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Tissue Engineering. Part B, Reviews Aug 2019Millions of people every year develop scars in response to skin injuries after surgery, trauma, or burns with significant undesired physical and psychological effects.... (Review)
Review
Millions of people every year develop scars in response to skin injuries after surgery, trauma, or burns with significant undesired physical and psychological effects. This review provides an update on engineering strategies for scar-free wound healing and discusses the role of different cell types, growth factors, cytokines, and extracellular components in regenerative wound healing. The use of pro-regenerative matrices combined with engineered cells with less intrinsic potential for fibrogenesis is a promising strategy for achieving scar-free skin tissue regeneration.
Topics: Animals; Cicatrix; Humans; Regeneration; Regenerative Medicine; Skin; Skin Physiological Phenomena; Wound Healing
PubMed: 30938269
DOI: 10.1089/ten.TEB.2018.0350 -
Plastic and Reconstructive Surgery Jan 2022In 2010, this Journal published my comprehensive review of the literature on hypertrophic scars and keloids. In that article, I presented evidence-based algorithms for... (Review)
Review
BACKGROUND
In 2010, this Journal published my comprehensive review of the literature on hypertrophic scars and keloids. In that article, I presented evidence-based algorithms for the prevention and treatment of these refractory pathologic scars. In the ensuing decade, substantial progress has been made in the field, including many new randomized controlled trials. To reflect this, I have updated my review.
METHODS
All studies were evaluated for methodologic quality. Baseline characteristics of patients were extracted along with the interventions and their outcomes. Systematic reviews, meta-analyses, and comprehensive reviews were included if available.
RESULTS
Risk factors that promote hypertrophic scar and keloid growth include local factors (tension on the wound/scar), systemic factors (e.g., hypertension), genetic factors (e.g., single-nucleotide polymorphisms), and lifestyle factors. Treatment of hypertrophic scars depends on scar contracture severity: if severe, surgery is the first choice. If not, conservative therapies are indicated. Keloid treatment depends on whether they are small and single or large and multiple. Small and single keloids can be treated radically by surgery with adjuvant therapy (e.g., radiotherapy) or multimodal conservative therapy. For large and multiple keloids, volume- and number-reducing surgery is a choice. Regardless of the treatment(s), patients should be followed up over the long term. Conservative therapies, including gel sheets, tape fixation, topical and injected external agents, oral agents, and makeup therapy, should be administered on a case-by-case basis.
CONCLUSIONS
Randomized controlled trials on pathologic scar management have increased markedly over the past decade. Although these studies suffer from various limitations, they have greatly improved hypertrophic scar and keloid management. Future high-quality trials are likely to improve the current hypertrophic scar and keloid treatment algorithms further.
Topics: Aftercare; Cicatrix, Hypertrophic; Combined Modality Therapy; Critical Pathways; Humans; Keloid; Postoperative Care; Postoperative Complications; Randomized Controlled Trials as Topic; Risk Factors; Severity of Illness Index; Surgical Wound; Wound Healing
PubMed: 34813576
DOI: 10.1097/PRS.0000000000008667 -
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 -
Dermatology (Basel, Switzerland) 2020The ultimate goal of wound healing following minor injury is to form a tissue regenerate that has functionality and visual appearance as close to the original skin as... (Review)
Review
BACKGROUND
The ultimate goal of wound healing following minor injury is to form a tissue regenerate that has functionality and visual appearance as close to the original skin as possible. The body's physiological response to any wound is traditionally characterised by three distinct steps: inflammation, proliferation and remodelling.
SUMMARY
New insights suggest that the three phases overlap (and even occur in parallel) in both time and space in the wound, necessitating a clinical approach that targets each stage simultaneously to ensure rapid repair and wound closure without further complications. Ingredients that exhibit activity across each of the three phases, such as dexpanthenol, are of value in the context of minor wound care and scar management. Key Messages: In addition to treatment and ingredient selection, it is also important to consider broader clinical best practices and self-care options that can be used to optimise the management of minor wounds. An individualised approach that can account for a patient's unique requirements and preferences is critical in achieving effective wound recovery.
Topics: Cell Movement; Cell Proliferation; Cicatrix; Dermatologic Agents; Humans; Hydrogen-Ion Concentration; Inflammation; Pantothenic Acid; Reactive Oxygen Species; Skin; Skin Physiological Phenomena; Wound Healing; Wounds and Injuries
PubMed: 31955162
DOI: 10.1159/000505291 -
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 -
Frontiers in Immunology 2020The underlying mechanisms of wound healing are complex but inflammation is one of the determining factors. Besides its traditional role in combating against infection... (Review)
Review
The underlying mechanisms of wound healing are complex but inflammation is one of the determining factors. Besides its traditional role in combating against infection upon injury, the characteristics and magnitude of inflammation have dramatic impacts on the pathogenesis of scar. Keloids and hypertrophic scars are pathological scars that result from aberrant wound healing. They are characterized by continuous local inflammation and excessive collagen deposition. In this review, we aim at discussing how dysregulated inflammation contributes to the pathogenesis of scar formation. Immune cells, soluble inflammatory mediators, and the related intracellular signal transduction pathways are our three subtopics encompassing the events occurring in inflammation associated with scar formation. In the end, we enumerate the current and potential medicines and therapeutics for suppressing inflammation and limiting progression to scar. Understanding the initiation, progression, and resolution of inflammation will provide insights into the mechanisms of scar formation and is useful for developing effective treatments.
Topics: Animals; Anti-Inflammatory Agents; Cicatrix, Hypertrophic; Collagen; Cytokines; Dermatologic Agents; Humans; Inflammation; Inflammation Mediators; Keloid; Prognosis; Signal Transduction; Skin; Wound Healing
PubMed: 33343575
DOI: 10.3389/fimmu.2020.603187 -
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 -
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 -
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 -
Biomedicine & Pharmacotherapy =... Sep 2020Aberrant scar formation, which includes keloid and hypertrophic scars, is associated with a pathological disorganized wound healing process with chronic inflammation.... (Review)
Review
Aberrant scar formation, which includes keloid and hypertrophic scars, is associated with a pathological disorganized wound healing process with chronic inflammation. The TGF-β/Smad signaling pathway is the most canonical pathway through which the formation of collagen in the fibroblasts and myofibroblasts is regulated. Sustained activation of the TGF-β/Smad signaling pathway results in the long-term overactivation of fibroblasts and myofibroblasts, which is necessary for the excessive collagen formation in aberrant scars. There are two categories of therapeutic strategies that aim to target the TGF-β/Smad signaling pathway in fibroblasts and myofibroblasts to interfere with their cellular functions and reduce cell proliferation. The first therapeutic strategy includes medications, and the second strategy is composed of genetic and cellular therapeutics. Therefore, the focus of this review is to critically evaluate these two main therapeutic strategies that target the TGF-β/Smad pathway to attenuate abnormal skin scar formation.
Topics: Animals; Cell- and Tissue-Based Therapy; Cicatrix, Hypertrophic; Dermatologic Agents; Genetic Therapy; Humans; Keloid; Molecular Targeted Therapy; Signal Transduction; Skin; Smad Proteins; Transforming Growth Factor beta; Wound Healing
PubMed: 32540643
DOI: 10.1016/j.biopha.2020.110287