Efficacy of Topical Enalapril in Treatment of Hypertrophic Scars.

Mansour Janati,Sina Kardeh,Ali Parand,Ali Akbar Mohammadi,Soheil Mohammadi

doi:10.29252/wjps.7.3.326

Abstract

BACKGROUNDAngiotensin II activation by angiotensin-converting enzyme (ACE) is a significant mediator in wound healing and collagen production. In this study, the effect of topical application of ACE on hypertrophic scar formation has been studied in a clinical trial.METHODSThirty patients with hypertrophic scar and itching after treatment of 2nd or 3rd degree burns participated in this double-blinded clinical trial. Subjects had two same-degree scars on symmetrical sites of body which were randomly allocated into two groups. One side was treated with 1% enalapril ointment and the other side with placebo twice daily. During a 6-months follow-up, a scoring table for itching was completed on a daily basis by patients. Furthermore, a single surgeon measured size of scars once a month. The mean size, thickness and itching score were calculated for each scar and compared between medication and placebo-treated scars. RESULTSThe mean size of scars in enalapril treated side was significantly less than scars in the placebo side. Additionally, enalapril treated scars had significantly lower itching scores compared to the placebo group.CONCLUSIONTopical enalapril significantly decreases the clinical parameters of hypertrophic scar and also itching as an indirect indicative of scar improvement. Furthermore, enalapril proved to be clinically safe for patients with low incidence of adverse drug reactions and acceptable cost effectiveness.

Highlights

Hypertrophic scaring (HTS) is a major clinical problem in both developing and industrialized worlds with manifestations of a dysfunctional form of dermal fibroproliferative disorders caused www.wjps.ir /Vol.7/No.3/September 2018 by exuberant wound healing response to skin injuries including burn, abrasions, laceration, surgery and trauma.[1]
The mean size of scars in enalapril treated side was significantly less than scars in the placebo side
Enalapril treated scars had significantly lower itching scores compared to the placebo group

Summary

Introduction

Hypertrophic scaring (HTS) is a major clinical problem in both developing and industrialized worlds with manifestations of a dysfunctional form of dermal fibroproliferative disorders caused www.wjps.ir /Vol.7/No.3/September 2018 by exuberant wound healing response to skin injuries including burn, abrasions, laceration, surgery and trauma.[1] The main characteristic of HTS is disruption of the exquisite balance of degradation and deposition of fibroblast-derived extracellular matrix (ECM) proteins, mainly by excessive collagen production.[2] Based on the expression of α-SMA, fibroblasts phenotype in HTS differs from the normal ones. Increased vascularization and emergence of prominent vertically oriented blood vessels, replacement of the papillary and reticular dermis by scar tissue, flattening of the epidermis, hypercellularity and reduction of small leucine-rich proteoglycans (SLRPs) are frequent features.[4] HTS occurs as a result of prolonged inflammatory response to injury and persistent fibrosis which results in the pathological characteristics of hypertrophic scars including a red, elevated and rigid scar associated with cutaneous and joint contractures, pruritus, and prolonged pain. In addition to these complications, the stigma of cosmetic disfigurement is another important concern for patients and surgeons which may lead to psychological and social issues.[5,6]

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Discussion

Conclusion