Prevention Of Hypertrophic Scars Research Articles

Evaluating Tamoxifen Effect in the Prevention of Hypertrophic Scars Following Surgical Incisions

To evaluate the clinical utility of tamoxifen in the prevention of hypertrophic scars (HTSs). In a double-blind randomized clinical trial, 300 patients with a history of HTSs who underwent surgery with different skin incisions were assigned randomly to two groups. The first received tamoxifen tablets postoperatively according to a standard protocol, and the control group received placebo. After 2 months, the two groups were compared according to the development of HTSs, and the results were analyzed. The studied population comprised 235 men (78.7%) and 65 women (21.7%) who developed HTSs after surgical incision, 138 of whom (92%) were in the study group and 78 (52%) in the control group. Tamoxifen seems to be an effective agent in the prevention of HTSs after surgery.

The Most Current Algorithms for the Treatment and Prevention of Hypertrophic Scars and Keloids

Previous reports on the treatment of hypertrophic scars and keloids have not described clear algorithms for multimodal therapies. This article presents an evidence-based review of previous articles and proposes algorithms for the treatment and prevention of hypertrophic scars and keloids. The methodologic quality of the clinical trials was evaluated, and the baseline characteristics of the patients and the interventions that were applied and their outcomes were extracted. Important factors that promote hypertrophic scar/keloid development include mechanical forces on the wound, wound infection, and foreign body reactions. For keloids, the treatment method that should be used depends on whether scar contractures (especially joint contractures) are present and whether the keloids are small and single, or large and multiple. Small and single keloids can be treated radically by surgery with adjuvant therapy (which includes radiation or corticosteroid injections) or by nonsurgical monotherapy (which includes corticosteroid injections, cryotherapy, laser, and antitumor/immunosuppressive agents such as 5-fluorouracil). Large and multiple keloids are difficult to treat radically and are currently only treatable by multimodal therapies that aim to relieve symptoms. After a sequence of treatments, long-term follow-up is recommended. Conservative therapies, which include gel sheeting, taping fixation, compression therapy, external and internal agents, and makeup (camouflage) therapy, should be administered on a case-by-case basis. The increase in the number of randomized controlled trials over the past decade has greatly improved scar management, although these studies suffer from various limitations. The hypertrophic scar/keloid treatment algorithms that are currently available are likely to be significantly improved by future high-quality clinical trials.

A comparative study to evaluate the effect of honey dressing and silver sulfadiazene dressing on wound healing in burn patients

ABSTRACTTo compare the effect of honey dressing and silver-sulfadiazene (SSD) dressing on wound healing in burn patients. Patients (n=78) of both sexes, with age group between 10 and 50 years and with first and second degree of burn of less than 50% of TBSA (Total body surface area) were included in the study, over a period of 2 years (2006-08). After stabilization, patients were randomly attributed into two groups: ‘honey group’ and ‘SSD group’. Time elapsed since burn was recorded. After washing with normal saline, undiluted pure honey was applied over the wounds of patients in the honey group (n=37) and SSD cream over the wounds of patients in SSD group (n=41), everyday. Wound was dressed with sterile gauze, cotton pads and bandaged. Status of the wound was assessed every third and seventh day and on the day of completion of study. Patients were followed up every fortnight till epithelialization. The bacteriological examination of the wound was done every seventh day. The mean age for case (honey group) and control (SSD group) was 34.5 years and 28.5 years, respectively. Wound swab culture was positive in 29 out of 36 patients who came within 8 hours of burn and in all patients who came after 24 hours. The average duration of healing in patients treated with honey and SSD dressing at any time of admission was 18.16 and 32.68 days, respectively. Wound of all those patients (100%) who reported within 1 hour became sterile with honey dressing in less than 7 days while none with SSD. All of the wounds became sterile in less than 21 days with honey, while tthis was so in only 36.5% with SSD treated wounds. The honey group included 33 patients reported within 24 hour of injury, and 26 out of them had complete outcome at 2 months of follow-up, while numbers for the SSD group were 32 and 12. Complete outcome for any admission point of time after 2 months was noted in 81% and 37% of patients in the honey group and the SSD group. Honey dressing improves wound healing, makes the wound sterile in lesser time, has a better outcome in terms of prevention of hypertrophic scarring and post-burn contractures, and decreases the need of debridement irrespective of time of admission, when compared to SSD dressing.

Disruption of Interleukin-1 Signaling Improves the Quality of Wound Healing

In this study, we investigated the role of interleukin (IL)-1 signaling in wound healing. IL-1 receptor type I (IL-1R) knockout (KO) mice showed reduced fibrosis in both cutaneous and deep tissue wounds, which was accompanied by a reduction in inflammatory cellular infiltration in cutaneous but not in deep tissue wounds. There were no differences in either total collagenolytic activity or in the expression of selected matrix metalloproteinases or tissue inhibitors of metalloproteinases between the wound fluids from wild-type or IL-1R KO mice. However, wound fluids from IL-1R KO mice contained lower levels of IL-6 compared with wild-type controls. In addition, the infusion of IL-6 into wounds in IL-1R KO mice did not increase fibrosis. Skin wounds in IL-1R KO animals had lower levels of collagen and improved restoration of normal skin architecture compared with skin wounds in wild-type mice. However, neither the tensile strength of incisional skin wounds nor the rate of closure of excisional wounds differed between IL-1R KO and wild-type animals. The reduced fibrotic response in wounds from IL-1R KO mice could be reproduced by the administration of an IL-1R antagonist. These findings suggest that pharmacological interference with IL-1 signaling could have therapeutic value in the prevention of hypertrophic scarring and in the treatment of fibrotic diseases.

Contribution of epidermal stem cells to hypertrophic scars pathogenesis

Hypertrophic scars are fibroproliferative disorders of excessive wound healing due to an imbalance between synthesis and degradation and the mechanism leading to hypertrophic scars formation is poorly understood and currently no successful treatment modality exists. We hypothesize epidermal stem cells (ESCs), which could inhibit epidermal fibrosis, plays a substantial contributory role in the pathogenesis of hypertrophic scars. Accepting the hypothesis to be correct, a therapy that inhibits cell and extracellular matrix proliferation can be used to prevent the hypertrophic scars formation. Current therapies are only partially effective and safe because they couldn't inhibit the cell and extracellular matrix proliferation and eliminate other relative factors of hypertrophic scars formation at all, such as: absence of epidermal-mesenchymal interaction, and at the same time inducing death (apoptosis and necrosis) of other normal cells. A more efficient prevention of hypertrophic scars could be achieved using tissue engineering skin enriched with ESCs and introduced recombinant genes into ESCs which could inhibit hypertrophic scars formation.

Wedge-Shaped Excision and Modified Vertical Mattress Suture Fully Buried in a Multilayered and Tensioned Wound Closure

A successful deep multilayered wound suture should provide a firm tension-relieving closure, good wound-edge eversion, hemostasis, and minimal intradermal extraneous materials. However, this is not always achieved with a single standard technique. The authors describe their modification of a wound closure method that can rapidly and reliably achieve these results. A wedge-shaped excision was adopted to obtain a trapezoid pattern transect, after which a modified fully buried vertical mattress suture technique was used to close the wound. These techniques were compared with the standard excision and suture techniques used for the same patient at different times after surgery. The wedge-shaped excision can facilitate good wound-edge eversion, and the modified fully buried vertical mattress suture can provide firm tension relief and optimal apposition. Compared with conventional excision and suture techniques, the described techniques brought about a better outcome in terms of hypertrophic scar prevention. The described modified technique seems to be more efficient than conventional procedures used to prevent hypertrophic scar formation.

A comparative study to evaluate the effect of honey dressing and silver sulfadiazene dressing on wound healing in burn patients.

To compare the effect of honey dressing and silver-sulfadiazene (SSD) dressing on wound healing in burn patients. Patients (n=78) of both sexes, with age group between 10 and 50 years and with first and second degree of burn of less than 50% of TBSA (Total body surface area) were included in the study, over a period of 2 years (2006-08). After stabilization, patients were randomly attributed into two groups: ‘honey group’ and ‘SSD group’. Time elapsed since burn was recorded. After washing with normal saline, undiluted pure honey was applied over the wounds of patients in the honey group (n=37) and SSD cream over the wounds of patients in SSD group (n=41), everyday. Wound was dressed with sterile gauze, cotton pads and bandaged. Status of the wound was assessed every third and seventh day and on the day of completion of study. Patients were followed up every fortnight till epithelialization. The bacteriological examination of the wound was done every seventh day. The mean age for case (honey group) and control (SSD group) was 34.5 years and 28.5 years, respectively. Wound swab culture was positive in 29 out of 36 patients who came within 8 hours of burn and in all patients who came after 24 hours. The average duration of healing in patients treated with honey and SSD dressing at any time of admission was 18.16 and 32.68 days, respectively. Wound of all those patients (100%) who reported within 1 hour became sterile with honey dressing in less than 7 days while none with SSD. All of the wounds became sterile in less than 21 days with honey, while tthis was so in only 36.5% with SSD treated wounds. The honey group included 33 patients reported within 24 hour of injury, and 26 out of them had complete outcome at 2 months of follow-up, while numbers for the SSD group were 32 and 12. Complete outcome for any admission point of time after 2 months was noted in 81% and 37% of patients in the honey group and the SSD group. Honey dressing improves wound healing, makes the wound sterile in lesser time, has a better outcome in terms of prevention of hypertrophic scarring and post-burn contractures, and decreases the need of debridement irrespective of time of admission, when compared to SSD dressing.

Multimodality Scar Management Program

This trial was undertaken to assess the efficacy of a multimodality management regime used for the prevention of hypertrophic scars. It follows previous research and experience (A.D. Widgerow et al, Aesthetic Plast Surg, 24(3):227-234, 2000) with a similar program but with the addition of active agents with specific effects against prolonged inflammation and enhanced hydrative capacity. The modalities specifically targeted are tension on the scar, hydration of the scar, collagen maturation, and controlled inflammation. Tape was impregnated with a combination of agents providing an occlusive dressing aimed at combatting exaggerated scarring. Patients who had undergone surgery were stratified into four groups: Group 1, 60 patients/60 scars following simple skin excisions, 30 treated scars, 30 untreated scars; Group 2, 20 patients/40 scars, each patient with two excisions, one treated, one untreated; Group 3, 10 patients/20 scars following bilateral breast surgery, one side treated with tape alone, one side treated with tape and gel; Group 4, 30 patients with varying cosmetic procedures/50 scars, all treated and compared with historical outcomes for hypertrophic scarring. Thus, 170 scars were assessed in 120 patients. Results were assessed at 1, 2, and 6 months using a combination of accepted scar assessment techniques. By amalgamating the Vancouver, Manchester, and morphologic table systems together with Patient and Observer Scar Assessment analyses, a comprehensive assessment of scar outcomes was undertaken and comparisons were made with control groups. Treated groups showed improvement outcomes in all variations of assessment. Patient and observer assessments correlated well, and morphologic appearances of the scars following the final assessment at 6 months showed statistically significant positive scar outcomes in the treatment groups. The multimodality approach to scar control showed significant benefits in the patient groups tested in this series.

Prevention and Management of Hypertrophic Scars and Keloids After Burns in Children

Hypertrophic scars and keloids are challenging to manage, particularly as sequelae of burns in children in whom the psychologic burden and skin characteristics differ substantially from adults. Prevention of hypertrophic scars and keloids after burns is currently the best strategy in their management to avoid permanent functional and aesthetical alterations. Several actions can be taken to prevent their occurrence, including parental and children education regarding handling sources of fire and flammable materials, among others. Combination of therapies is the mainstay of current burn scar management, including surgical reconstruction, pressure therapy, silicon gels and sheets, and temporary garments. Other adjuvant therapies such as topical imiquimod, tacrolimus, and retinoids, as well as intralesional corticosteroids, 5-fluorouracil, interferons, and bleomycin, have been used with relative success. Cryosurgery and lasers have also been reported as alternatives. Newer treatments aimed at molecular targets such as cytokines, growth factors, and gene therapy, currently in developing stages, are considered the future of the treatment of postburn hypertrophic scars and keloids in children.

Laser treatment of keloids and hypertrophic scars

Lasers have been used in the treatment of hypertrophic scars and keloids for more than 20 years. Different laser systems have been examined; among them pulsed dye lasers are currently considered the laser of choice in these settings. The purpose of this study is to review the pertinent literature and provide updated information on different laser therapies available for treatment of keloids and hypertrophic scars. A Medline literature search was performed for relevant publications. In this review the results of published studies in the treatment and prevention of hypertrophic scars and keloids are presented. Suggested mechanisms of action are reviewed. A review of the optimal laser parameters to modulate treatment outcome will be discussed. Different lasers are effective in not only the treatment but also the prevention of hypertrophic scars and keloids, among them PDL is more promising. Most of the suggested theories are based on the selective photothermolysis in which the light energy emitted from a vascular laser is absorbed by hemoglobin, generating heat and leading to coagulation necrosis, neocollagenesis, collagen fiber heating with dissociation of disulfide bonds and subsequent collagen fiber realignment. The optimal laser is currently 585 nm PDL, although the recent results of Q-switched 532 nm frequency-doubled Nd:YAG are promising. Early use of lasers are beneficial, especially in those who are prone to develop these lesions.

Use of Onion Extract, Heparin, Allantoin Gel in Prevention of Scarring in Chinese Patients Having Laser Removal of Tattoos: A Prospective Randomized Controlled Trial

With rapid advancement in cutaneous laser therapy, Q-switched lasers have become the standard treatment for tattoo removal. The longer wavelength Q-switched Nd:YAG laser is used when removing tattoos in darker skin patients to avoid scarring and permanent pigment changes. Nevertheless, the local experience revealed that nearly 25% of the Chinese patients developed scarring. Meanwhile, multiple clinical studies have shown that Contractubex gel (Merz Pharma, Frankfurt, Germany) was effective in the treatment and prevention of hypertrophic scars and keloids. To evaluate the efficacy of Contractubex gel in the prevention of scarring after laser removal of tattoos in Chinese patients. A total of 120 Chinese patients with 144 professional blue-black tattoos were recruited into the study. They were randomly assigned into the Contractubex group or the control group. All patients were treated with a QS 1,064-nm Nd:YAG laser using a 3-mm spot size, a 10-Hz repeat rate, a pulse duration of 6 nanoseconds, and fluences that ranged from 3.6 to 4.8 J/cm2 (mean fluence, 4.2 J/cm2). The treated areas were assessed 3 months after the last treatments for clinical clearance and complications. Fifty-two patients with 61 tattoos in the Contractubex group were able to achieve a mean clearing rate of 82.3+/-11.6%. There were 7 tattoos in 7 patients that developed scarring, 4 patients had permanent hypopigmentation, and 3 patients had transient hyperpigmentation. In contrast, 55 patients with 68 tattoos in the control group had a mean clearing rate of 80.4+/-11.3%. Among them, 16 tattoos in 14 patients developed scarring, 4 patients had permanent hypopigmentation, and 5 patients had transient hyperpigmentation. Although there was no significant difference in age, sex, fluence, treatment session, and clinical clearance between the two groups, the Contractubex group had a statistically significantly lower rate of scarring than the control group (p<.05). Contractubex gel is effective in scar prevention in Chinese patients having laser removal of tattoos.

Botulinum Toxin to Improve Results in Cleft Lip Repair

Archives of Facial Plastic SurgeryVol. 8, No. 3 Brief CommunicationBotulinum Toxin to Improve Results in Cleft Lip RepairTravis T. Tollefson, Craig M. Senders, Jonathan M. Sykes, and Paul J. ByorthTravis T. TollefsonCorrespondence: Dr Tollefson, Department of Otolaryngology–Head and Neck Surgery, University of California, Davis Medical Center, 2521 Stockton Blvd, Suite 7200, Sacramento, CA 95817 E-mail Address: travis.tollefson@yahoo.comSearch for more papers by this author, Craig M. SendersSearch for more papers by this author, Jonathan M. SykesSearch for more papers by this author, and Paul J. ByorthSearch for more papers by this authorPublished Online:1 May 2006https://doi.org/10.1001/archfaci.8.3.221AboutSectionsView articleView Full TextPDF/EPUB ToolsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"Botulinum Toxin to Improve Results in Cleft Lip Repair." Archives of Facial Plastic Surgery, 8(3), pp. 221–222FiguresReferencesRelatedDetailsCited ByEffect of Lip Closure on Early Maxillary Growth in Patients With Cleft Lip and Palate Pascal Rousseau, Marc Metzger, Sibylle Frucht, Wipke Schupp, Mareike Hempel, and Jörg-Elard Otten19 September 2013 | JAMA Facial Plastic Surgery, Vol. 15, No. 5Comparison of Effectiveness of Silicone Gel Sheeting With Microporous Paper Tape in the Prevention of Hypertrophic Scarring in a Rabbit Model Travis T. Tollefson, Faranak Kamangar, Shervin Aminpour, Andrew Lee, Blythe Durbin-Johnson, and Steven Tinling2 January 2012 | Archives of Facial Plastic Surgery, Vol. 14, No. 1Botulinum Toxin–Induced Immobilization of Lower Facial Wounds Holger G. Gassner, David A. Sherris, and Oren Friedman2 March 2009 | Archives of Facial Plastic Surgery, Vol. 11, No. 2Fatal Septic Thrombosis of the Superior Sagittal Sinus After Face-lift Surgery Caused by Community-Associated Methicillin-Resistant Staphylococcus aureus Costi D. Sifri and NinaJ. Solenski2 March 2009 | Archives of Facial Plastic Surgery, Vol. 11, No. 2Changing Perspectives in Cleft Lip and PalateFrom Acrylic to Allele Travis T. Tollefson, Craig W. Senders, and Jonathan M. Sykes3 November 2008 | Archives of Facial Plastic Surgery, Vol. 10, No. 6Full-text Online Access3 November 2008 | Archives of Facial Plastic Surgery, Vol. 10, No. 6 Volume 8Issue 3May 2006 InformationCopyright 2006 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.To cite this article:Travis T. Tollefson, Craig M. Senders, Jonathan M. Sykes, and Paul J. Byorth.Botulinum Toxin to Improve Results in Cleft Lip Repair.Archives of Facial Plastic Surgery.May 2006.221-222.http://doi.org/10.1001/archfaci.8.3.221Published in Volume: 8 Issue 3: May 1, 2006PDF download

A Randomized, Controlled Trial to Determine the Efficacy of Paper Tape in Preventing Hypertrophic Scar Formation in Surgical Incisions that Traverse Langer??s Skin Tension Lines

How a scar is managed postoperatively influences its cosmetic outcome. After suture removal, scars are susceptible to skin tension, which may be the trigger for hypertrophic scarring. Paper tape to support the scar may reduce multidirectional forces and prevent hypertrophic scarring. Seventy patients who had undergone cesarean section at the Royal Brisbane and Women's Hospital were randomized to treatment and control groups. Patients in the control group received no postoperative intervention. Patients in the treatment group applied paper tape to their scars for 12 weeks. Scars were assessed at 6 weeks, 12 weeks, and 6 months after surgery using ultrasound to measure intradermal scar volume. Scars were also assessed using the International Clinical Recommendations. Paper tape significantly decreased scar volume by a mean of 0.16 cm3, (95 percent confidence interval, 0.00 to 0.29 cm3). At 12 weeks after surgery, 41 percent of the control group developed hypertrophic scars compared with none in the treatment group (exact test, p = 0.003). In the treatment group, one patient developed a hypertrophic scar and four developed stretched scars only after the tape was removed. The odds of developing a hypertrophic scar were 13.6 times greater in the control than in the treatment group (95 percent confidence interval, 3.6 to 66.9). Of the 70 patients randomized, 39 completed the study. Four patients in the treatment group developed a localized red rash beneath the tape. These reactions were minor and transient and resolved without medical intervention. The development of hypertrophic and stretched scars in the treatment group only after the tape was removed suggests that tension acting on a scar is the trigger for hypertrophic scarring. Paper tape is likely to be an effective modality for the prevention of hypertrophic scarring through its ability to eliminate scar tension.

Rehabilitation of burn injured patients following lightning and electrical trauma

Electrical burn injuries are complicated because of damage to many structures including: blood vessels, muscles, nerves, tendons, bone and skin. Surgeons must confront many problems such as wound healing coverage, scarring, loss of nerve and tendons, progressive joint stiffness and amputation. The goals of burn therapists are to achieve wound healing, functional recovery, and good cosmetic results. Rehabilitation is both preventive and therapeutic and is a fundamental part of managing these patients. In this article, rehabilitation is discussed with emphasis on the following: pain management, wound coverage, positioning, splinting, and exercises (range-of-motion and ambulation). The treatment and prevention of hypertrophic scarring is evaluated. Finally, the use of engineering and assistive technologies for rehabilitation of the electrical burn injured patient is discussed. Successful management of electrical burn injured patients involves communication among the different burn specialists, such as surgeons, anesthesiologists, neurologists, nurses, and kinesitherapists; engineers from the garments/prostheses companies; psychologists; and the patient him/herself.

Novel Opportunities in the Treatment and Prevention of Scarring

Numerous treatments have been described for the treatment and prevention of scars, but the optimal management strategy is yet to be defined. In this article we present and evaluate new opportunities for the treatment and prevention of hypertrophic scars, keloids, and atrophic scars. Clinical, animal, and in vitro studies reporting novel techniques for the treatment and prevention of scarring were identified primarily from the MEDLINE/PubMed database. We found that a variety of new treatments exist with potential effectiveness for the treatment of hypertrophic scars and keloids, including interferon, imiquimod 5% cream, tacrolimus, botulinum toxin, 5-fluorouracil, bleomycin, and verapamil. For atrophic scars, different types of lasers represent modern treatment modalities with satisfactory results. Several agents have been reported to be effective in reducing scarring in vitro and in animal studies, representing potential opportunities for scarring management. We conclude that several novel modalities may be potential therapies for scarring.

Foreword: Emerging Role of Topical Immunomodulatory Therapies in Dermatology

During the last decade, advancements in the development and application of topical therapies, whether as monotherapy or adjunctive therapy, have provided dermatologists with greater options in the management of cutaneous disease. This special issue of the Journal of Cutaneous Medicine and Surgery provides readers with current and novel strategies for the treatment of several important dermatologic conditions that may present in the clinic. Articles were contributed by leading US experts in the diagnosis and management of dermatoses. These clinicians/researchers have a special interest in the topics they cover in this supplement. The supplement begins with my overview on the mechanism of action of immune response modifiers (IRMs) currently available for the treatment of a variety of common dermatologic conditions. Proinflammatory IRMs include the Toll-like receptor agonist imiquimod 5% cream, which applies a novel mechanism of action and stimulates the body s natural defenses to target diseased tissue. Immunosuppressive IRMs discussed include anti-tumor necrosis factor agents (e.g., infliximab and etanercept) and anti–T-cell agents (e.g., pimecrolimus and tacrolimus). Although IRM activity encompasses several different mechanisms of action, these immunomodulatory agents leverage the body s immune system to effectively treat numerous dermatoses. The next article, by Joseph Jorizzo, highlights a number of topical therapies currently available for the treatment of actinic keratosis. Several topical therapies are available including 5-fluorouracil, diclofenac, photodynamic therapy, and imiquimod 5% cream. The article reviews data on the newer formulation of 5-fluorouracil, 0.5%, and discusses newer treatment strategies using photodynamic therapy (e.g., shorter incubation times and various topical formulations of aminolevulinic acid). This review article also highlights exciting data on imiquimod 5% cream in the treatment of superficial actinic keratosis. With a number of dosing regimens already clinically evaluated, topical therapies such as imiquimod 5% cream will provide the opportunity for healthcare providers to tailor treatment to individual patient needs. The article by Robert Skinner provides a comprehensive overview of topical agents effective in the treatment of a number of conditions. Data are reviewed on the efficacy and safety of imiquimod 5% cream in the treatment of several dermatoses, including condyloma acuminata, basal cell carcinoma, and lentigo maligna. The efficacy and safety of pimecrolimus 1% cream and tacrolimus ointment (0.1% and 0.03%) in the treatment of atopic dermatosis in children and adults are also reviewed. Data suggest that topical immunotherapy will continue to play an important and useful role in managing dermatologic conditions during the next decade. Finally, the article by Brian Berman explores new opportunities for the treatment and prevention of hypertrophic scars, keloids, and atrophic scars. Although abnormal scarring represents a difficult and continuing challenge for healthcare providers, published studies suggest that several novel modalities may be effective for scarring. Discussions include the use of laser therapy for the treatment of atrophic scars, and surgical excision, in combination with topical therapies (e.g., imiquimod 5% cream), for the treatment and management of keloids and hypertrophic scars. In summary, it is my hope that you will find this special issue of Journal of Cutaneous Medicine and Surgery to be an important educational resource, providing a state-of-the-art synopsis on several important dermatologic conditions that readers may encounter in their clinical practice.

The use of pulsed dye laser for the prevention and treatment of hypertrophic scars in chinese persons.

Pulse dye laser has been used with variable degrees of success in the treatment of hypertrophic scars, and although earlier reports suggested a significant degree of improvement, more recent studies have raised concern about its effectiveness. Furthermore, most previous studies examined its use in patients with light skin types, and the use of pulse dye laser in dark-skinned patients for the treatment of hypertrophic scars is not well established. The objective was to assess the role of pulsed dye laser therapy in the treatment and prevention of hypertrophic scars in Chinese persons. Twenty-nine patients (35 scars) who had scars for less than 6 months were recruited into the prevention group, and 27 patients (36 scars) who had scars for more than 6 months were recruited into the treatment arm of the study. Each received pulse dye laser treatment (585 nm, 1.5-msec pulse duration, 5-mm spot size, 7-8 J/cm(2)) for three to six treatments at 8-week intervals. Half of the scar was treated with the laser and the other half was used as a control. All patients were assessed for subjective improvement with the use of a structured questionnaire and objectively with ultrasonography for thickness and a cutometer for viscoelasticity. Scars were marked on every patient and mapped with a translucent paper at the first appointment to ensure the consistency of location. At the end of the study, 15 patients from the prevention group (15 scars) and 23 patients from the treatment group (34 scars) agreed to return for spectrophotometer assessment. Fifty-four percent of patients in the prevention group and 66% of patients in the treatment group considered their scars to be better or much better. For both groups of patients, there was significant improvement in term of pruritics after laser treatment. For objective assessment, although scar thickness reduced significantly compared to baseline in the treatment group, such change was not significant when changes in the control side were taken into consideration. There was insignificant change in viscoelasticity. Spectrophometer assessment indicated a significant degree of lightening in the treatment group. Our study indicated that although there was significant symptomatic improvement, there was an insignificant degree of objective improvement in terms of scar thickness and viscoelasticity in the prevention group compared to the control group. Our findings are in line with several previous controlled studies and contradict the results of several others. Such differences can be due to differences in assessment methodology, laser settings, skin type, and scar location. Suprapurpuric pulsed dye laser should not be considered as the standard of practice for the treatment and prevention of hypertrophic surgical scars especially in the chest in Asians patients.

合成吸収糸による頚部皮膚縫合法

In neck surgery, the exposed scars of the primary suture should be fine for favorable cosmetic results. We previously used subcuticular and epithelial nylon sutures, but recently we have been using monofilament synthetic absorbable sutures (Polydioxanone; PDS-II®) in subcuticular closure to avoid indurations beneath the skin and late foreign body reactions. The scars of surgical incisions closed with PDS-II® were not inferior to those with nylon sutures, and we report below.In the prevention of hypertrophic scars, providing tensile relief and eliminating level differences of the skin are most important. The tensile strength of PDS-II® is retained for about 2 months, which is not long enough. Thus, subcuticular PDS-II® sutures require sufficient eversion to reduce scar stretching by providing dermal support for longer terms. We call this technique “hypereversion”. This technique does not require the control of degree of eversion according to patient age, and allows uniform sutures.Moreover, to get fine scars without suture marks, we are using film dressing (Op-site®) for wound fixation instead of epithelial suture in the early post operative period. When epithelial suturing is eliminated, level differences of the skin must be avoided in the subcuticular closure.

The Current Therapy and Prevention of Hypertrophic Scars and Keloids

The Current Therapy and Prevention of Hypertrophic Scars and Keloids

Suppression of insulin-like growth factor signalling pathway and collagen expression in keloid-derived fibroblasts by quercetin: its therapeutic potential use in the treatment and/or prevention of keloids.

Keloids are characterized by abnormal proliferation of fibroblasts and overproduction of collagen. Insulin-like growth factor (IGF)-I is mitogenic for fibroblasts and a stimulatory factor for collagen synthesis. We have assessed the in vitro effects of quercetin on proliferation, collagen synthesis and the expression of the IGF system in keloid-derived fibroblasts. Fibroblasts were isolated from earlobe keloids and exposed to quercetin at different concentrations. The inhibitory effects of quercetin on fibroblast proliferation were assayed using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay, Western and Northern blot analyses. Quercetin inhibited keloid fibroblast (KF) proliferation in a dose-dependent manner. Significant growth inhibition was observed on day 2 of culture. The dose required for 50% growth inhibition was approximately 25 microg mL-1. Collagen 1 expression was significantly decreased while collagen 3 was almost undetectable following quercetin treatment. Basal levels of IGF-I receptor (IGF-IR) beta subunits, p85 subunit of phosphatidylinositol 3-kinase, c-Raf, phospho-Raf-1, phospho-MEK 1/2, phospho-mitogen-activated protein kinase, phospho-Elk-1 and phospho-Akt-1 were significantly reduced when KF cells were exposed to quercetin for 24 h. Blocking IGF-IR activity with IGF-IR antibody or neutralizing endogenous IGF-I activity with IGF-I antibody led to significant growth inhibition suggesting the role of IGF-I in regulation of KF proliferation. Because the IGF system plays an important part in fibroblast cell proliferation and collagen production, the described activities of quercetin on the IGF system and collagen expression may provide a novel approach for the use of quercetin in treatment and/or prevention of hypertrophic scar and keloid.