Pressure Therapy with a Round Rod for Hypertrophic Scars

Abstract

Sir Hypertrophic scars represent an abnormal, exaggerated healing response after skin injury such as trauma, surgical intervention, or burn, and usually cause major physical, psychological, and cosmetic problems. The pathogenesis for this deformity is the unusual and abnormal proliferation of fibroblasts and the overproduction of collagen. It is more important to prevent scar formation at the early stage after wound healing than to treat established scars. There is no universally accepted treatment regimen for the management of hypertrophic scars. A combination of treatment methods should be applied to improve the lesions. These include pressure therapy, corticosteroid injection, silicone gel sheeting, hydrogel dressing therapy, laser therapy, radiotherapy, cryotherapy, and adhesive tape therapy. However, Mustoe et al. believed that silicone gel sheeting and intralesional corticosteroids were internationally applicable for the management of a wide variety of abnormal scars and concluded that these were the only treatments for which sufficient evidence existed to make evidence-based recommendations.1 Besides, pressure therapy was also considered to be one of the most widespread strategies.2 However, some hypertrophic scars are in special locations, such as near the articularis, and are smaller lesions (e.g., <100 mm2). The silicone gel sheeting cannot be kept close to the lesions because of the movement of the joints, and the use of elastic bandages or pressure garments is obviously not suitable for scars that are too small. Moreover, high pressures can lead to treatment suspension, unpleasant side effects, and even deformity. Some patients do not accept intralesional drug injection. In such clinical situations, we have conducted pressure therapy using a small round rod. The technique we suggest is the application of a small round rod, such as a pen or pencil. The rod is placed transversely on the surface of the scar and rolled; meanwhile, suitable pressure is exerted on the hypertrophic scar by the patient him- or herself for 4 to 5 minutes, five to six times a day, and should be great enough for the patient to able to tolerate it. Fourteen of these scars in 10 patients were managed with this technique. To compare the effects of treatment, six larger scars in six patients were selected and randomized into two groups: half of each scar comprised the control group and the other half of each scar was treated with pressure therapy. The treatment lasted for 3 to 6 months. Scar volume, height, erythema, and pliability were measured at months 0, 1, 3, 6, and 9. Desquamation appeared on the surfaces of the lesions while the therapy was progressing. The volume of treated segments decreased significantly after 1 month of treatment. Treated segments showed significantly greater improvement than control segments after 3 months of treatment. Elasticity of treated segments was significantly greater than that of the control segments after 3 months of treatment (Figs. 1 and 2). We have already obtained impressive results after treating all of our cases. Six to 12 months of follow-up results showed that no scar recurrence was seen and that pigmentation appeared in the treated regions in some cases. This technique seems to be a satisfactory method for managing hypertrophic scars.Fig. 1.: (Above) Patient with a hypertrophic scar on the right buttock of 6 months’ duration; the scar was erythematous and raised above skin level. (Below) The scar was divided into two halves, with the left half being the control and the right half receiving pressure therapy. After 6 months of treatment, the right half of scar was flatter and lighter compared with the left half.Fig. 2.: (Above) A hypertrophic scar at the dorsum of the metacarpophalangeal joint of the right digitus minimus, before treatment. (Below) After 1 year of treatment, the scar regressed and pigmentation almost returned to normal.Xiaochun Zhong, M.D., Ph.D. Xiaosheng He, M.D. Clinical Medical College, Hangzhou Normal University, Hangzhou, China