جستجوی مقالات مرتبط با کلیدواژه « hypertrophic scar » در نشریات گروه « پزشکی »

Different therapies have been applied to keloids and hypertrophic scars. Intense pulsed light (IPL) has recently been used but the evidence is limited. This study was to evaluate the effectiveness and safety of IPL as monotherapy for keloids and hypertrophic scars.

This was a before-and-after interventional study on 16 patients with 50 scars who underwent IPL. Seven scars receive one IPL session, seven received two sessions, and 36 received three sessions. Outcomes were evaluated by the Vancouver Scar Scale (VSS), Patient and Observer Scar Assessment Scale (POSAS), scar ultrasound, colorimeter for pigmentation and erythema, and side effects.

After the treatment, most outcomes significantly improved except that the pigmentation of the scars did not change. Scar thickness significantly reduced by nearly 10% after the first IPL session, 15% after the second session, and > 20% after the third session. All side effects were mild with crust (33.3-46%), blisters (8.3-40%), and hyperpigmentation around the scar (0-14%); the pain was moderate as assessed by the patients.

IPL is a safe and effective treatment for keloids and hypertrophic scars. More studies are required to confirm our results.

Silicone-based products are often used to improve signs and symptoms of hypertrophic and keloid scars. An improved silicone product, ScarLess™ Hydrogel (SH), is a 5% silicone-based super-oxidized hydrogel meant to reduce keloid scars’ vascularity, elasticity, and height. This study aimed to compare the efficacy between SH and hydrocortisone (HCT) 1% ointment in keloid treatment. This study was a prospective, single-centered, randomized, double-blind study involving twenty-eight subjects with keloid scars. The scars were assigned randomly as Scar A and Scar B in a 1:1 ratio to receive HCT or SH under occlusion, respectively, for over 12 weeks. The Patient and Observer Scar Assessment Scale (POSAS) was used for clinical evaluation. According to the POSAS, there were significant improvements in both patient and observer scorings in both treatment arms. SH has equal therapeutic efficacy as HCT in keloid treatment. SH did not present with any safety issues or side effects.

 In this case report of a 31-year-old female, we describe the effects of dry needling on scar tissue following total hip arthroplasty.

   Case report: 

A 31-year-old woman underwent an elective bilateral total hip replacement due to a motor vehicle accident. Based on physical examination, the patient had burning pain at the incision site at the time of menstruation and limited hip range of motion worse on the right side. The treatment program consisted of six sessions of dry needling over a three-week period alongside infrared radiation for 20 minutes during each session. The needles were spaced along the entire length of the scar tissue and rotation was performed back and forth across the scar region to release the adhesion between the scar line and the underlying tissue, focusing more on the painful-to-touch spots and adhesive points. Following the completion of the dry needling treatments hip range of motion and the patient’s functional outcome improved. Dry needling may be an effective and rapid treatment for scar tissue adhesion after surgical procedures. High-quality randomized-controlled studies are needed to verify the efficacy of this method.

Hypertrophic scars are dermal complication that may lead to considerable morbidity. There is an intense medical need for novel therapies for this disease. Tranilast is an anti-allergic agent that clinically used for the treatment of keloids and hypertrophic scars. In this study, we aimed to evaluate the effect of tranilast 0.5% topical formulation on hypertrophic scars resulted by burn injury in rats.

Burn wounds were inflicted on the skin area of the backs of all rats, following that the scars are created, treatment started and continued for 28 days. Animals were divided into two groups (n=8): the control scar group, which received a placebo and the treatment group that received 0.5% tranilast gel. After this period, skin biopsies were collected from each group for the following analyses. The tissue samples were analyzed by hematoxylin-eosin, Masson’s trichrome staining and qRT-PCR.

Histologically, topical tranilast reduced hypertrophic scar signs as compared to placebo. Tranilast treatment also resulted in a reduction in type I and III collagen, transforming growth factor-beta1, Smad2 and vascular endothelial growth factor , and increased Smad7 mRNA expression in the skin scar site.

These findings showed that the 0.5% tranilast topical gel could be effective in the treatment of hypertrophic scars in a rat experiment.

Keloid and hypertrophic scars (HTS) caused by an imbalance between the production and destruction of collagen during wound healing with an unknown underlying pathophysiological mechanism. This study was designed to evaluate the histamine level in the Keloid and HTS and comparison of results with normal skin.

This pilot study included 36 participants, aged from 18 to 70 years with keloid (n=11), HTS (n=13) and normal (n=12) skin. The level of histamine in the skin samples was measured using enzyme-linked immunosorbent assay (ELISA).

Histamine level in keloid samples was significantly higher than in the normal (p=0.0012) or HTS (p=0.0028) groups. However, there was no significant difference between the normal and HTS samples (p=0.92).

The increased histamine level in the keloid tissue may contribute to its pathogenesis and the application of anti-histamines could be of benefit for the prevention and treatment of keloids.

 Hypertrophic scars are the consequences of the aberration of normal wound healing. To date, therapeutic strategies for abnormal scarring have been unsuccessful. ‎‏The abnormal extracellular‎ matrix is one of the most important contributing factors to ‎hypertrophic scars. ‏Scrophularia striata has been used in Iranian folk medicine for the treatment of burn wounds. ‏The plant extract accelerates wound healing and attenuates scar formation.

 The study was performed to investigate the effects of Scrophularia striata hydroalcoholic extract (SSE) on MMP1, MMP8, fibronectin, collagen type І, and total collagen produced by human skin fibroblasts in the culture medium.

 The effects of SSE on the expression of MMP1, MMP8, fibronectin, and collagen type І in human skin fibroblast (HSF) were evaluated using Q-PCR and Western blotting methods. In addition, the effect of SSE on the total collagen content was measured in cultured HSF using Red Sirius Kit.

 SSE significantly induced the expression of MMP1 and suppressed the production of fibronectin at the mRNA and protein levels. The total collagen content was significantly lower in SSE-treated cells than in untreated cells. SSE did not have any significant effect on MMP8 and collagen type І expression.

 The results of this study revealed that SSE could modulate the extracellular matrix turnover and had the potential for the prevention and treatment of hypertrophic scars.
 

Wound healing is a process that has three overlapping inflammatory, proliferative, and reconstruction phases. Silicone gel and Contractubex (onion extract gel) are two main topical agents used for the prevention and treatment of hypertrophic scars. This clinical trial study aimed to evaluate the efficacy and safety of onion extract and silicone gel on hypertrophic scars of the upper extremity and compare it to non-treated patients.

This randomized, double-blind, parallel, clinical trial was done on 120 male patients who had undergone upper extremity sharp injury repair. Patients were assigned to three groups, i.e., Silicone gel (Kelo-cort™; WA, USA) (group 1; 40 patients), Onion extract (Contractubex™, Merz Pharma, Frankfurt, Germany) gel (group 2; 40 patients), and No Intervention (group 3; 40 patients), using drawing sealed envelopes and a computer-based table of randomization. Data were recorded using the Vancouver scale in each visit by two surgeons who were blinded to the study groups. IBM SPSS Statistics for Windows, Version 22.0. (Armonk, NY: IBM Corp). Data were compared using the ANOVA test. A P-value of less than 0.05 was considered statistically significant.

Vascularity (p=0.200), pliability (p=0.058), pigmentation (p=0.701), and height (p=0.438) as subjective scar parameters were approximately similar in post-upper extremity sharp injury wound hypertrophic scar among the three groups.

Vascularity, pliability, pigmentation and height, as subjective scar parameters, were not statistically different in post-upper extremity sharp injury wound hypertrophic scar among the groups. Even though onion extract gel and Silicone gel show preventive effects in the literature, especially in burns wounds, further studies are recommended to be conducted to prove the topical effects of above-mentioned gels in patients.

Angiotensin II activation by angiotensin-converting enzyme (ACE) is a significant mediator in wound healing and collagen production. In this study, the effect of topical application of ACE on hypertrophic scar formation has been studied in a clinical trial. Thirty patients with hypertrophic scar and itching after treatment of 2nd or 3rd degree burns participated in this double-blinded clinical trial. Subjects had two same-degree scars on symmetrical sites of body which were randomly allocated into two groups. One side was treated with 1% enalapril ointment and the other side with placebo twice daily. During a 6-months follow-up, a scoring table for itching was completed on a daily basis by patients. Furthermore, a single surgeon measured size of scars once a month. The mean size, thickness and itching score were calculated for each scar and compared between medication and placebo-treated scars. The mean size of scars in enalapril treated side was significantly less than scars in the placebo side. Additionally, enalapril treated scars had significantly lower itching scores compared to the placebo group. Topical enalapril significantly decreases the clinical parameters of hypertrophic scar and also itching as an indirect indicative of scar improvement. Furthermore, enalapril proved to be clinically safe for patients with low incidence of adverse drug reactions and acceptable cost effectiveness

Keloids are raised fbrous scars that extend beyond the boundaries of the original wound and usually reappear after surgical excision. Hypertrophic scars are similar lesions but are limited to wound edges and may regress over time. The aim of the present study was to provide a comparative assessment of intralesional cryotherapy with 2 methods of intralesional injection of triamcinolone and 5-fluorouracil.
The study was conducted on Iranian Azeri patients with hypertrophic and keloid scars in Sina hospital (Tabriz-Iran) from August 2016 to May 2017. Twenty-one scars were assigned to each group. The frst group received intralesional cryotherapy and the second and third groups were treated with intralesional triamcinolone acetonide (40 mg/mL) 0.2 mL/cm2 and 5-fluorouracil (50 mg/mL) 0.2 mL/cm2, respectively. Dimensions of the scars (including surface area, height and volume) were measured before and after the study. Therapies were repeated every 4 weeks and would be reapplied for 6 sessions depending on the presence of scar tissue.
A signifcant decline was found in surface area, height and volume of the scars with cryotherapy after the frst session compared to other 2 methods. The decline in surface area, height and volume after the sixth session was 52.9%, 61.37%, and 78.06% respectively with steroid injection and 32.16%, 58.07%, and 60.67% with 5-FU injection. Results also showed that in terms of surface area, height and volume of the disease, there was a signifcant difference between steroid and 5-FU groups in the sixth session, with the results being more favorable in the former group. Side effects were permanent hypopigmentation, telangiectasia and atrophy in the steroid group; surface wound, hyperpigmentation and increased pain in the 5-FU group; and temporary hypopigmentation in the cryotherapy group.
Results showed that intralesional cryotherapy accelerates keloid healing and has fewer side effects than other treatments.

Therapeutic effect of many selectable methods applied in clinical practice for treating hypertrophic scar (HS) is not still so satisfactory. Meanwhile, a few medicines may lead to several undesirable complications. The traditional Chinese medicine, Rg3, has been reported for multiple antitumor effects previously. We have conducted series of animal experiments and confirmed the inhibitory effect of Rg3 in HS before. The aim of this study was to further verify the conclusions of previous studies and reveal the specific functional mechanisms of Rg3.
The HS specimens were obtained from the patients aged from 15 to 36 years without systemic diseases and the primary cultured cells were isolated from the scar tissue and expanded in vitro. In every experiment, hypertrophic scar fibroblasts (HSFs) were divided into three groups and respectively cultured in medium with or without different Rg3 concentrations (50, 100 μg/ml). Cell viability assay, flow cytometry analysis (FCM), quantitative PCR, cell migration assay, immunofluorescence staining, western blot and ELISA were employed.
The outcomes demonstrated that Rg3 could suppress cell proliferation, vascularization and extracellular matrix (ECM) deposition of HSFs in vitro by TGF-β/SMAD and Erk signaling pathways. Significant statistical differences were between control group and Rg3-treated groups (P This study provides sufficient in vitro evidences for Rg3 as a promising drug in the treatment of human HS.

Hypertrophic scars (HSC) and Keloids are fibroproliferative dermal lesions resulting in excessive accumulation of extracellular matrix in the dermis and subcutaneous tissue. Corticosteroid, especially triamcinolone acetonide, injections may be the first line treatment for the prevention and treatment of keloids and HSC. Some drugs that inhibit calcium channels, such as verapamil, have also been effective in treatment of these lesions. The present study aimed to assess and compare the efficacy of these two treatment options in patients with HSC and keloids.

The study used a randomized, single blind, parallel design to compare the effect of verapamil in comparison with triamcinolone on the healing of HSC and keloids in two groups comprising 25 patients. Patients were randomly allocated using random numbers to receive intralesional injection of 1 mL of either verapamil (2.5 mg) or triamcinolone (20 mg) every 3 weeks for 3 months.

Downward trends in all lesion parameters including height of lesion, as well as the scores for erythema, pigmentation in both groups was revealed. The change in characteristics of the lesion within the treatment was independent to patients’ gender and age. Regarding drug - related complications, one case of atrophy was reported in triamcinolone group, however, not in the verapamil group.

Both verapamil and triamcinolone have significant therapeutic effects in decreasing the height of the lesion, improving erythema, improving the pliability of the lesion, and improving the hyperpigmentation. It seems that verapamil has less cost and side effects in comparison with triamcinolone, thus, it could be a good choice in treatment of keloids.

Hypertrophic scar involves excessive amounts of collagen in dermal layer and may be painful. Nowadays, we can’t be sure about effectiveness of procedure for hypertrophic scar management. The application of stem cells with natural scaffold has been the best option for treatment of burn wounds and skin defect, in recent decades. Fibrin glue (FG) was among the first of the natural biomaterials applied to enhance skin deformity in burn patients. This study aimed to identify an efficient, minimally invasive and economical transplantation procedure using novel FG from human cord blood for treatment of hypertrophic scar and regulation collagen synthesis. In this case series study, eight patients were selected with hypertrophic scar due to full-thickness burns. Human keratinocytes and fibroblasts derived from adult skin donors were isolated and cultured. They were tested for the expression of cytokeratin 14 and vimentin using immunocytochemistry. FG was prepared from pooled cord blood. Hypertrophic scars were extensively excised then grafted by simply placing the sheet of FG containing autologous fibroblast and keratinocytes. Histological analyses were performed using Hematoxylin and eosin (H&E) and Masson’s Trichrome (MT) staining of the biopsies after 8 weeks. Cultured keratinocytes showed a high level of cytokeratin 14 expression and also fibroblasts showed a high level of vimentin. Histological analyses of skin biopsies after 8 weeks of transplantation revealed re-epithelialization with reduction of hypertrophic scars in 2 patients. These results suggest may be the use of FG from cord blood, which is not more efficient than previous biological transporters and increasing hypertrophic scar relapse, but could lead to decrease pain rate.