Abstract
Abnormal scarring and its accompanying esthetic, functional, and psychological sequelae still pose significant challe nges. To date, there is no satisfactory prevention or treatment option for hypertrophic scars (HSs), which is mostly due to not completely comprehending the mechanisms underlying their formation. That is why the apprehension of regular and controlled physiological processes of scar formation is of utmost importance when facing hypertrophic scarring, its pathophysiology, prevention, and therapeutic approach. When treating HSs and choosing the best treatment and prevention modality, physicians can choose from a plethora of therapeutic options and many commercially available products, among which currently there is no efficient option that can successfully overcome impaired skin healing. This article reviews current therapeutic approach and emerging therapeutic strategies for the management of HSs, which should be individualized, based on an evaluation of the scar itself, patients’ expectations, and practical, evidence-based guidelines. Clinicians are encouraged to combine various prevention and treatment modalities where combination therapy that includes steroid injections, 5-fluorouracil, and pulsed-dye laser seems to be the most effective. On the other hand, the current therapeutic options are usually empirical and their results are unreliable and unpredictable. Therefore, there is an unmet need for an effective, targeted therapy and prevention, which would be based on an action or a modulation of a particular factor with clarified mechanism of action that has a beneficial effect on wound healing. As the extracellular matrix has a crucial role in cellular and extracellular events that lead to pathological scarring, targeting its components mostly by regulating bone morphogenetic proteins may throw up new therapeutic approach for reduction or prevention of HSs with functionally and cosmetically acceptable outcome.
Highlights
Skin is the largest organ in the human body that is in constant contact with the environment with its primary role to adapt to stresses and tension and to protect other systems within the body
We can expect around 30% of these to undergo abnormal growth due to aberrations in physiologic healing that result in hypertrophic scar (HS) or keloid formation, which are frequently accompanied by a number of esthetic, functional, and social impairments and may lead to decreased quality of life [4]
It has been thought that they are differentiated, this study showed that adipocytes may be regenerated from myofibroblasts during wound healing through activation of adipocyte transcription factors expressed during development, triggered by crucial bone morphogenetic proteins (BMPs) signaling from the actively growing hair follicles
Summary
Zrinka Bukvic Mokos 1*, Anamaria Jovic 1, Lovorka Grgurevic 2, Ivo Dumic -Cule 2, Krešimir Kostovic 1, Romana Ceovic 1 and Branka Marinovic 1. Reviewed by: Cristina Has, Albert Ludwig University of Freiburg, Germany Elisabetta Palazzo, Universita’ di Modena, Italy. Specialty section: This article was submitted to Dermatology, a section of the journal
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