Actual view on skin scarring and clinical experience of conservative treatment of keloids

Abstract

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.