Abstract
Background: Hypertrophic scar (HTS) is a dermal form of fibro-proliferative disorder often caused by thermal injury to the deep dermis. Transforming growth factor β1 & 2 are well known pro-fibrotic cytokines promoting ECM production and tissue fibrosis. The present study was designed to evaluate the different therapeutic modalities for management of hypertrophic scar and correlate it with altered expression of TGF beta gene at the molecular level.
 Materials and Methods: One hundred and twenty patients with hypertrophic post burn scar were randomly distributed into three different treatment groups of Pressure Garments, Silicone Gel Sheet and Triamcinolone Injection. Total RNA was isolated from the scar tissue in cases before and 6 months after the therapy and from normal skin in controls to evaluate the expression of TGF beta (1, 2 & 3) by real time PCR.
 Results: Following treatment, the expression of TGF β-1 & 2 was down regulated while that of β-3 up regulated. The overall positive response (combining all the groups) was 94% out of which, 16.6% were cured, 47.5% showed major improvement and minor changes were observed in 30.8% of patients.
 Discussion: All the three modalities of treatment were effective in bringing down the level of TGF β-1&2 and in up-regulating antifibrotic β3 and this correlated well with the clinical improvement in the scar thickness, pliability etc. Conclusion: Out of all, intralesional Triamcinolone Injection achieved the best result.
 Keywords: Hypertrophic Scar, Transforming Growth Factor β, Pressure Garments, Silicone Gel Sheet, Triamcinolone Injection
Highlights
Abnormal wound healing represents a tremendous clinical challenge and causes significant burden on patients and healthcare professionals
The study observed the higher mRNA expression of TGF β-1 (2.6 ±0.37 fold) & TGF β-2 gene (3.8 ± 0.40) in pretreated hypertrophic scar cases when compared with controls
The present study demonstrates the alteration of TGF β (1, 2 & 3) gene expression in relation to the formation of hypertrophic scars
Summary
Abnormal wound healing represents a tremendous clinical challenge and causes significant burden on patients and healthcare professionals. Delayed and prolonged process of wound healing leads to abnormal scar formation like hypertrophic scar that does not extend beyond the initial zone of injury These scars may cause abnormal sensations including pain, itchiness, severe functional impairment, and psychological morbidity.[1,2] The incidence of hypertrophic scar ranges from 40% to 94% following surgery and from 30% to 91 % following burns.[3,4,5] Transforming growth factor beta (TGF- β) is a cytokine that plays a central role in growth, differentiation, development and immune response and is involved in all stages of wound healing.[6] It is important for migration of Keratinocytes and regulation of wound reepithelialization.[7].
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