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Journal of Nippon Medical School =... Mar 2021In 2006, we established a scar/keloid-specialized unit in the Department of Plastic, Reconstructive, and Aesthetic Surgery at Nippon Medical School (NMS) in Tokyo,... (Review)
Review
In 2006, we established a scar/keloid-specialized unit in the Department of Plastic, Reconstructive, and Aesthetic Surgery at Nippon Medical School (NMS) in Tokyo, Japan. In the ensuing 15 years, we treated approximately 2,000 new scar/keloid patients annually. This extensive experience has greatly improved the efficacy of the treatments we offer. Therefore, we discuss here the latest NMS protocol for preventing and treating keloids and hypertrophic scars. While this protocol was optimized for Japanese patients, our experience with a growing body of non-Japanese patients suggests that it is also effective in other ethnicities. The extensive evidence-based experience underlying the NMS protocol suggests that it may be suitable as the foundation of a standard international prevention/treatment algorithm for pathological scars.
Topics: Adrenal Cortex Hormones; Algorithms; Cicatrix, Hypertrophic; Combined Modality Therapy; Evidence-Based Medicine; Female; Follow-Up Studies; Hospitals, University; Humans; Japan; Keloid; Laser Therapy; Male; Patient Education as Topic; Radiotherapy, Adjuvant; Risk; Schools, Medical; Surgery Department, Hospital; Triamcinolone Acetonide
PubMed: 32741903
DOI: 10.1272/jnms.JNMS.2021_88-106 -
Facial Plastic Surgery Clinics of North... Nov 2019An ideal scar is flat, thin, and color matched to the surrounding skin. Incision planning, skin closure, and postoperative care are vital to create an inconspicuous... (Review)
Review
An ideal scar is flat, thin, and color matched to the surrounding skin. Incision planning, skin closure, and postoperative care are vital to create an inconspicuous scar. Depressed, hypertrophic, and keloid scars each pose unique challenges to the facial plastic surgeon. Several surgical and nonsurgical options exist in the treatment of scars. Appropriate treatment is based on scar location, quality, and size as well as patient history, preferences, and expectations. This article discusses techniques for prevention and treatment options for unsightly and hypertrophic scars.
Topics: Cicatrix; Humans; Surgical Wound; Wound Closure Techniques; Wound Healing
PubMed: 31587770
DOI: 10.1016/j.fsc.2019.07.013 -
Skin Research and Technology : Official... Mar 2023The skin is a protective barrier of the body against external factors, and its damage leads to a loss of integrity. Normal wound healing results in a correct, flat,...
BACKGROUND
The skin is a protective barrier of the body against external factors, and its damage leads to a loss of integrity. Normal wound healing results in a correct, flat, bright, and flexible scar. Initial skin damage and patient specific factors in wound healing contribute that many of these scars may progress into widespread or pathologic hypertrophic and keloid scars. The changes in cosmetic appearance, continuing pain, and loss of movement due to contracture or adhesion and persistent pruritis can significantly affect an individual's quality of life and psychological recovery post injury. Many different treatment methods can reduce the trauma and surgical scars. Manual scar treatment includes various techniques of therapy. The most effectiveness is a combined therapy, which has a multidirectional impact. Clinical observations show an effectiveness of manual scar therapy.
MATERIAL AND METHODS
The aim of this work was to evaluate effectiveness of the scar manual therapy combined with complementary methods on the postoperative scars. Treatment protocol included two therapies during 30 min per week for 8 weeks. Therapy included manual scar manipulation, massage, cupping, dry needling, and taping.
RESULTS
Treatment had a significant positive effect to influence pain, pigmentation, pliability, pruritus, surface area, and scar stiffness. Improvement of skin parameters (scar elasticity, thickness, regularity, color) was also noticed.
CONCLUSION
To investigate the most effective manual therapy strategy, further studies are needed, evaluating comparisons of different individual and combined scar therapy modalities.
Topics: Humans; Cicatrix, Hypertrophic; Keloid; Pain; Pruritus; Quality of Life; Cicatrix; Wound Healing; Therapy, Soft Tissue; Cupping Therapy; Complementary Therapies; Dry Needling
PubMed: 36973982
DOI: 10.1111/srt.13272 -
Physical Medicine and Rehabilitation... Nov 2023Hypertrophic scars frequently develop post-burn, and are characterized by their pruritic, painful, raised, erythematous, dyschromic, and contractile qualities. This... (Review)
Review
Hypertrophic scars frequently develop post-burn, and are characterized by their pruritic, painful, raised, erythematous, dyschromic, and contractile qualities. This article aims to synthesize knowledge on the clinical and molecular development, evolution, management, and measurement of hypertrophic burn scar for both patient and clinician knowledge.
Topics: Humans; Cicatrix, Hypertrophic; Pain
PubMed: 37806697
DOI: 10.1016/j.pmr.2023.05.002 -
Actas Dermo-sifiliograficas 2022Burn scars cause high morbidity in the form of contractures, body disfigurement, and itching, and they also have a high emotional impact that adversely affects patient... (Review)
Review
Burn scars cause high morbidity in the form of contractures, body disfigurement, and itching, and they also have a high emotional impact that adversely affects patient quality of life. Laser therapy has proven effective in this setting. It is superior to topical treatments and can be used in conjunction with surgery, helping to reduce morbidity. The use of lasers in hospital dermatology departments, however, is still limited. Carbon dioxide laser resurfacing is the most widely used modality for reducing scar thickness, improving textural abnormalities, and treating contractures. Treatments improve mobility for patients with constrictions. Pulsed dye laser treatments are particularly useful for reducing erythema in recent burn scars and preventing subsequent hypertrophy. Pigment laser treatments with short pulse durations (nanoseconds or picoseconds) can improve hyperpigmentation. In this article, we review the evidence for the use of laser therapy for burn scars and propose a treatment algorithm.
Topics: Humans; Cicatrix; Cicatrix, Hypertrophic; Lasers, Gas; Burns; Quality of Life; Laser Therapy; Contracture; Treatment Outcome
PubMed: 35963335
DOI: 10.1016/j.ad.2022.06.018 -
Facial Plastic Surgery Clinics of North... Nov 2023Scar therapy is truly important in medicine. Patients experience great loss in quality of life with scars. There are many treatment modalities that help treat scars,... (Review)
Review
Scar therapy is truly important in medicine. Patients experience great loss in quality of life with scars. There are many treatment modalities that help treat scars, including topical, intralesional, surgical, and energy-based devices. In addition, early intervention can help mitigate scar formation. Lasers represent a major innovation in the treatment of all types of scars. Treating scars is a multimodal and multispecialty endeavor. This article highlights the use of many therapies to treat scars and scar symptoms including pruritus, pain, and range of motion. This also highlights key literature including multiple recent consensus guidelines in treating scars.
Topics: Humans; Cicatrix; Quality of Life; Skin; Treatment Outcome; Burns; Cicatrix, Hypertrophic
PubMed: 37806679
DOI: 10.1016/j.fsc.2023.06.005 -
Journal of Alternative and... Oct 2020The aim of this systematic review with meta-analysis was to describe the status on the effects of physical scar treatments on pain, pigmentation, pliability, pruritus,... (Meta-Analysis)
Meta-Analysis
The aim of this systematic review with meta-analysis was to describe the status on the effects of physical scar treatments on pain, pigmentation, pliability, pruritus, scar thickening, and surface area. Systematic review and meta-analysis. Adults with any kind of scar tissue. Physical scar management versus control or no scar management. Pain, pigmentation, pliability, pruritus, surface area, scar thickness. The overall results revealed that physical scar management is beneficial compared with the control treatment regarding the management of pain ( = 0.012), pruritus ( < 0.001), pigmentation ( = 0.010), pliability ( < 0.001), surface area ( < 0.001), and thickness ( = 0.022) of scar tissue in adults. The observed risk of bias was high for blinding of participants and personnel (47%) and low for other bias (100%). Physical scar management demonstrates moderate-to-strong effects on improvement of scar issues as related to signs and symptoms. These results show the importance of specific physical management of scar tissue.
Topics: Cicatrix; Female; Humans; Male; Pigmentation Disorders; Postoperative Complications; Pruritus; Wound Healing
PubMed: 32589450
DOI: 10.1089/acm.2020.0109 -
American Journal of Clinical Dermatology Apr 2018Acne vulgaris is a chronic inflammatory skin disease that can lead to permanent scarring. Although grading scales exist for acne scarring, there are many limitations,... (Review)
Review
Acne vulgaris is a chronic inflammatory skin disease that can lead to permanent scarring. Although grading scales exist for acne scarring, there are many limitations, and there is still a need for a well validated gold standard scale for use in clinical practice or research trials. An objective measure of scar severity should be a component of global acne severity evaluations. This manuscript reviews currently available acne scar grading modalities: lesion counting; subjective self-assessment; Acne Scar Rating Scale (ASRS); evaluator-based qualitative and quantitative scarring grading systems; Echelle d'Evaluation Clinique des Cicatrices d'acne (ECCA); Global Scale for Acne Scar Severity (SCAR-S); and imaging. Despite the varying tools, most of the currently available scales do not account for scar color, depth, or change over time. A new, validated scale is needed that would allow for a more objective and accurate assessment of scar progression over time to assist with effective treatment and research.
Topics: Acne Vulgaris; Cicatrix; Disease Progression; Humans; Self-Assessment; Severity of Illness Index
PubMed: 28891036
DOI: 10.1007/s40257-017-0321-x -
La Radiologia Medica Jun 2021Radial scar (RS) or complex sclerosing lesions (CSL) if > 10 mm is a benign lesion with an increasing incidence of diagnosis (ranging from 0.6 to 3.7%) and... (Review)
Review
Radial scar (RS) or complex sclerosing lesions (CSL) if > 10 mm is a benign lesion with an increasing incidence of diagnosis (ranging from 0.6 to 3.7%) and represents a challenge both for radiologists and for pathologists. The digital mammography and digital breast tomosynthesis appearances of RS are well documented, according to the literature. On ultrasound, variable aspects can be detected. Magnetic resonance imaging contribution to differential diagnosis with carcinoma is growing. As for the management, a vacuum-assisted biopsy (VAB) with large core is recommended after a percutaneous diagnosis of RS due to potential sampling error. According to the recent International Consensus Conference, a RS/CSL lesion, which is visible on imaging, should undergo therapeutic excision with VAB. Thereafter, surveillance is justified. The aim of this review is to provide a practical guide for the recognition of RS on imaging, illustrating radiological findings according to the most recent literature, and to delineate the management strategies that follow.
Topics: Breast; Breast Diseases; Cicatrix; Disease Management; Female; Humans; Mammography
PubMed: 33743143
DOI: 10.1007/s11547-021-01344-w -
International Journal of Molecular... Mar 2018Hypertrophic scars and keloids are fibroproliferative disorders that may arise after any deep cutaneous injury caused by trauma, burns, surgery, etc. Hypertrophic scars... (Meta-Analysis)
Meta-Analysis Review
Hypertrophic scars and keloids are fibroproliferative disorders that may arise after any deep cutaneous injury caused by trauma, burns, surgery, etc. Hypertrophic scars and keloids are cosmetically problematic, and in combination with functional problems such as contractures and subjective symptoms including pruritus, these significantly affect patients' quality of life. There have been many studies on hypertrophic scars and keloids; but the mechanisms underlying scar formation have not yet been well established, and prophylactic and treatment strategies remain unsatisfactory. In this review, the authors introduce and summarize classical concepts surrounding wound healing and review recent understandings of the biology, prevention and treatment strategies for hypertrophic scars and keloids.
Topics: Biomarkers; Cicatrix, Hypertrophic; Combined Modality Therapy; Cytokines; Extracellular Matrix; Humans; Keloid; Wound Healing
PubMed: 29498630
DOI: 10.3390/ijms19030711