Treatment Of Hypertrophic Scars Research Articles

The effectiveness of long Pulsed Nd:YAG Laser alone for treatment of keloids and hypertrophic scars versus its combination with bleomycin.

Pathological scars are benign hyper-proliferative growths of dermal collagen that causes severe psychological and physical problems. This study was performed to assess and compare safety and clinical efficiency of combined pulsed Nd-YAG laser and intralesional bleomycin versus pulsed Nd-YAG laser alone to treat the hypertrophic scars and keloids. Randomly, 40 patients with hypertrophic scars or keloids were divided into two groups A and B. Group A were handled by pulsed Nd:YAG laser and intralesional bleomycin while group B were handled by pulsed Nd:YAG laser only. Response was assessed subjectively by clinical imaging and modified Vancouver Scar Scale (mVSS). While for objective evaluation, skin biopsies were taken from volunteer patients before and after treatment, and were examined by Hematoxylin and eosin staining (H&E) and Masson trichrome staining. Our study demonstrated almost complete improvement in 4 (20%) patients, partial improvement in 16 (80%) patients and 0 patient with no improvement in group A. Furthermore, in group B, we demonstrated almost complete improvement in 2 (10%) patients, partial in 14 (70%) patients and no improvement in 4 (20%) patients. Modified Vancouver Scar Scale reduced from 10.15 to 3.5 in group A and from 11.05 to 4.95 in group B. Elastica Masson-Goldner staining and Hematoxylin and eosin staining showed that treatment in both groups structurally changed tissue collagen. Long-pulsed Nd-YAG laser combined with intralesional bleomycin could be a promising way for treatment of keloids or hypertrophic scars.

A critical review on the potential role of adipose-derived stem cells for future treatment of hypertrophic scars.

Adipose-derived stem cells (ASCs) have recently gained researchers' interest as a solution to various diseases and conditions, including hypertrophic scar. This literature review aims to elucidate ASCs as a potential solution to alleviate hypertrophic scar in human subjects. Literature search was done in databases which includes PubMed, MEDLINE, and ProQuest using terms 'adipose derived stem cells', 'adipose cells', 'fat graft', 'fat grafting', 'autologous fat graft', 'fat injection', 'lipofilling', 'scar management', 'scar treatment', 'burn scar', and 'wound management'. The included articles which were published during year 2000-November 2020 must describe the use of ASCs or fat grafting or lipofilling as an attempt to alleviate hypertrophic scar. Clinically, ASCs improve hypertrophic scars in terms of scar color, elasticity, texture, thickness, and size. Histologically, ASCs promotes healthy tissue regeneration, reduction in fibroblasts, and reorganisation of collagen, resembling those of normal skin. In terms of molecular aspects, ASCs alleviates hypertrophic scars through direct differentiation and paracrine mechanisms. Adipose-derived stem cells, emerge to be a potential solution for alleviating hypertrophic scar, as demonstrated in various studies. However, there has been no studies conducted in human subjects to investigate the effect of ASCs on hypertrophic scar.

Evolution of compressive mechanical properties of early hypertrophic scar during laser treatment

Laser therapy has been widely used in the treatment of hypertrophic scars (HPS), but whether the mechanical properties of HPS tissue after laser treatment can be restored to those of normal skin remains unclear. In this paper, the relationship between the evolution of compressive mechanical properties and histological changes of HPS tissues following three successive combined pulsed dye laser (PDL) and fractional CO2 laser (CO2) treatments was investigated by compression tests and histological analysis. The early HPS model of rabbit ear was established by CO2 laser ablation. The loading–unloading tests and strain creep tests under the compression forces of 1 N, 2 N, and 3 N were carried out for normal skin, untreated HPS and HPS after different treatment times, respectively. The results showed that the compression ratio λ of all tissues revealed force dependence and rose with the increasing compression force, which was similar to the trend of most biological soft tissues. The histological changes of HPSs following laser treatment have a significant influence on the compressive mechanical response. Compared with the normal skin, the toughness and anti-deformation ability of HPS reduced due to the proliferation of collagen fibers and the destruction of elastic fibers, resulting in higher energy dissipation, compression ratio λ, and stable creep rate D, and lower elastic modulus. After three successive combined PDL/ CO2 laser treatments, the compressive mechanical properties and creep properties of HPS gradually approached that of the normal skin owing to the gradual restoration of the amount and distribution of collagen and elastic fibers in HPS. The results provide a new method for evaluating the clinical efficacy of laser therapy for treatment of HPS tissue.

Evaluation of fractional carbon dioxide laser in the treatment of hypertrophic scars

Background Scars affect millions of patients and can significantly influence the physical and psychological functions of patients. Hypertrophic scars are raised nodules or plaques that develop as a result of an excessive collagen deposition during the wound healing process. There are several medical and surgical treatments available. Fractional carbon dioxide (CO2) laser is currently emerging as a minimally invasive therapeutic alternative. Aim The aim was to evaluate the effect of fractional CO2 laser in the treatment of hypertrophic scars. Patients and methods This study included 11 patients with hypertrophic scars (skin type III–IV), and their age ranged from 5 to 25 years old, with a mean of 18.27±7.43 years. Each patient received four sessions of treatment with 1-month interval. Final evaluation was performed 1 month after the last session by the opinion of three dermatologists blinded to the study protocol. The Vancouver scar scale and patient satisfaction before and after treatment were assessed. Skin biopsies were obtained before and 1 month after treatment for light microscopic studies. Results All patients showed clinical improvement. There was a statistically significant difference in the Vancouver scar scale between before and after treatment, where P=0.003. Response to treatment was excellent in 18.2%, good in 27.3%, fair in 36.4%, and poor improvement in 18.2% of patients according to dermatologists’ assessments. Overall, 27.3% of patients were highly satisfied, 54.5% were satisfied, and 18.2% were slightly satisfied. Patients tolerated the procedure well with minimal adverse effects. Conclusion Fractional CO2 can be an effective modality in the treatment of hypertrophic scars, without serious adverse events.

Inflammatory and infectious complications of laser therapy in treatment of hypertrophic burn scars: Correlations in literature review & case reports

IntroductionHypertrophic burn scars contribute to morbidity through secondary symptoms of pain, pruritus, and scar contracture. Traditional treatment methods are now augmented by the use of monochromatic light therapies, which are generally accepted as safe and effective. However, little literature is available regarding the complications of laser treatments of hypertrophic burn scars and even less regarding inflammatory and infectious complications. MethodsA literature search using PubMed was performed to identify literature pertaining to infectious and inflammatory complications of cutaneous laser treatments. Additionally, we reviewed cases of inflammatory and infectious complications occurring at our institution after laser treatment of hypertrophic burn scars. ResultsWe identified 1 publication related to complications of laser therapy in the treatment of burn scars. In this series of 163 laser sessions, the reported incidence of adverse events was 25.1%, of which 6 cases 3.7% were related to inflammatory and infectious processes. In the 391 laser sessions performed at our institution (December, 2015 and July, 2016) 9 cases of inflammatory and infectious complications were noted yielding an incidence of 2.3%. Cases included 3 each of cellulitis, Systemic Inflammatory Response Syndrome (SIRS), and complicated SIRS. ConclusionWe found the most common inflammatory complication was SIRS with MSSA positive wound cultures. Three cases underwent hospitalization along with fluids and vasopressors, despite negative blood cultures. In light of the high prevalence of MSSA in the natural skin flora and negative blood cultures, the inability to establish a true source of infection lead to declaring these cases “complicated SIRS” and not sepsis. Correlative factors that may have led to complications reported in our cases were: preoperative evidence of infection, no preoperative antibiotics administered, no postoperative antibiotic dressings, combined procedures, and large treatment areas. The true mechanism of inflammatory and infectious complication is yet to be determined, but we postulate that these factors place a greater challenge on an already burdened immune system. Determining whether this is a true causal mechanism, leading to an aggravated inflammatory response, benefits from further investigation. Applicability of research to practiceWe urge institutions preforming such procedures to advise patients on preoperative wound preparation. We recommend that each individual with a preexisting history of infection and/or preoperative culture evidence of infection receive antibiotics, particularly when undergoing combined procedures or procedures involving higher surface areas. Although complications are rare, the benefits of these precautionary measures outweigh the risks when it comes to prevention and management.

Comparative efficacy of intralesional verapamil hydrochloride, triamcinolone acetonide and combination of both drug in hypertrophic scars and keloids at tertiary care center

Background: Keloids and hypertrophic scars are still a therapeutic problem. Despite numerous proposed therapies reported in the literature, the management of keloid and hypertrophic scars is still challenging as there is no universally accepted treatment regimen. Compare the efficacy intralesional verapamil hydrochloride and triamcinolone acetonide separately as well as combination of both drug in treatment of hypertrophic scars and keloids.Methods: A retrospective study was carried out at the general surgery department (plastic surgery unit) at the JNUIMSRC Jaipur, Rajasthan. Total of 150 patients (60 males and 90 females) between 18 to 60 years of age were enrolled fulfilling the inclusion criteria. They were randomly categorized in to three groups (group A, B and C), based on treatment they received viz. verapamil alone, triamcinolone alone and combination of both drugs respectively. Assessment of the scars were done prior to or on the day of the first injection and at 24 weeks after the end of injection scheme by Vancouver scar scale (VSS). The decreasing values reflected clinical improvement of the scar.Results: Better improvement observed in all four parameters: height, vascularity, pliability and pigmentation among patients receiving combination of both triamcinolone-verapamil drugs as compare to those patients receiving drugs separately either verapamil or triamcinolone alone. For parameters height, pliability and pigmentation, the improvement was found to be statistically significant (p<0.05)Conclusions: Study highlights that the combined verapamil and triamcinolone therapy scheme causes remarkable scar improvement in keloid and hypertrophic scars in comparison to single drug scheme.

Silicone gel sheeting for treating hypertrophic scars.

Silicone gel sheeting for treating hypertrophic scars.

MicroRNA‑18a‑5p represses scar fibroblast proliferation and extracellular matrix deposition through regulating Smad2 expression

The aim of the present study was to investigate the expression and role of microRNA-18a-5p (miR-18a-5p) during the formation of hypertrophic scar (HS), and to further explore the molecular mechanisms involved. Downregulation of miR-18a-5p in HS tissues and human HS fibroblasts (hHSFs) was detected by reverse transcription-quantitative polymerase chain reaction. The binding sites between miR-18a-5p and the 3'-untranslated region of SMAD family member 2 (Smad2) were predicted by TargetScan and confirmed by dual-luciferase reporter assay. To investigate the role of miR-18a-5p in HS formation, the effects of miR-18a-5p downregulation or upregulation on hHSFs were subsequently determined. Cell proliferation was detected by an MTT assay, while cell apoptosis was measured by flow cytometry. In addition, the protein expression levels of Smad2, Collagen I (Col I) and Col III were examined by western blot assay. The findings indicated that miR-18a-5p downregulation in hHSFs significantly promoted the cell proliferation, decreased cell apoptosis and enhanced the expression levels of Smad2, Col I and Col III protein and mRNA, whereas miR-18a-5p upregulation in hHSFs exerted opposite effects. Notably, the effects of miR-18a-5p upregulation on hHSFs were eliminated by Smad2 upregulation. In conclusion, the data indicated that miR-18a-5p was downregulated during HS formation, and its upregulation repressed scar fibroblast proliferation and extracellular matrix deposition by targeting Smad2. Therefore, miR-18a-5p may serve as a novel therapeutic target for the treatment of HS.

Ellagic acid exerts anti-fibrotic effects on hypertrophic scar fibroblasts via inhibition of TGF-\u03b21/Smad2/3 pathway

Hypertrophic scar (HS) is a kind of serious pathological scar with no currently effective treatment. HS fibroblasts (HSFs) are the main effector cells for HS formation. Ellagic acid (EA) exerts regulatory effects in some diseases, but its role in HS remains unclear. This study aimed to evaluate the effect of EA on the fibrotic phenotypes of HSFs and to further investigate the downstream signaling mechanism. The cell counting kit-8 (CCK-8) assay was used to perform cytotoxicity and proliferation assays. HSFs migration was assessed using wound healing and transwell assays. HSFs contraction was measured by a collagen lattice contraction assay and detection of α-smooth muscle actin (α-SMA) expression. The levels of mRNA and protein were determined by qPCR and western blotting, respectively. The results showed that EA inhibited the proliferation, migration, and contraction of HSFs and collagen expression in HSFs in a dose-dependent manner. Furthermore, EA not only suppressed the Smad2/3 pathway but also reversed TGF-β1-induced activation of the Smad2/3 pathway and up-regulation of the fibrotic cellular phenotypes in HSFs. These findings demonstrate that EA exerts anti-fibrotic effects on HSFs by blocking the TGF-β1/Smad2/3 pathway, which indicates that EA is a potential therapeutic candidate for treatment of HS.

Effectiveness and safety of fractional micro-plasma radio-frequency treatment combined with ablative fractional carbon dioxide laser treatment for hypertrophic scar: a retrospective study.

Hypertrophic scars can be caused by various injuries and lead to a decrease in quality of life of those affected. This study was performed retrospectively in our center to investigate the safety and effectiveness of fractional micro-plasma radio-frequency treatment combined with ablative fractional carbon dioxide (CO2) laser treatment in patients with hypertrophic scar. This was a retrospective study performed in a single center between January 2019 and December 2020. All patients with hypertrophic scars receiving fractional micro-plasma radio-frequency treatment, ablative fractional CO2 laser treatment, or combined therapy of both were recruited to the study. The participants were then divided into a single therapy group or combined therapy group. The Vancouver scar scale was used to score and subsequently assess the effectiveness of scar treatment and the changes of scar thickness. Some adverse complications were also recorded to evaluate the safety of treatments. A subgroup analysis was then performed to investigate the differences of effectiveness and safety of combined therapy in scar patients at the early stage and late stage. A total of 64 patients with hypertrophic scars were enrolled in this study, including 45 receiving combined treatment, and 19 receiving single treatment. There was no significant difference in demographic data between the two groups. Notably, combined therapy could more effectively reduce the score of Vancouver scar scale (P=0.026) without significantly increasing the incidence of adverse complications. However, no significant difference was observed in scar thickness between the two groups. Moreover, multiple treatments could further increase the effectiveness of combined therapy according to either the score of Vancouver scar scale or the thickness of scars. Subgroup analysis revealed that combined therapy could reduce the score of Vancouver scar scale and scar thickness in patients much more at the early stage than at the late stage (P=0.032 and 0.042, respectively). This study revealed that fractional micro-plasma radio-frequency treatment combined with ablative fractional CO2 laser treatment could be more effective in improving hypertrophic scars then single therapy. Also, multiple treatments could enhance the effectiveness of combined treatment, and patients should be encouraged to receive treatment as early as possible.

Letter to the Editor: Evaluation of Efficacy of Corticosteroid and Corticosteroid Combined with Botulinum Toxin Type A in the Treatment of Keloid and Hypertrophic Scars—A Meta-Analysis

Letter to the Editor: Evaluation of Efficacy of Corticosteroid and Corticosteroid Combined with Botulinum Toxin Type A in the Treatment of Keloid and Hypertrophic Scars—A Meta-Analysis

A Randomized, Double-Blind, Active- and Placebo-Controlled Trial Evaluating a Novel Topical Treatment for Keloid Scars.

Keloid and hypertrophic scars are fibroproliferative disorders resulting from abnormal wound healing in genetically susceptible individuals. Current therapies are often ineffective. Kynurenine shows promise as a topical treatment for keloids and hypertrophic scars. In this study, healthy adult male and female subjects seeking treatment for mature keloid scars were enrolled. Subjects were randomized in double-blind fashion to receive kynurenic acid 0.5% (FS2) cream (Group 1), an active onion extract comparator treatment (Group 2), or the inactive vehicle (Group 3). Each treatment was applied twice-daily. Qualitative assessments were made using the Vancouver Scar Scale (VSS), as well as the Patient and Observer Scar Assessment Scales (POSAS). Among subjects in Group 1, there was a substantial decrease in mean PGSS scores after 30 days of treatment that continued to trend downward, becoming significant versus Group 2 at days 90 and 180 (P<0.05) and versus Group 3 at day 180 (P<0.01). Based on mean VSS scores, subjects in Group 1 achieved beneficial effects that became significant versus Group 2 at day 90 (P<0.01), day 120 (P<0.05), and day 180 (P<0.001) and versus Group 3 at day 180 (P<0.05). There were no significant improvements in Groups 2 or 3. There were no adverse events or local skin reactions. The twice-daily application of FS2 Cream represents a potentially new and effective treatment for mature keloid scars. J Drugs Dermatol. 2021;20(9):964-968. doi:10.36849/JDD.6197.

Long non-coding RNA H19 acts as a microRNA-194 sponge to inhibit the apoptosis and promote the proliferation of hypertrophic scar fibroblasts

The effects of long non-coding RNAs (lncRNAs) on the proliferation of hypertrophic scars have been described, however, the underlying mechanisms are not well characterized. The present study aimed to investigate the mechanisms of lncRNA H19 in hypertrophic scars. The effects of the lncRNA H19 on the proliferation and apoptosis of hypertrophic scar fibroblasts (HSFs) were analyzed using 5'-ethynyl-2'-deoxyuridine staining, flow cytometry, and 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2H-tetrazolium bromide (MTT). The results revealed H19 promoted the proliferation and inhibited the apoptosis in HSF. In addition, the binding associations between H19 and microRNA-194 (miR-194), and miR-194 and insulin-like growth factor I receptor (IGF1R) were identified using bioinformatics screening and verified using dual-luciferase assays. Furthermore, the effects of the IGF1R knockdown on H19-induced HSF phenotypes and regulation over the p38 MAPK pathway were determined. Mechanistically, miR-194 was identified as the downstream effector of the H19-mediated phenotypes of HSFs through its ability to directly target IGF1R, thus modulating the p38 MAPK signaling pathway. In conclusion, the findings suggested that H19 may inhibit the apoptosis and promote the proliferation of HSFs through the miR-194/IGF1R/p38 MAPK signaling axis, thereby contributing to the progression of hypertrophic scars. These findings may provide novel targets for the treatment of hypertrophic scars.

Knockdown of lysyl oxidase like 1 inhibits the proliferation and pro-fibrotic effects of transforming growth factor-β1-induced hypertrophic scar fibroblasts.

The excessive healing response during wound repair can result in hypertrophic scars (HS). Lysyl oxidase like 1 (LOXL1) has been reported to be associated with fibrosis via targeting transforming growth factor β1 (TGF-β1) signaling. This study aimed to investigate the effect of LOXL1 on HS formation. The expression of LOXL1 in HS tissues and TGF-β1-induced HS-derived fibroblasts (HSFs) was detected via reverse transcription quantitative PCR and Western blot. LOXL1 was silenced in HSFs using transfection with short hairpin RNA (shRNA), then wound healing process including cell proliferation, cell cycle distribution, migration, and extracellular matrix (ECM) deposition along with Smad expression were measured by cell counting kit-8, EdU staining, flow cytometry, transwell, immunofluorescence, and Western blot assays. LOXL1 was upregulated in HS tissues and TGF-β1-induced HSFs. Knockdown of LOXL1 inhibited proliferation and migration but promoted cell cycle G0/G1 phase arrest in TGF-β1-induced HSFs; it increased expression of cyclin D1, CDK4, MMP2, MMP9, COL1A1, COL1A2, fibronectin, COL3A1, α-SMA, but decreased expression of p27, and the phosphorylation of Smad2 and Smad3 caused by TGF-β1 were also blocked by LOXL1 silencing. Silence of LOXL1 could effectively inhibit TGF-β1-induced proliferation, migration, and ECM deposition in HSFs via inactivating Smad pathway. Targeting LOXL1 may have future therapeutic implications for HS treatment.

A clinical study of carbon dioxide lattice laser-assisted or microneedle-assisted 5-aminolevulinic acid-based photodynamic therapy for the treatment of hypertrophic acne scars.

To study the clinical efficacy, recurrence rate and safety of 5-aminolevulinic acid-based photodynamic therapy (ALA-PDT) combined with microneedle or CO2 lattice laser (CO2FL), in comparison with intrascar betamethasone injection in the treatment of hypertrophic acne scar. Fifty-two patients with hypertrophic acne scars at the mandibular angle were enrolled and assigned to different therapy groups. Sixteen patients were treated with microneedle-assisted incorporation of ALA. Twenty-eight patients underwent CO2FL-assisted incorporation of ALA. Eight patients received standard therapy with intrascar injection of glucocorticoid. Two dermatologists, blinded to the therapy groups, independently evaluated the scars in all patients using the average value of the Vancouver Scar Scale score, which was treated as an integer variable. After three rounds of treatment, there was no significant difference in therapeutic effective rate among the microneedle, laser and topical glucocorticoid groups (93.75% vs 100% vs 100%, P=.855). One out of 16 patients (6.25%) in the microneedle group, no patient (0%) in the laser group and two out of eight patients (25%) in the topical glucocorticoid group had recurrence. The laser group showed a higher rate of adverse effects, which were usually mild and reversible, except for pigmentation. Adverse reactions could be completely subsided within 3weeks. Either CO2FL or microneedle combined ALA-PDT for hypertrophic scar, as to topical glucocorticoid therapy, showed equivalent clinical effects but lower recurrence rate within 6months of follow-up period.

Treatment of keloids and hypertrophic scars. Position statement of the Brazilian expert group GREMCIQ.

Keloids (K) and hypertrophic scars (HS) are abnormal responses to wound healing that occur as the result of dermal inflammation. Despite the advances on their treatment, many patients still suffer from the negative effects of excessive scarring; its approach is impaired by the lack of objective data on different treatments and the large genetic variability among patients and the difficulties in producing multicentre studies. Their incidence among the Brazilian population is high, as the result of an admixture of Amerindians, Europeans and Africans ancestral roots. With the aim of producing multicentre studies on K and HS, a panel of senior Brazilian dermatologists focused on their treatment was invited to contribute with the K and HS Treatment Brazilian Guidelines. In the first part of this study, different treatment modalities for keloids and HS are fully reviewed by the panel. The second part of the study presents a consensus recommendation of treatment for different types of lesions. More than a literature review, this article aims to show the pitfalls and pearls of each therapeutic option, as well as a therapeutic approach by the Panelof Experts on keloids and Scars on a highly mixed population, providing simple guidelines.

Current Advances in Hypertrophic Scar and Keloid Management.

Hypertrophic scars and keloids are caused by excessive tissue response to dermal injury due to local fibroblast proliferation and collagen overproduction. This response occurs because of pathologic wound healing due to dysregulation in the inflammatory, proliferative, and/or remodeling phase. Patients with hypertrophic scars or keloids report reduced quality of life, physical status, and psychological health. Hypertrophic scars or keloids will develop in 30 to 90% of individuals, and despite their prevalence, treatment remains a challenge. Of the treatments currently available for hypertrophic scars and keloids few have been adequately supported by studies with appropriate experimental design. Here, we aim to review the available literature to provide up-to-date information on the etiology, epidemiology, histology, pathophysiology, prevention, and management options available for the treatment of hypertrophic scars and keloids and highlight areas where further research is required.

A Review of Hypertrophic Scar and Keloid Treatment and Prevention in the Pediatric Population: Where Are We Now?

Significance: This body of work gives a concise and comprehensive overview for the clinician and scientist on the latest treatment modalities for hypertrophic scars (HTS) and keloids in the pediatric population, as well as the most promising methods of prevention currently being investigated. This review will serve as a guide to the clinician for treatment selection and as an efficient tool for the scientist to achieve a comprehensive overview of the scientific literature to guide their future experiments aimed at pathologic scar prevention. Recent Advances: Current studies in the literature suggest carbon dioxide (CO2) laser and E-light (bipolar radiofrequency, intense pulsed light, and cooling) are two of the most effective treatment modalities for HTS, while surgical excision+CO2 laser+triamcinolone injection was one of the most successful treatments for keloids. In animal models, drug impregnated electrospun nanofiber dressings offer encouraging results for HTS prevention, while Kelulut honey showed promising results for keloid prevention. Critical Issues: Treatment outcome reproducibility is hindered by small cohorts of patients, inadequate-follow up, and variability in assessment tools. Prevention studies show multiple ways of achieving the same result, yet fall short of complete prevention. Furthermore, some studies that have purported full prevention have not been validated. Future Directions: To establish a standard of care, large clinical trials of the most successful modalities in small cohorts are needed. The key for prevention will be validation in animal models of the most successful methods, followed by translational and clinical studies.

COMPARISON OF INTRALESIONAL METHOTREXATE WITH TRIAMCINOLONE ACETONIDE IN TREATMENT OF HYPERTROPHIC SCARS

Background: Keloid and hypertrophic scars are common dermatological complaints produced by disruption of the normal wound-healing process. Since their earliest description, keloids have beleaguered patients and clinicians alike. These scars can be aesthetically disfiguring, functionally debilitating, and emotionally distressing. Objective: Our study was carried out on 40 patients complaining of keloids divided into two equal groups A and B from November 2019 to June 2020: Group A: treated by triamcinolone acetinoid (TAC) every three weeks, and Group B treated by methotrexate (MTX) every three weeks for maximum eight sessions, We used multiple intralesional injections until the lesion was blanched. Patients were selected from out-patient clinic of Dermatology, Venereology and Andrology Department of Al-Azhar University Hospitals. Results: The present study showed that the vascularity became normal (score 0) in 14 patients (70%), pink (score 1) in 6 patients (30%) in group A. Twelve patients (60%) became with normal vascularity (score 0), pink (score 1) in 8 patients (40%) in group B. Flatting of lesions (score 0) occurred in 14 patients (70%), while reduction to 2mm (score 1) documented in 6 patients (30%) in group A, and flattening (score 0) occurred in 10 patients (50%), reduction of the lesions to 2mm (score 1) occurred in 8 patient (40%) and 2 patient (10%) had score (2) height 2-5 mm in group B. Normal pigmentation (score 0) occurred in 16 patients (80%), mixed pigmentation (score 2) in 2 patients (10%) and hyperpigmentation (score 3) in 2 patients (10%) in group A and 6 patients (30%) showed normal pigmentation (score 0), 2 patients (10%) showed mixed pigmentation (score 2), 4 patients (10%) showed hypopigmentation(score 1) and 8 patients (40%) showed hyperpigmentation (score 3) in group B. Normal pliability in 16 patients (80%) (Score 0), 4 patients (20%) showed supple pliability (score 1) in group A. Normal pliability (score 0) was in 10 patients (50%), 2 patients (10%) showed yielding pliability (score 2), and 8 patients (40%) supple pliability (score 1) in group B. Assessment of the scar was based on Vancouver scar scale. Conclusion: Triamcinolone acetinoid (TAC) was effective in treatment of hypertrophic scars than methotrexate with statistically significant difference at end of treatment period and follow up.

Evaluation of Efficacy of Corticosteroid and Corticosteroid Combined with Botulinum Toxin Type A in the Treatment of Keloid and Hypertrophic Scars: A Meta-Analysis.

Both keloid and hypertrophic scars are common benign skin lesions manifested by hyperplasia of fibroblasts. Clinically, this will not only have physiological effects on patients, but also cause psychological damage. However, there is no unified standard treatment method at present. Intralesional corticosteroid injection alone and corticosteroid combined with botulinum toxin type A has been gradually found to be useful for the treatment of keloid and hypertrophic scars, but the difference in efficacy between the two is controversial. A systematic search was made of the relevant experiments from Web of Science, PubMed, Scopus, Google Scholar, Cochrane Library, and China National Knowledge Infrastructure (CNKI). The scores of Visual Analog Scale (VAS), Vancouver Scar Score sheet (VSS), scar thickness, itching degree and patient satisfaction after the combination of corticosteroid and botulinum toxin type A were superior than those after corticosteroid (P<0.05). Compared with corticosteroid alone, corticosteroid combined with botulinum toxin type A is more effective in the treatment of keloid and hypertrophic scar. Although clinical case studies for the treatment of keloid or hypertrophic scars are limited, it is necessary and helpful to understand the effectiveness of corticosteroid combined with botulinum toxin type A in the treatment of keloid or hypertrophic scars. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .