterine leiomyoma was borderline significant in Black women (OR, 1.93; 95% CI, 1.00-3.71; P = .05), whereas the association with atopic eczema was significant in White participants (OR, 1.68; 95% CI, 1.34-2.12; P < .001) and showed a similar trend in Asian (OR, 2.17; 95% CI, 1.01-4.67; P = .048) and Black participants (OR, 1.89; 95% CI, 0.83-4.28; P = .13). The PheWAS identified 110 significant associations across disease systems; of the nondermatological, musculoskeletal disease and pain symptoms were prominent.
Conclusions and Relevance
This cross-sectional study validated comorbidities of excessive scarring in UKB with comprehensive coverage of health outcomes. It also documented additional phenome-wide associations that will serve as a reference for future studies to investigate common underlying pathophysiologic mechanisms.
Background:
Scars can cause pain as well as long-term physical dysfunction and psychological harm. Botulinum toxin type A (BoNT-A) is one of the treatment choices for scars. However, further evidence is needed to confirm its efficacy.
Methods:
This systematic review included randomized controlled trials (RCTs) that investigated the effectiveness of BoNT-A on scars. We extracted the mean and standard deviation for the Vancouver scar scale (VSS), Stony Brook Scar Evaluation Scale (SBSES), Visual Analog Scale (VAS) for appearance evaluation, VAS for scar pain evaluation and scar width. Subgroup analysis was performed to understand the effect of active control.
Results:
Overall, 21 RCTs met the inclusion criteria. VSS results revealed that the BoNT-A group had a lower score than the saline group [standardized mean difference (SMD): -0.82, 95% confidence interval (CI): -1.24 to -0.39, I2 = 65%, P = 0.0002], whereas the BoNT-A group had a higher score than the steroid group (SMD: 0.85, 95% CI: 0.27 to 1.43, P = 0.004). Moreover, the BoNT-A group exhibited a higher grade than the saline group in SBSES (SMD: 1.42, 95% CI: 0.83 to 2.20, I2 = 48%, P < 0.00001). VAS for appearance evaluation revealed significantly higher scores in the BoNT-A group than in the saline group (SMD: 1.25, 95% CI: 0.77 to 1.74, I2 = 72%, P < 0.00001). Moreover, VAS for scar pain evaluation revealed that the BoNT-A group had a significantly lower score than the steroid group (SMD: -2.57, 95% CI: -4.40 to -0.74, I2 = 95%, P = 0.006). Furthermore, the scar width was significantly shorter in the BoNT-A group than in the control group (SMD: -1.19, 95% CI: -1.49 to -0.89, I2 = 0%, P < 0.00001).
Conclusion:
BoNT-A injection is more effective in treating scars than saline injection, although steroids may exhibit higher potency. Therefore, BoNT-A can be considered an alternative in patients not amenable to steroid treatment.
The role of angiotensin receptor blocker in wound healing and cutaneous fibrosis has become a hotspot in recent years. We have developed a losartan cream that is comparable to triamcinolone ointment in inhibiting scarring. Considering the effects of chitosan and asiaticoside on wound healing and scarring, we added them to the losartan cream this time and improved the formula, expecting to get a better anti-scarring effect. The effects of creams were investigated on mouse scar model with triamcinolone ointment, onion extract gel, and commercial asiaticoside cream set as positive controls. A preliminary exploration of the mechanism involved in TGF-β/Smad pathway was performed in vivo and in vitro. With all results of anti-scarring, the compound losartan cream (containing chitosan, asiaticoside, and losartan) shows the best effect, followed by the chitosan asiaticoside cream. The treatment of the compound losartan cream inhibited expression of TGF-β1, collagen, and Smads, and decreased phosphorylation of Smad in vivo. These inhibitory effects were also confirmed in vitro. Our findings indicated that the compound losartan cream could inhibit scarring via TGF-β/Smad pathway. This cream might be an effective option for scar treatment.
Acne scars are caused by inflammatory reactions, infections, and improper handling of acne lesions. Such scars have a high incidence and are difficult to treat. There are many methods currently used to treat acne scars, including medications, photoelectric technology, surgery, filling, chemical peeling, traditional Chinese medicine, biotherapy, and microneedle therapy, and many new methods are constantly emerging. However, there are still many issues, such as the lack of high-quality clinical studies, non-uniform treatment methods, and unsatisfactory therapeutic effects. The selection of appropriate methods for the comprehensive treatment of different types of acne scars at different stages in clinical practice remains challenging and is a research topic of great interest. From the perspective of evidence-based medicine, this consensus aims to provide a reference for the treatment of acne scars in clinical practice.
Abnormal activation of fibroblasts plays a crucial role in keloid development. However, the mechanism of fibroblast activation remains to be determined. YAP/TAZ are key molecules in the Hippo signaling pathway that promote cell proliferation and inhibit apoptosis. Here, we show that keloid fibroblasts have higher levels of YAP/TAZ mRNA and proteins on primary culture. Targeted knockdown of endogenous YAP or TAZ significantly inhibited cell proliferation, reduced cell migration, induced cell apoptosis and down‐regulated collagen1a1 production by keloid fibroblasts. Moreover, we demonstrate that verteporfin, an inhibitor of YAP/TAZ, has similar but stronger inhibitory effects on fibroblasts compared to YAP/TAZ knockdown. Our study provides evidence that YAP/TAZ may be involved in the pathogenesis of keloids. Targeted inhibition of YAP/TAZ could change the biological behaviors of fibroblasts and can potentially be used as therapy for keloids.
The use of hyaluronic acid (HA) injectable fillers has become increasingly widespread in facial recontouring and rejuvenation. We report our experiences to emphasize the role of HA fillers as tools beyond aesthetic treatments in cases of post-surgical facial sequelae. HA fillers are generally used for aesthetic rejuvenation, but one potential new horizon could be their application in trauma, reconstructive, and craniofacial surgery. This study was conducted retrospectively, evaluating medical reports of patients treated at the Maxillofacial Surgery Unit, University of Campania “Luigi Vanvitelli”, Naples, for lip incompetence, trauma, oncological, reconstructive, and craniosynostosis surgery sequelae. Visual analog scale (VAS) evaluation was performed to assess patient satisfaction. No major complications (i.e., impending necrosis or visual loss) were reported. Bruising and swelling was reported for 48 h after lip injection. At the immediate VAS evaluation, 67% of the patients were “extremely satisfied” and 33% “satisfied”. In those 33%, VAS scores changed to “extremely satisfied” at 6–9 weeks and 3–6 months of VAS evaluation (contextually to improvement in tissue flexibility, elasticity, and aesthetic appearance). Results indicate that this minimally invasive approach achieves a high level of aesthetic enhancement, improving patient satisfaction. The concept of HA filler applications could be a frontier that may be applicable to other areas of reconstructive facial plastic surgery.
Introduction
Postburn hypertrophic scarring pain is a common and perennial complaint which not only affects patients’ quality of life, but also their recovery and reintegration. Physical therapy and medicine regimens are all available for the treatment of hypertrophic scarring pain. Unfortunately, the efficacy of clinical practice is not very satisfactory and the management of hypertrophic scarring pain remains challenging. Therefore, it is of utmost importance to explore the risk factors for hypertrophic scarring pain and further identify whether it is neuropathic pain, aiming to guide the clinical therapy and help patients live a pain-free life.
Methods
This retrospective study enrolled patients with postburn hypertrophic scarring pain between 2017 and 2020 in a burn center in Shanghai. Research objects were included strictly according to the inclusion criteria and every enrolled patient was included in the study only once. Demographic information, burn and scar characteristics, and pain scores were collected through the Changhai Hospital Medical Information System, patient questionnaire and physician assessment. Using SPSS 26.0 software, the data were first processed by descriptive statistics, and linear and logistic regression analyses were further employed to explore the significant factors.
Results
The sample involving 123 patients was consisted of 56.9% males, 79.7% caused by fire with a median age 40.5 years, total body surface burn-area (TBSA) 44.4%, wound healing time of target scar 57.9 days, hyperplasia time 9.3 months and the scar location mainly in the limbs (55.3%). Of all the included objects, the modified Vancouver Scar Scale (mVSS) total, visual analogue scale (VAS) score, brief pain inventory (BPI) total and the percentage of neuropathic pain were 9.6, 3.3, 36.0 and 74.8%, respectively. Integrating covariates with a P value of < 0.10 through preliminary univariate analysis, multivariable linear regression showed sex (P = 0.049), age (P = 0.020), target scar location (P = 0.017, P = 0.254), and pliability (P = 0.016) were linked with severe VAS score; and burn depth of target scar (P = 0.023), hyperplasia time (P = 0.027, P = 0.001), vascularity (P = 0.028), and pliability (P = 0.001) were associated with higher BPI score. Adjusting for potential confounders, hyperplasia time (P = 0.005, P = 0.039) was found to be the only independent risk factor for hypertrophic scarring neuropathic pain in the multivariate logistic regression analysis, with mVSS total of P = 0.062.
Conclusions
The model in our study has clarified that sex, age, target scar location, burn depth of target scar, hyperplasia time, and vascularity, especially pliability, may provide excellent prediction of hypertrophic scarring pain outcome; for neuropathic pain, only hyperplasia time has further prospects, with mVSS total as a potential forecast. In an era increasingly aware of life quality, this work may contribute to the elaboration of strategies to hypertrophic scarring pain management, provide an individualized therapy, and help patients live a pain-free life.
Background
Many products claiming to improve scar appearance are readily available on the Internet. Data behind these claims are often difficult to find or summarize. Patients often ask their surgeon for advice for scarring postdermatologic surgery.
Objective
We aim to review the evidence behind several advertised products and techniques that claim to improve postsurgical scarring.
Methods
A PubMed search was performed using products and methods claiming to improve scar appearance along with the terms “scar” and “scarring”.
Results
Published literature on scar massage, taping of scars, silicone gel and sheeting, onion‐based extract products, and vitamin E was reviewed. Silicone gel/sheeting as well as taping have the most evidence to help improve scarring, but even then the evidence is conflicting and weak.
Conclusion
Online advertising may tempt patients to buy and trial products to help minimize scarring, although the evidence for the effectiveness of these products is absent to minimal. Dermatologists must be aware of these products to maintain effective patient counseling.
Background
Cutaneous surgery is associated with multiple complications including hemorrhage, surgical site infection, necrosis, and scarring. As demand for dermatologic surgery rises, it is imperative that dermatologists have a comprehensive understanding of the potential surgical risks to enhance patient safety and outcomes.
Aims
The purpose of this review is to highlight the rates, prevention, and management of common complications associated with cutaneous surgery, with a focus on scalpel‐based surgeries including Mohs micrographic surgery and standard surgical excision.
Material and Methods
Articles from PubMed are highlighted and our clinical experience is presented.
Results
Cutaneous surgery is overall safe and associated with low rates of complications that are predominantly minor and not life‐threatening. Prevention and management strategies vary according to the specific complication being addressed.
Discussion
Dermatologists should be familiar with the complications of cutaneous surgery. As our knowledge of surgical complications expands, the outcomes of our patients will continue to improve.
Keloid is a common and frequently-occurring disease in plastic surgery, and its ugly appearance and itching symptoms bring mental and life pain to patients. However, the clinical treatment of keloid, such as drug injection treatment, surgical resection, cryotherapy, laser treatment and other therapeutic effects are poor. Since the discovery of tumor necrosis factor related apoptosis inducing ligand (TRAIL) in 1995, its selective apoptosis on tumor cells makes it have a great prospect in the targeted treatment of tumor. In recent years, it has been found that the formation of keloid is related to the imbalance of apoptosis of fibroblasts in scar and the binding of TRAI to its receptor mediates the apoptosis of fibroblasts. Therefore, the use of TRAIL and TRAIL-R2/death receptor 5 (DR5) in the treatment of keloid has become a hot research topic.In this paper, the present situation, mechanism and development prospect of TRAIL and TRAIL-R2/DR5 targeted treatment of keloid were reviewed, which provided a reference for promoting the development of keloid treatment.
ResearchGate has not been able to resolve any references for this publication.