Treatment Of Pathological Scars Research Articles

The Role of Biomechanical Forces in the Formation and Treatment of Pathological Scars

The Role of Biomechanical Forces in the Formation and Treatment of Pathological Scars

Application and progress of new technologies and new materials in the treatment of pathological scar.

Pathological scars (PS), including hypertrophic scars (HTS) and keloids, are a common complication of poor wound healing that significantly affects patients' quality of life. Currently, there are several treatment options for PS, including surgery, drug therapy, radiation therapy, and biological therapy. However, these treatments still face major challenges such as low efficacy, high side effects, and a high risk of recurrence. Therefore, the search for safer and more effective treatments is particularly urgent. New materials often have less immune rejection, good histocompatibility, and can reduce secondary damage during treatment. New technology can also reduce the side effects of traditional treatments and the recurrence rate after treatment. Furthermore, derivative products of new materials and biomaterials can improve the therapeutic effect of new technologies on PS. Therefore, new technologies and innovative materials are considered better options for enhancing PS. This review concentrates on the use of two emerging technologies, microneedle (MN) and photodynamic therapy (PDT), and two novel materials, photosensitizers and exosomes (Exos), in the treatment of PS.

Clinical efficacy of ablative laser combined with pulsed dye laser in the treatment of pathological scars: A systematic review and meta‐analysis

AbstractObjectiveA systematic review and meta‐analysis were conducted to evaluate the efficacy and safety of ablative laser combined with pulsed dye laser to treat pathological scars.MethodsA systematic literature review was conducted to identify all blind, randomized, controlled trials of ablative laser and pulsed dye laser for treating pathological scars. The databases PubMed, Embase, and Cochrane were used. All research on ablative laser combined with PDL in treating pathological scars with ablative laser or no treatment as controls were included in the meta‐analysis. The retrieved studies' reference lists were thoroughly examined.ResultsPOSAS and VSS were used as evaluation criteria in seven studies involving 189 patients. Effect of combined laser group therapy (−1.259 95% confidence interval, −1.515 to −1.003; p < 0.0001). The difference between the combined treatment and control groups was (−1.375; 95% CI, −1.727 to −1.023; p < 0.0001) and (−1.150; 95% CI, −1.523 to −0.777; p < 0.0001).ConclusionsAblative laser combined with PDL is more effective and safer than ablative laser or PDL alone in the treatment of pathological scars.

Liposomes Loaded with 5-Fluorouracil Can Improve the Efficacy in Pathological Scars.

Pathological scars, such as hypertrophic scars and keloids, are characterized by the proliferation of fibroblasts and the deposition of collagen that often cause pruritus, pain, and disfigurement. Due to their high incidence and deformity, pathological scars have resulted in severe physical and psychological trauma for patients. Intralesional injection of 5-fluorouracil (5-Fu) is a recommended option for treating pathological scars. However, the efficacy of 5-Fu injection was limited and unstable due to limited drug penetration and short retention time. Liposomes are promising carriers that have advantages, such as high biocompatibility, controlled release property, and enhanced clinical efficacy. Here, we constructed a transdermal 5-Fu-loaded liposome (5-Fu-Lip) to provide a more effective and safer modality to scar treatment. Compared to 5-Fu, 5-Fu-Lip showed superior ability in inhibiting primary keloid fibroblasts proliferation, migration, and collagen deposition, and also significantly inhibited human umbilical vein endothelial cells (HUVECs) proliferation and microvessel construction. In vivo experiments demonstrated that 5-Fu-Lip can significantly reduce the severity of hypertrophic scars in a rabbit ear wounding model. 5-Fu-Lip provides a promising strategy to improve drug efficacy, which has great potential in the treatment of pathological scars.

Non-invasive imaging of pathological scars using a portable handheld two-photon microscope.

Pathological scars are a disorder that can lead to various cosmetic, psychological, and functional problems, and no effective assessment methods are currently available. Assessment and treatment of pathological scars are based on cutaneous manifestations. A two-photon microscope (TPM) with the potential for real-time non-invasive assessment may help determine the under-surface pathophysiological conditions in vivo . This study used a portable handheld TPM to image epidermal cells and dermal collagen structures in pathological scars and normal skin in vivo to evaluate the effectiveness of treatment in scar patients. Fifteen patients with pathological scars and three healthy controls were recruited. Imaging was performed using a portable handheld TPM. Five indexes were extracted from two dimensional (2D) and three dimensional (3D) perspectives, including collagen depth, dermo-epidermal junction (DEJ) contour ratio, thickness, orientation, and occupation (proportion of collagen fibers in the field of view) of collagen. Two depth-dependent indexes were computed through the 3D second harmonic generation image and three morphology-related indexes from the 2D images. We assessed index differences between scar and normal skin and changes before and after treatment. Pathological scars and normal skin differed markedly regarding the epidermal morphological structure and the spectral characteristics of collagen fibers. Five indexes were employed to distinguish between normal skin and scar tissue. Statistically significant differences were found in average depth ( t = 9.917, P <0.001), thickness ( t = 4.037, P <0.001), occupation ( t = 2.169, P <0.050), orientation of collagen ( t = 3.669, P <0.001), and the DEJ contour ratio ( t = 5.105, P <0.001). Use of portable handheld TPM can distinguish collagen from skin tissues; thus, it is more suitable for scar imaging than reflectance confocal microscopy. Thus, a TPM may be an auxiliary tool for scar treatment selection and assessing treatment efficacy.

Current Research of Botulinum Toxin Type A in Prevention and Treatment on Pathological Scars.

Dermatologists have been looking for ways to improve wound healing and postoperative scar appearance. The safety and efficacy of botulinum toxin type A (BTXA) in the prevention and treatment on pathological scars have become the current research hotspot since it was approved by the US FDA in medical cosmetology in 2002. This article aims to provide an overview of the clinical research, limitations, and application prospects of BTXA in the prevention and treatment of traumatic or postoperative pathological scars, which can provide a reference and better understanding of relevant studies. The current research progress was summarized and discussed, with new problems and research ideas being proposed ranging from the molecular mechanism of BTXA in preventing and treating pathological scars to its clinical application via investigation and reference research. BTXA is effective in relieving itching and pain associated with pathological scars, limiting scar hyperplasia along with preventing scar contracture, but the specific mechanism is still not clear. Most of the clinicians have confirmed the clinical effectiveness of BTXA in the prevention and treatment of pathological scars, yet its mode of action and combination therapy need more research.

Preliminary results of the use of carboxytherapy in the treatment of pathologic scars: A minimally invasive alternative

BackgroundCarboxytherapy involves injecting carbon dioxide in the dermal and subcutaneous layers to achieve an increase in the local microvascularization of the tissue where it is applied. Our aim is to analyze its effectiveness in the treatment of pathological scars, as well as its adverse effects. MethodsWe conducted a prospective single-center study in patients under 18 years of age with atrophic and hypertrophic scars caused by surgical interventions or trauma, mainly burns. Each patient underwent two sessions, 6 weeks apart in time. Scar quality was evaluated using the Vancouver Scar Scale before the first session and 6 weeks after the second session. Adverse effects observed during the procedure and at follow-up in outpatient clinic were collected. ResultsA total of 16 patients were included (5 males; 11 females), with a median age of 12.7 years (interquartile range 8.5–15.2), in whom 25 pathologic scars were treated (14 atrophic and 11 hypertrophic). All sessions were performed under sedation, and patients were discharged the same day, without the need for hospitalization. Regarding scar quality, an improvement was observed in the median Vancouver scale score at 6 weeks after the second session (7 points) compared to the initial median score (12 points), this difference being statistically significant (p = 0.031). No serious adverse effects were observed during the procedure or during subsequent follow-up, with a median follow-up of 14 weeks. ConclusionsCarboxytherapy is an effective and safe minimally invasive therapy for pathologic scars, achieving a significant improvement in scar quality, with almost no contraindications. Level of evidenceLevel IV. Type of studyProspective Single-Center Case Series.

Could hyperbaric oxygen be an effective therapy option for pathological scars? A systematic review and meta-analysis

Background Hyperbaric oxygen (HBO) therapy involves breathing pure oxygen or a high oxygen concentration above atmospheric (ATM) pressure in an enclosed chamber. Studies on pathological scars have demonstrated that HBO can inhibit the formation of pathological scars. Objective To evaluate the efficacy of HBO in the treatment of pathological scars via meta-analysis. Methods Searches were run on various databases, including the Cochrane, Embase, PubMed, Web of Science, and CNKI databases. A comparative study was conducted on patients with pathological scars treated with or without HBO. We used RevMan 5.4 software to determine the recurrence rate, treatment satisfaction, and Vancouver Scar Scale(VSS) score in the pathological scar. Results A total of 543 publications were identified; after screening, four were selected for review, including one randomized controlled trial (RCT), one controlled clinical trial (CCT), and two retrospective cohort studies. Meta-analysis results showed that HBO treatment reduced the pathological scar recurrence rate after surgery and radiotherapy (OR = 0.26, 95% CI: 0.13–0.52, p = 0.0001). Patients had higher satisfaction after HBO therapy (OR = 4.45, 95% CI: 1.49–13.30, p = 0.007). The Vancouver scar scale (VSS) score of patients with pathological scars was significantly improved in the HBO group (SMD: −3.82, 95% CI: −6.07to −0.49, p = 0.02). Conclusions HBO treatment decreased the recurrence rate of pathological scars after surgery and radiotherapy, increased patient satisfaction, and reduced the VSS score, thus providing a new way to treat pathological scar hyperplasia. However, evaluation of the longer-term effects of HBO treatment requires further comprehensive studies, including more RCTs.

Treatment of Pathological Scars with Nanofat Lipograft at the Hermanos Ameijeiras Hospital

Introduction: The healing is the result of the natural restoration of the organism before a corporal aggression produced by a surgical wound or trauma. Poor wound and injury healing represents a functional and aesthetic problem, which is why it deserves special attention. Objective: To evaluate the aesthetic results of the treatment of pathological scars with lipotransfer by nanofat. Method: A prospective longitudinal and descriptive study was carried out with 8 patients from Plastic Surgery Hospital ‘‘Hermanos Ameijeiras” with pathological scars, who received lipotransfer treatment by Coleman method and processing of adipose tissue by nanofat from January to June 2020. Results: 8 patients with ages between 25 and 50 years with a mean age of 39 years were included. The female sex predominated with 75%. The predominant skin color was grades 3 and 5 of the Fitzpatrick classification, both with 50%. The most frequent etiologies were post acne, postoperative and injection scars of allogenic substances, all with 25%. The main anatomical locations were the facial region and in the breasts with 3 patients each, followed by 2 cases in the gluteal region. The postoperative aesthetic results at three months were 100% good, observing macroscopic and microscopic positive changes with the nanograft. No patient presented complications. Conclusions: The treatment of pathological scars with lipotransfer by nanofat is an available, simple and reproducible option that offers objective improvement of the scar with rapid recovery.

自体脂肪注射治疗病理性瘢痕的研究进展

自体脂肪注射治疗病理性瘢痕的研究进展

COMPREHENSIVE EXAMINATION OF PATIENTS WITH PATHOLOGICAL FACIAL SCARS

Introduction. The urgency of the issue on diagnosis of pathological head and neck scars has resulted from a growing prevalence of pathological scars. Quite often, patients with pathological scars require psychological rehabilitation. The purpose of our study is to improve the effectiveness of the treatment of scars by identifying a specific type of scar and taking into account the psychological state of the patient. Materials and methods. Under our supervision, there were 60 people with head and neck scars aged 20-50 years (mean age 31.2 ± 11.1 years). In addition, the study involved 20 healthy individuals (mean age 30.9 ± 10.7 years). Clinical examination of patients was supplemented by digital imaging of graphic images in the RGB system in Adobe Photoshop. An integral part of the clinical examination of patients with head and neck scars was a detailed study of their individual personality characteristics. The study included the techniques to assess patients’ general health condition, general activity and emotional state; a questionnaire for evaluating mental stress and the "Integrative Anxiety Test" was also used.&#x0D; Results. By applying the RGB colour system, statistically significant differences in colour indices were revealed. It was established that all the indicators of intensity of spectral radiation tended to decrease: the red colour indicator tended to decrease on average by 4 units, the same was relevant for the green spectrum indicator. The average values of the reduction of the blue colour intensity were 10 units.&#x0D; Mental and emotional states of the patients with pathological scars are characterized by specific features that distinguish them from the emotional state of healthy individuals. Significant differences in the emotional states between the emotional states of the patients and healthy individuals included both quantitative (higher rates of most of the investigated parameters) and qualitative parameters (different proportion of components in the structure of the emotional state). The obtained data testify that the patients with pathological scars tend to respond to the traumatic situation (including the situation of the disease) by intense feeling of physiological and psychological discomfort, depressed mood, mental stress, anxiety, hypochondria, exaggeration of negative experience.&#x0D; Conclusions. The application of the RGB system in the diagnosis of pathological scarring in the face allows us to reliably determine the type of scar, and depending on the scar type to choose the optimal method of the therapy. Inclusion in the comprehensive examination of psychodiagnostic methods is sufficiently feasible and can contribute to the development of an integrated approach in the treatment of pathological scars.

Effects of transplanted adipose derived stem cells on the expressions of α-SMA and DCN in fibroblasts of hypertrophic scar tissues in rabbit ears.

To study the effects of transplanted adipose derived stem cells (ADSCs) on the expressions of α-smooth muscle actin (α-SMA) and decorin (DCN) in fibroblasts of hypertrophic scar tissues in rabbit ears. Twelve New Zealand white rabbits were selected; the normal subcutaneous adipose tissues in inguinal region were removed, ADSCs were extracted via enzyme digestion, cultured in Dulbecco's modified Eagle's medium (DMEM) and inoculated into the culture dish (3–5×104 cells/ml). After the rabbit ear hypertrophic scar model was established successfully, the fibroblasts of hypertrophic scar tissues in rabbit ears were separated and cultured using the mechanical method combined with enzyme digestion, and the ADSCs and scar fibroblasts were cultured in non-contact Transwell co-culture system for 21 days (experimental group); the corresponding scar fibroblasts were cultured in an ordinary 6-well plate without any treatment for 21 days (control group). The content of collagen I in fibroblasts was detected using the enzyme-linked immunosorbent assay (ELISA) kit, the mRNA expressions of α-SMA and DCN were detected via reverse transcription-polymerase chain reaction (RT-PCR), the protein expressions of α-SMA and DCN were detected via western blot analysis, and the expressions and distribution of α-SMA and DCN were detected via immunofluorescence assay. The results of ELISA showed that the content of collagen I in experimental group was decreased significantly (p<0.01). The results of RT-PCR and western blot analysis revealed that the mRNA and protein expression levels of α-SMA were significantly decreased (P<0.01, but those of DCN were significantly increased (p<0.01). Moreover, the results of immunofluorescence assay showed that the expression of α-SMA in experimental group was significantly decreased, while the expression of DCN was significantly increased. ADSCs can inhibit the mRNA and protein expressions of α-SMA and promote the mRNA and protein expressions of DCN in in vitro culture system, and they are expected to be used in the prevention and treatment of pathological scars.

Advances in the research of treatment of angiogenesis inhibitor on pathological scars

Angiogenesis inhibitors are a class of agents that prevent the angiogenesis by inhibiting the activation, migration, and proliferation of endothelial cells. In recent years, studies have found that there was a close relationship between the occurrence of pathological scars and angiogenesis. The vascular density in pathological scars is significantly higher than that in normal skin and scars. Neovascularization supports the fibroblasts growth and collagen production, which contribute to the development of pathological scars. Therefore, the angiogenesis inhibitor may become a possible agent for prevention and treatment of pathological scars. This review explores the relationship between pathological scars and angiogenesis inhibitor.

Advances in Mechanisms for Prevention and Treatment of Pathological Scars with Mesenchymal Stem Cells.

Pathological scars,including keloids and hypertrophic scars,result from aberrations in the process of physiologic wound healing.An exaggerated inflammatory process is one of the main pathophysiological contributors.Pathological scars may cause pain and pruritis,limit joint mobility,and cause a range of cosmetic deformities that affect the patient's quality of life.However,the effectiveness of currently available prevention and treatment measures remains unsatisfactory.Mesenchymal stem cells,among their multifunctional roles,have the functions of immunomodulation and promotion of angiogenesis.Thus,they have been proposed to be a major candidate for cell therapy to treat or prevent pathologicalscars.This article reviews the mechanism and potentials of stem cell therapy in the prevention and treatment of pathological scars.

The Characteristics of Blood Supply and Tissue Hypoxia in Pathological Scars.

Blood supply is believed to be an important aspect in the development of pathological scars. However, there are controversies about vascular distribution, vascular structure and blood flow in pathological scars. Additionally, hypoxic microenvironment plays an important role in the vascularization of pathological scar tissues, and hypoxic conditions can be reflected by metabolic indexes and some cytokines. Furthermore, the correlation between blood supply and tissue hypoxia is controversial. The aim of this article is to review the literature on the characteristics of blood supply and tissue hypoxia in pathological scars, from which we can see pathological scars have unique characteristics of blood supply that are closely associated with tissue hypoxia. Moreover, development in the treatment of pathological scars is herein reviewed.

Long non-coding RNA and wound healing

Long non-coding RNA (lncRNA) is a class of RNA molecules longer than 200 nucleotides which does not encode proteins or only encode a few proteins, and it plays important regulatory roles in the expression of genes at the epigenetic, transcriptional, and posttranscriptional levels. The recent reports suggest that lncRNA plays a significant role in growth and development of body, cellular biological processes including in cell proliferation, differentiation, migration, and apoptosis, and regulation of wound healing processes such as re-epithelialization, angiogenesis, and scar formation. The lncRNA has become a new research hotspot in wound healing. This article reviews the role of lncRNA in different stages of wound repair to get a further understanding of molecular mechanisms of wound healing and provide a new target spot for prevention and treatment of pathological scars and wound healing.

Influences of human dermis derived mesenchymal stem cells on α-SMA and DCN expressions of hypertrophic scars fibroblasts

To preliminarily explore the effects of human dermis derived mesenchymal stem cells (hDMSCs) on expressions of α-smooth muscle actin (α-SMA) and decorin (DCN) in hypertrophic scars fibroblasts (HSFB) at different periods,and to explore the feasibility of MSCs in prevention and treatment of HSFBs. hDMSCs were cultured with mechanical method combined with enzyme digestion.The cells of the third generation which were well grown were taken,and flow cytometry (FCM) was used to detect CD molecules in hDMSCs.Immunocytochemistry was used to detect cytokeratin 19 (CK19) and vimentin and identify the separated cells.The cells were differentiated into lipoblasts,chondroblasts and osteoblasts.According to the formation course of hypertrophic scar,the scar specimens were divided into 6-month,l-year,and 2-year group with three cases in each group.HSFBs from different groups were co-cultured with well-adherent hDMSCs of the third generation in non-contact transwell co-culture system for 21 days. And HSFBs from the corresponding groups were cultured in normal six-well plate as the controls.Real-time fluorescent-polymerase chain reaction (RT-PCR) and Western Blot were used to detect the expressions of mRNA and proteins of α-SMA and DCN in HSFBs from different groups. hDMSCs highly expressed the surface markers including CD73,CD105,CD44 and CD90,etc.,but did not express hematopoietic stem cell surface markers including CD 14,CD34 and CD45.They positively expressed vimentin but not CK19.The cells can be differentiated into lipoblasts,chondroblasts and osteoblasts,which was in line with the minimum identification standards of mesenchymal stem cells.For HSFB cultured in normal six-well plates,α-SMA mRNA and protein expressions of HSFB in the 6-month,1-year and 2-year groups were 198.20 ± 15.46/0.29 ± 0.070,175.24 ± 17.04/0.38 ± 0.110,and 125.73 ± 6.99/0.33 ±0.085,respectively;while DCN mRNA and protein expressions of HSFB in the corresponding groups were 61.30 ± 9.79/0.015 ± 0.003,70.89 ± 11.29/0.020 ± 0.007,and 77.31 ± 4.80/0.023 ± 0.003,respectively.For HSFB co-cultured with 5 × 104 hDMSCs, oα-SMA mRNA and protein expressions of HSFB in the 6-month,1-year and 2-year groups were 48.40 ± 6.42/ 0.100 ± 0.020,192.16 ± 11.37/0.110 ± 0.014,and 73.33 ± 6.29/0.110 ± 0.016,respectively;while DCN mRNA and protein expressions of HSFB in the corresponding groups were 156.92 ± 14.91/0.049 ±0.015,154.42 ± 18.17/0.033 ± 0.008,and 140.82 ± 7.32/0.030 ± 0.004,respectively.Compared with the control group(Cultured in normal six-well plates), mRNA and protein expressions of α-SMA in HSFBs were decreased after co-culture with 5 × 104 hDMSCs, mRNA and protein expressions of DCN were increased. Furthermore, it suggested that hypertrophic scar changed significantly in the early formation stage namely in the 6-month group. hDMSCs can down-regulate α-SMA mRNA and protein expressions of HSFBs and up-regulate mRNA and protein expressions of DCN in the in-vitro culture system.Those effects were particularly obvious on fibroblasts at the early formation of hyperplastic scar.Anti fibrosis role of hDMSCs is expected to be used in increasing the healing quality of the wound and in the prevention and treatment of pathological scars.

Photodynamic therapy for the treatment of pathological scars

Pathological scars are caused by abnormal healing after skin damage, and are characterized by fibroblast proliferation and collagen deposition. At clinics, comprehensive therapy is usually applied for treating scars, and has exerted some therapeutic effects. However, the severe adverse effects of some therapies have caused treatment refusal by patients. Photodynamic therapy has been widely used to treat superficial lesions, and has also been well studied for therapeutic intervention in visceral tumors. Because of the hypotoxicity of photodynamic therapy, its therapeutic effect on scars has been widely studied by domestic and foreign scholars. These researches have shown that photodynamic therapy can inhibit the proliferation and migration of fibroblasts, induce apoptosis, inhibit the formation of extracellular matrix, improve the appearance of scars, and exert definite therapeutic effects on scars. Key words: Cicatrix; Pathologic processes; Photochemotherapy; Photosensitizing agents; Fibroblasts; Collagen

Loureirin B inhibits fibroblast proliferation and extracellular matrix deposition in hypertrophic scar via TGF-β/Smad pathway.

The ethanolic extract of Resina Draconis (RDEE) has been reported beneficial to normal wound healing yielding more regularly arranged collagen fibres. Loureirin B, a major component in RDEE, has been supposed to be effective on the prevention and treatment of pathological scars. To investigate the therapeutic effects of loureirin B on hypertrophic scar (HS), fibroblasts from human HS and normal skin (NS) were isolated. Results showed that loureirin B dose-dependently downregulated both mRNA and protein levels of type I collagen (ColI), type III collagen (ColIII) and α-smooth muscle actin (α-SMA) in HS fibroblasts. Loureirin B also suppressed fibroblast proliferative activity and redistributed cell cycle, but did not affect cell apoptosis. In vivo rabbit ear scar model, loureirin B significantly improved the arrangement and deposition of collagen fibres, decreased protein levels of ColI, ColIII and α-SMA and suppressed myofibroblast differentiation and scar proliferative activity. In NS fibroblasts, loureirin B effectively inhibited TGF-β1-induced upregulation of ColI, ColIII and α-SMA levels, myofibroblast differentiation and the activation of Smad2 and Smad3. Loureirin B also affected mRNA levels of major MMPs and TIMPs in TGF-β1-stimulated fibroblasts. Taken together, this study demonstrates that loureirin B could downregulate the expression of fibrosis-related molecules by regulating MMPs and TIMPs levels, inhibit scar fibroblast proliferation and suppress TGF-β1-induced fibrosis, during which TGF-β1/Smad2/3 pathway is likely involved. These findings suggest that loureirin B is a potential therapeutic compound for HS treatment.

Эффективность топического такролимуса в комплексном лечении келоидов

В статье представлены результаты комплексного лечения патологических рубцов путем применения топических ингибиторов кальциневрина — такролимуса. В исследование вошли 25 пациентов в возрасте от 18 до 35 лет с посттравматическими и послеоперационными келоидными рубцами. Разработанный метод позволяет улучшить результаты лечения патологических рубцов, а также предотвратить появление келоидов после плановых и ургентных хирургических вмешательств.