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Hypertrophic Scars (hypertrophic + scar)

Distribution by Scientific Domains

Medical Sciences	95%

Selected Abstracts

Hypertrophic Scars and Keloids,A Review of Their Pathophysiology, Risk Factors, and Therapeutic Management

DERMATOLOGIC SURGERY, Issue 2 2009
DOLORES WOLFRAM MD
BACKGROUND Hypertrophic scars and keloids result from an abnormal fibrous wound healing process in which tissue repair and regeneration-regulating mechanism control is lost. These abnormal fibrous growths present a major therapeutic dilemma and challenge to the plastic surgeon because they are disfiguring and frequently recur. OBJECTIVE To provide updated clinical and experimental information on hypertrophic scars and keloids so that physicians can better understand and properly treat such lesions. METHODS A Medline literature search was performed for relevant publications and for diverse strategies for management of hypertrophic scars and keloids. CONCLUSION The growing understanding of the molecular processes of normal and abnormal wound healing is promising for discovery of novel approaches for the management of hypertrophic scars and keloids. Although optimal treatment of these lesions remains undefined, successful healing can be achieved only with combined multidisciplinary therapeutic regimens. [source]

Treatment of Pigmented Hypertrophic Scars with the 585 nm Pulsed Dye Laser and the 532 nm Frequency-Doubled Nd:YAG Laser in the Q-Switched and Variable Pulse Modes: A Comparative Study

DERMATOLOGIC SURGERY, Issue 8 2002
Leyda Elizabeth Bowes MD
background. Pigmented hypertrophic scars are a difficult condition to treat. They may result from traumatic injuries or from surgical and cosmetic procedures. The 585 nm flashlamp-pumped pulsed dye laser (FLPDL) has been used to treat this condition, with significant improvement of varying degrees. It remains to be determined whether other laser modalities may have a similar or even greater success in the treatment of pigmented hypertrophic scars. objective. To determine the efficacy of the 532 nm frequency-doubled Nd:YAG laser in the treatment of pigmented hypertrophic scars as compared to the 585 nm FLPDL. methods. Six patients with pigmented hypertrophic scars and skin phototypes II,IV were chosen. A scar was selected for treatment in each patient and divided into four equal 2 cm segments. Three segments were each treated with a different laser modality and one was left untreated to serve as the control. A 585 nm FLPDL was used with an energy of 3.5 J, a pulse duration of 450 ,sec, and a 10 mm spot size. A 532 nm Q-switched frequency-doubled Nd:YAG laser was set to an energy of 2.8 J, a 10-nsec pulse, and a 3 mm spot size. The same 532 nm laser was set to the variable pulse mode to treat a 2 cm scar segment, with an energy of 9.5 J, a 10-msec pulse, and a 4 mm spot size. An average of 3.3 treatments were performed on each scar segment, at intervals of 4,6 weeks and long-term follow-up at 22 weeks. Treatment outcome was graded by a blind observer using the Vancouver General Hospital (VGH) Burn Scar Assessment Scale. A SigmaStat t -test was used to determine the statistical significance of the values obtained. results. Treatment of pigmented hypertrophic scars with the 532 nm Q-switched Nd:YAG laser led to a significant improvement of 38% in the VGH scores when compared to baseline (P = .005). The 585 nm FLPDL also had a favorable effect on the scars, with an average improvement of 36.1% in the VGH scores. There was no significant difference noted between the outcome of treatment with either of these two lasers. Treatment with the 532 nm variable pulse Nd:YAG laser led to a 19% improvement in the VGH scores of scars, which did not differ significantly from the 16.1% improvement observed in control scars on the last follow-up visit. No side effects or complications from treatment were noted or reported during the course of the study. At the conclusion of the study, five of six patients chose the segment treated with the 532 nm Q-switched Nd:YAG laser as the best segment overall. conclusion. The 532 nm Q-switched Nd:YAG laser and the 585 nm FLPDL offer comparable favorable results in the treatment of pigmented hypertrophic scars. The 532 nm Q-switched Nd:YAG laser may be preferred by patients particularly distressed by the dark color of their scars. [source]

Hypertrophic Scars and Keloids,A Review of Their Pathophysiology, Risk Factors, and Therapeutic Management

Shedding of microparticles by myofibroblasts as mediator of cellular cross-talk during normal wound healing

JOURNAL OF CELLULAR PHYSIOLOGY, Issue 3 2010
Véronique J. Moulin
Interactions between cells are a crucial mechanism to correctly heal a wounded tissue. Myofibroblasts have a central role during healing but their means to communicate with other cells is unknown. Microparticles (MP) have demonstrated a potential role as mediators of cellular interactions during various diseases. We have analyzed the production of MP by normal (Wmyo) and pathological (hypertrophic scar, Hmyo) myofibroblasts and human dermal fibroblasts (Fb) when treated with serum or plasma as examples of body fluids. We have shown that the presence of these body fluids induced a very significant increase in MP production by Wmyo while no MP production was denoted for Hmyo and Fb. These effects were at least due to thermally sensitive protein(s) with a molecular mass >30,kDa. Furthermore, the increase in MP production was not linked to an increase in apoptotic Wmyo. MP characterization showed that VEGF and FGF2 were present in MP and that endothelial and (myo)fibroblast cell growth can be stimulated by MP treatment. We postulated that MP production by myofibroblasts could modulate mesenchymal cell growth and angiogenesis during normal healing. J. Cell. Physiol. 225: 734,740, 2010. © 2010 Wiley-Liss, Inc. [source]

Effects of antisense oligodeoxynucleotide to type I collagen gene on hypertrophic scars in the transplanted nude mouse model

JOURNAL OF CUTANEOUS PATHOLOGY, Issue 11 2009
Julin Xie
Background:, Antisense nucleic acids are effective in inhibiting harmful or uncontrolled gene expression. We had previously proved that the antisense DNA to type I collagen could effectively inhibit the synthesis of collagen type I in cultured hypertrophic scar fibroblasts, suggesting a potential role in anti-scarring, but there are no published reports of its effect on scar in the transplanted nude mouse model. Aims:, To investigate the effects of antisense oligodeoxynucleotide (ASODN) to type I collagen gene on hypertrophic scars in the transplanted nude mouse model and clarify the potential of ASODN for the treatment of scars. Methods:, The nude mouse model of hypertrophic scar was created and subjected to daily injections with ASODN and LipofectamineÔ for 2 ,4 or 6 weeks. We then examined the scars for changes in histopathological characteristics. The effects of ASODN on type I collagen gene expression were examined by reverse transcription-polymerase chain reaction and Western blots. Results:, The ASODN could remarkably alleviate the scar in the nude mouse model and consistently inhibit type I collagen gene expression at both the mRNA and protein levels. Conclusion:, ASODN was effective in downregulating type I collagen gene expression and could prove to be useful in the treatment of scars. [source]

Plantar hypertrophic scar: an unusual localization in a pregnant woman

JOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 4 2003
P Oztas
[source]

Hypertrophic scarring of the neck following ablative fractional carbon dioxide laser resurfacing

LASERS IN SURGERY AND MEDICINE, Issue 3 2009
Mathew M. Avram MD
Abstract Background Ablative fractional carbon dioxide (CO2) laser treatments have gained popularity due to their efficacy, shortened downtime, and decreased potential for scarring in comparison to traditional ablative CO2 resurfacing. To date, scarring with fractional CO2 lasers has not been reported. Objective Five patients treated with the same fractional CO2 laser technology for photodamage of the neck were referred to our practices 1,3 months after treatment. Each patient developed scarring. Of the five cases, two are discussed in detail. The first was treated under general anesthesia on the face and anterior neck at a pulse energy of 30 mJ (859 µm depth) with 25% coverage. Eleven days after treatment, three non-healing areas along the horizontal skin folds of the anterior neck were noted. At 2 weeks after CO2 ablative fractional resurfacing, these areas had become thickened. These raised areas were treated with a non-ablative fractionated 1,550 nm laser to modify the wound healing milieu. One week later, distinct firm pale papules in linear arrays with mild hypopigmentation had developed along involved neck skin folds. Skin biopsy was performed. For the second patient, the neck was treated at a pulse energy of 20 mJ (630 µm depth) with 30% coverage of the exposed skin, with a total treatment energy of 5.0 kJ. Minimal crusting was noted on the neck throughout the initial healing phase of 2 weeks. She then experienced tightness on her neck. Approximately 3 weeks after treatment, she developed multiple vertical and horizontal hypertrophic scars (HS). Results Histopathology for the first case confirmed the presence of a hypertrophic scar. The papules in this case completely resolved with mild residual hypopigmentation after treatment with topical corticosteroids. HS failed to resolve in the second case to date after 1 month. Conclusion As with traditional ablative CO2 laser resurfacing, HS is a potential complication of ablative fractional CO2 laser resurfacing, particularly on the neck. With early diagnosis and appropriate treatment HS of neck skin may be reversible. We urge caution when treating the neck with this device and close attention to wound care in the post-operative period. Lasers Surg. Med. 41:185,188, 2009. © 2009 Wiley-Liss, Inc. [source]

Minimally Invasive Thyroidectomy: Basic and Advanced Techniques

THE LARYNGOSCOPE, Issue 3 2006
David J. Terris MD
Abstract Objective: Minimal access surgery in the thyroid compartment has evolved considerably over the past 10 years and now takes many forms. We advocate at least two distinct approaches, depending on the disease process and multiple patient factors. The technical aspects are explored in depth with liberal use of videographic demonstration. Methods: The authors conducted a comparison of two distinct surgical techniques with photographic and videographic documentation of two distinct minimal access approaches to the thyroid compartment termed minimally invasive thyroidectomy (MITh) and minimally invasive video-assisted thyroidectomy (MIVAT). Both historic and previously unpublished data (age, gender, pathology, incision length, and complications) are systematically analyzed. Results: Patients who underwent minimally invasive thyroidectomy (n = 31) had a mean age of 39.4 ± 10.7 years; seven were male and 24 were female. The most common diagnosis was follicular or Hürthle cell adenoma (29%), followed by papillary or follicular cancer (26%). The mean incision length was 4.9 ± 1.0 cm. One patient developed a hypertrophic scar and one patient developed thrombophlebitis of the anterior jugular vein. There were 14 patients in the MIVAT group with a mean age of 43.7 ± 11.4 years; one was male and 13 were female. The majority of patients had follicular adenoma (42.9%) or papillary carcinoma (21.4%) as their primary diagnosis. The mean incision length was 25 ± 4.3 mm (range, 20,30 mm), and there were no complications. Conclusions: Two distinct approaches to minimal access thyroid surgery are now available. The choice of approach depends on a number of patient and disease factors. Careful patient selection will result in continued safe and satisfactory performance of minimally invasive thyroid surgery. [source]

Cutaneous abscess by Trichosporon asahii developing on a steroid injection site in a healthy adult

CLINICAL & EXPERIMENTAL DERMATOLOGY, Issue 4 2006
S. J. Yun
Summary We report a rare case of cutaneous abscess by Trichosporon asahii in an immunocompetent adult. A 31-year-old Korean woman presented to our hospital with a cutaneous abscess. She had received an intralesional steroid injection 4 months earlier on the site of a hypertrophic scar. Direct sequencing of the intergenic spacer regions of the rRNA genes identified T. asahii. The decreased local immunity after the steroid injection might have triggered the infection by T. asahii. A cutaneous abscess formation by T. asahii in an immunocompetent patient is an unusual cutaneous finding that to our knowledge has not been reported previously. The local immune reaction of the skin is important for the prevention of Trichosporon infection. [source]

Hypertrophic Scars and Keloids,A Review of Their Pathophysiology, Risk Factors, and Therapeutic Management

Carcinoma En Cuirasse Presenting as Keloids of the Chest

DERMATOLOGIC SURGERY, Issue 2 2004
Kimberly Mullinax
Background. Carcinoma en cuirasse is a form of metastatic cutaneous breast malignancy occurring most commonly on the chest as a recurrence of breast cancer, but it can be the primary presentation. Objective. To discuss the clinical features of carcinoma en cuirasse that distinguish it from hypertrophic scars and keloids of the chest. Method. We report a 63-year-old woman with primary cutaneous breast carcinoma presenting as keloid nodules on the chest that failed treatments for keloids. Biopsy revealed a pattern of breast carcinoma in the skin. Results. After further workup, no tumor was found in the deep breast tissue, but metastases were found in her axillary lymph nodes. Conclusions. Unusual keloid-like nodules or scars on the chest that fail to respond to therapy may be primary or metastatic malignancies, and adequate histologic verification should be obtained to avoid delay in the proper treatment. [source]

Silicone Gel Sheeting for the Management and Prevention of Onychocryptosis

DERMATOLOGIC SURGERY, Issue 3 2003
A. Burhan Aksakal MD
BACKGROUND Onychocryptosis, commonly referred to as ingrown nails, has many therapeutic alternatives for its management. Although mild cases can be treated conservatively, in severe cases, surgical treatment is preferred. Silicone gel sheeting is found to be effective in the treatment of hypertrophic scars and keloids. OBJECTIVE To document the effectiveness of silicone gel sheeting in the management of patients with onychocryptosis and in the prevention of the recurrences by breaking the devil's circle, which usually took place after the surgical procedures used in the treatment of the onychocryptosis. METHODS Fourteen patients were enrolled in the study. Entry criteria required the presence of slight (2 patients), moderate (2 patients), or severe (10 patients) onychocryptosis. The simple technique used in the study was the excision of the one-quarter part of the lesional side of the nail plate without excising the granulation tissue. After 24 hours, the silicone was placed on the granulation tissue and the exposed nail bed. Silicone gel sheet was bandaged loosely without applying any pressure. Patients entering the study were given detailed instructions in applying and using the gel for 12 hours during the daytime. The study lasted for 14 months and was composed of a treatment period of 4 months and a follow-up period of 10 months. The patients were evaluated every 2 weeks in the first month and then monthly. The change in thickness of granulation tissue was evaluated by comparing them with the baseline photographs and those taken at each visit. RESULTS The management and prevention of onychocryptosis were achieved in 12 of 14 patients (85.71%). The silicone gel sheeting treatment was well tolerated except for an occasional transient exudation, which was resolved when the treatment was withdrawn. CONCLUSION The results show that the new method that we used for the treatment of onychocryptosis is successful in reducing the thickness of the hypertrophic nail fold and prevents the recurrence of the condition during the regrowth of the nail plate by breaking the devil's circle. The advantage of this method is that it is not destructive to the nail matrix and the adjacent tissue. [source]

Treatment of Pigmented Hypertrophic Scars with the 585 nm Pulsed Dye Laser and the 532 nm Frequency-Doubled Nd:YAG Laser in the Q-Switched and Variable Pulse Modes: A Comparative Study

Pretibial epidermolysis bullosa: is this case a new subtype with loss of types IV and VII collagen?

INTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 8 2009
Hong-sun Lee MD
Pretibial epidermolysis bullosa (PEB) is an extremely rare subtype of dominant dystrophic epidermolysis bullosa (DDEB), in which recurrent blistering with scarring predominantly involves the pretibial skin. Nail dystrophy, albopapuloid lesions, and hypertrophic scars may also occur. In PEB, immunohistochemical and electron microscopic studies demonstrate the complete or partial loss of the anchoring fibril (AF) in the basement membrane zone, suggesting disturbed synthesis or excessive degradation of collagen VII, the main component of AF. Interestingly, we report a case of PEB with unusual results of joint loss of types IV and VII collagen. [source]

Effects of antisense oligodeoxynucleotide to type I collagen gene on hypertrophic scars in the transplanted nude mouse model

Pulsed dye laser: what's new in non-vascular lesions?

JOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 7 2007
S Karsai
Abstract Background and objective, In dermatology, the pulsed dye laser (PDL) is the therapeutic instrument of choice for treating most superficial cutaneous vascular lesions. In addition, clinical experience over the last decade allowed us to treat patients with an ever increasing number of non-vascular indications. The purpose of this report is to summarize and critically appraise the scientific evidence that support the role of PDL in treating non-vascular skin lesions. Methods, A literature-based study has been conducted, including the review of publications over the period January 1995 to December 2006, using the Medline Database. We also included our own experience in managing non-vascular lesions with the PDL. Four sets of preoperative and postoperative photos are presented. Results, For viral skin lesions, PDL proved to be an alternative to other therapy options. This applies particularly to periungual warts and mollusca contagiosa. The mechanism of PDL with inflammatory dermatoses has not yet been elucidated. The effect seems to be better if there is a vascular component to the disease. With most of these indications (such as psoriasis and acne), PDL currently plays a rather minor or complementary role. Regarding collagen remodelling (hypertrophic scars, keloids, stretch marks, and skin rejuvenation), the question of whether a therapy makes sense or not has to be decided from case to case. Conclusion, With PDL, it is possible to achieve good results with numerous, partly less well-known indications (i.e. lupus erythematosu). With other diseases, PDL has so far been considered to be a complementary therapy method or to be in an experimental state. [source]

Hypertrophic scarring of the neck following ablative fractional carbon dioxide laser resurfacing

Lasers in skin resurfacing

AUSTRALASIAN JOURNAL OF DERMATOLOGY, Issue 2 2000
Jeffrey S Dover
SUMMARY Laser skin resurfacing has revolutionized the approach to facial skin rejuvenation over the last decade. It has also added an approach to managing both atrophic and hypertrophic scars. This paper will review the basic principles of laser skin resurfacing, the different lasers used, the approach to treatment and potential complications of the procedure, followed by a discussion of future prospects in the field. [source]

Intralesional triamcinolone alone or in combination with 5-fluorouracil for the treatment of keloid and hypertrophic scars

CLINICAL & EXPERIMENTAL DERMATOLOGY, Issue 2 2009
A. Darougheh
Summary Background., Keloids and hypertrophic scars are benign growths of dermal collagen that can cause physical and psychological (cosmetic) problems for patients. Methods., In this 12-week, double-blind, clinical trial, 40 patients were randomized into two study groups. Patients in group 1 were given intralesional triamcinolone acetonide (TAC), and patients in group 2 were given a combination of TAC and 5-fluorouracil (5-FU); both groups received injections at weekly intervals for 8 weeks. Lesions were assessed for erythema, pruritus, pliability, height, length and width. Results., Four patients in group 1 and three patients in group 2 failed to complete the study. At the 8-week and 12-week follow-up visits, both groups showed an acceptable improvement in nearly all parameters, but these were more significant in the TAC + 5-FU group (P < 0.05 for all except pruritus and percentage of itch reduction). Good to excellent (> 50%) improvement were reported by 20% of the patients in group 1 and 55% of the patients in group 2, which was significantly different (P = 0.02). Good to excellent responses was reported by trained observers as 15% in group 1 and 40% in group 2. Their difference was not significant (P = 0.08). Conclusion., The overall efficacy of TAC + 5-FU was comparable with TAC, but the TAC + 5-FU combination was more acceptable to patients and produced better results. [source]