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Cutaneous scarring can cause patients symptoms ranging from the psychological to physical pain. Although the process of normal scarring is well described the ultimate cause of pathological scarring remains unknown. Similarly, exactly how early gestation fetuses can heal scarlessly remains unsolved. These questions are crucial in the search for a pr...
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... are both characterised by increased vascularity, high mesenchymal density, inflammatory cell infiltration, and a thickened epidermis [36]. However, their clinical char- acteristics and pathologies intrinsically differ with keloids being the more complex, extreme, and challenging to treat (see Table 1). The treatment of both of these types of scar can be protracted and is best managed by a specialist from the outset. ...
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INTRODUCTION
Marjolin’s ulcer (MU) is an uncommon malignancy occurring on top of old scars. Once thought to be more common in Caucasians, is now detected increasingly in Africa.
METHODS
This was a retrospective study of patients with MU attending a tertiary centre within Mansoura University (Egypt) from 2004 to 2015. An institutional-based registr...
Background: Fabricated (fictitious, forged or invented) wounds are usually superficial injuries mostly produced by a person on his own body (self-inflicted) or occasionally, caused by another person acting in agreement with him (self-suffered). Assault means a physical attack by another person.
Case Report: We received two cases, within a short per...
Citations
... Pathologic scarring and fibrosis can be defined at the tissue level by over-exuberant deposition of extracellular matrix components, primarily collagen, due to dysregulation of various cytokines such as TGF-b and PDGF. These chemical messengers cause increased activation of fibroblasts and lead to excess collagen deposition and development of the clinical signs of keloidal/hypertrophic scarring (Andrews et al., 2016;Baker et al., 2009). In addition, the ratios of subtypes of collagen present in pathologic scars can differ from those of normal skin. ...
Acting on the renin–angiotensin–aldosterone system, angiotensin-converting enzyme inhibitors (ACE-Is) and angiotensin receptor blockers (ARBs) are mechanisms of some of the most prescribed medications in the world. In addition to their routine use for the treatment of hypertension, such agents have gained attention for their influence on the angiotensin receptor pathway in fibrotic skin disorders, including scars and keloids. To evaluate the current level of evidence supporting the use of these agents, a systematic review related to ACE-Is/ARBs and cutaneous scarring was conducted. We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus from database inception through January 26, 2022. Two independent reviewers identified eligible studies for inclusion and extracted data. Data were insufficient for meta-analysis and are presented narratively. Of 461 citations identified, seven studies were included (199 patients). The studies included two randomized clinical trials, one comparative observation study, and four case reports. All the included studies reported statistically significant improvement in cutaneous scarring in patients using ACE-Is/ARBs compared with that in those treated with placebo/control using various outcome measures such as scar size and scar scales. However, much of the literature on this subject to date is limited by study design.
... AMP cells display many favorable characteristics of stem cells, including the ability to differentiate into various cell types. Wound healing therapy with AMP cells has been shown to reduce the incidence of laparotomy wound failure [4]. Treatment with AMP cells was shown to significantly attenuate axonal degeneration and improve motor impairment in a model of traumatic brain injury [5]. ...
Objective To examine the effect of Human Amnion-Derived Multipotent Progenitor (AMP) cells and their novel ST266 secretome on neointimal hyperplasia after arterial balloon injury in rats.Material and Methods Sprague-Dawley male rats were randomly divided into four groups (n=7): Control (PBS) group, systemic ST266 group, systemic AMP group and local AMP implant group. Neointimal hyperplasia was induced in the iliac using a 2F Fogarty embolectomy catheter. After surgery, the rats in the ST266 group were treated with 0.1, 0.5, or 1ml ST266 iv daily. In the systemic AMP groups, a single dose (SD) of 0.5 ×106 or 1×106 AMP cells was injected via the inferior vena cava after arterial balloon injury. In local AMP implant groups, 1×106, 5×106, or 20×106 AMP cells were implanted in 300 µl Matrigel (Mtgl) around the iliac artery after balloon injury. The iliac arteries were removed for histologic analysis at 28 days after the surgery. Re-endothelialization index was measured at 10 days after balloon injury.Results ST266 (1 ml) group had a lower level of the Neointima / Neointima+Media ratio (N / N+M) 0.3±0.1 vs 0.5±0.1, p=0.004) and luminal stenosis (LS) percentage (18.2±1.9 % vs 39.2±5.8 %, p=0.008) compared with the control group. Single-dose AMP (1×106) decreased LS compared to the control group (19.5±5.4 % vs 39.2±5.8 %, p=0.033). Significant reduction in N / N+M were found between implanted AMPs (20×106) and the control group (0.4±0.1 vs 0.5±0.1, p=0.003) and the Mtgl-only group (0.5±0.1, p=0.007). Implanted AMPs (20×106) decreased the LS compared with both the control (39.2±5.8 %, p=0.001) and Mtgl-only group (37.5±8.6 %, p=0.016). ST266 (1 ml) significantly increased the re-endothelialization index compared to the control (0.4±0.1 vs 0.1±0.1, p=0.002).Conclusion ST266 and AMP cells reduce neointimal formation and increase the re-endothelialization index after arterial balloon injury. ST266 is potentially a novel, therapeutic agent to prevent vascular restenosis in human.
... Furthermore, an abnormal scarring process can result in hypertrophic scars or keloids. Preventing pathological 1 scarring should ideally be started as early as possible after the injury or surgery. 2,3 Good surgical 2 technique is essential to minimize scarring, but currently there are no recommended prophylactic 3 pharmaceuticals or medical devices that could be administered during surgery to supplement 4 surgical skill. ...
Background
CACIPLIQ20 (OTR3, Paris, France) is a medical device used for the treatment of chronic skin ulcers. It contains a heparan sulfate mimetic which accelerates tissue healing by stabilizing matrix proteins and protecting heparin-binding growth factors. In humans, an open self-controlled study suggested that the topical application of CACIPLIQ20 optimizes skin healing following surgery.
Objectives
To expand previous findings using different CACIPLIQ20 administration regimen.
Methods
Twenty-four females were refered for breast reduction surgery. Each patient was its own control with 1 CACIPLIQ20-treated and 1 saline-treated control breast. The treated side (right or left) was randomly assigned by the operating surgeon. Scar appearance was assessed by six independent raters using a global visual scar comparison scale based on scars photographs. All raters were blinded towards the CACIPLIQ20-treated side.
Results
The follow-up period following surgery ranged from 1 to 12 months with a median follow-up of 6 months. Overall, there was a mean improvement of 15.2% (SD = 26.7) in favor of CACIPLIQ20, (p = 0.016). On the CACIPLIQ20-treated side, the mean score per patient was above 20% in 11 patients and above 30% improvement in 8 cases. In contrast, only 3 patients were considered improved by at least 20% on the control side and only one above 30%. Comparison of different application regimen suggested that the best trend was obtained with a single administration of CACIPLIQ20 at Day 0.
Conclusions
In conclusion, CACIPLIQ20 could represent an interesting scar prophylactic therapy, based on a single administration at the time of surgery, and without any known adverse effects.
... Based on the research results in Prof. Dr. R. D. Kandou Hospital, Manado, from January 2008 to December 2010, 61 patients with keloid were found, and 93 cases of keloid from 5550 cases of skin diseases were found from January 2011 to December 2015. 1 While 63 out of 478 cases of benign skin tumor keloid were found from the research of benign skin tumors in the same hospital from 2009 to 2011, 2 meanwhile in the United Kingdom, hypertrophic scar occurs in 23 million cases on postoperative patients. 3 The prevalence of patients with the hypertrophic scar in Regional Public Hospital of dr. Slamet of Garut Regency was increased from 160 patients in 2013 to 200 patients in 2014. ...
Introduction: Keloid and hypertrophic scar are pathological scars resulting from excessive accumulation of collagen in wound healing process. Data about profiles of keloid and hypertrophic scar are rarely found in Indonesia. Therefore, it is necessary to conduct research related to keloid and hypertrophic scar. This study aimed to provide valuable data for further research.
Methods: This was descriptive retrospective study evaluating 105 patients treated for keloid and hypertrophic scar from 2014 to 2017 using medical records of working-age patients.
Results: Mostly in patients between 17-25 years old (40%). Comparison between male and female patients were 1.07:1 (keloid) and 1.09:1 (hypertrophic scar). As many as 10.71% of patients of keloid and 17.39% patients of hypertrophic scar were private employees. 23.21% patients with keloid and 23.91% patients of hypertrophic scar were Javanese. 14.29% patients of keloid and 19.57% patients of hypertrophic scar tend to have daily indoor activities. 17.86% patients of keloid and 26.09% patients of hypertrophic scar felt dark-skinned toned. Most keloid scars were caused by traumatic lesions (32.14%), located on the chest (19.54%), and treated by corticosteroid injection. Hypertrophic scar mostly caused by burn injury (54.35%), located on the face (29.55%), and treated by excision surgery.
Conclusion: Both keloid and hypertrophic scars were mostly developed in 17-25 years old, male, private employees, Javanese ethnic, dark skin tone patients, with daily indoor activities, caused by traumatic lesion and located on the chest, earlobe, and hand, treated by corticosteroid injection (keloid). Meanwhile, hypertrophic scars are mostly caused by a burn injury on the face and treated by excision surgery.
... Skin fibrosis such as hypertrophic scars and keloids affect millions of people worldwide. Fibrotic tissue is like a scar showing a bumpy, irregular and thick surface due to the excessive accumulation of protein under the skin [157][158][159] . A major cause of fibrotic diseases is the uncontrolled overexpression of connective tissue growth factor (CTGF). ...
... LbL assemblies have also been used for scar therapy. The process of wound healing often results in thick, collagen-enriched tissue called scar tissue, which can negatively impact quality of life 157,158 . Cutaneous scars from serious traumatic injury can cause long-lasting complications due to scar contraction and poor tissue remodeling reducing the range of motion and joint mobility and subsequently impairing function 159,186 . ...
A growing variety of biological macromolecules are in development for use as active ingredients in topical therapies and vaccines. Dermal delivery of biomacromolecules offers several advantages compared to other delivery methods, including improved targetability, reduced systemic toxicity, and decreased degradation of drugs. However, this route of delivery is hampered by the barrier function of the skin. Recently, a large body of research has been directed toward improving the delivery of macromolecules to the skin, ranging from nucleic acids (NAs) to antigens, using noninvasive means. In this review, we discuss the latest formulation‐based efforts to deliver antigens and NAs for vaccination and treatment of skin diseases. We provide a perspective of their advantages, limitations, and potential for clinical translation. The delivery platforms discussed in this review may provide formulation scientists and clinicians with a better vision of the alternatives for dermal delivery of biomacromolecules, which may facilitate the development of new patient‐friendly prophylactic and therapeutic medicines.
... Scars and trauma have long been recognized in neural therapy as a source of chronic pain as a result of sympathetic nervous system upregulation [123][124][125]. It is theorized that damaged local cells lose their normal membrane potential, transmitting abnormal electric signals throughout the rest of the body via the autonomic nervous system, acting as agonists to sympathetic upregulation resulting in stress and pain [126,127]. ...
... A cutaneous scar is an area of dermal fibrous replacement tissue, the physiological result of the wound healing process [11]. When injured, the skin must consistently and rapidly repair itself. ...
... As well known, it consists of three predictable and overlapping phases (inflammatory, proliferative and remodeling phase). An alteration of one or more of these phases may result in greater or lesser scarring [11]. More specifically, pathological scars are usually characterized by a prolonged inflammation, excessive fibroblast proliferation and abnormal deposition of extracellular matrix proteins. ...
Background
Transmen are individuals who live a marked incongruence between the assigned gender and the experienced gender. Crucial and life-changing steps in their transition are testosterone treatment and mastectomy to remove the stigma of feminine identity. After surgery, patients’ attention turns to the scars, often not aesthetically pleasant. We thus created an innovative galenic preparation for scar treatment after surgery composed by spironolactone, alfa bisabolol and silicone gel. Functional outcomes, side effects and satisfaction were assessed.Methods
For the present prospective randomized controlled study, 30 patients with similar demographic characteristics who underwent double incision mastectomy with NA grafts between February 2014 and June 2019 were selected. The treatment Group A (n = 15) was treated for 12 months with “Top Surgery Scar go,” the control Group B (n = 15) with silicon gel. Statistical analysis including Wilcoxon test and Kruskal–Wallis test per variable was performed. To assess satisfaction, a second Wilcoxon test was applied.ResultsThe differences between Group A and Group B were statistically significant, especially at T12 with very low p values. Satisfaction was greater in Group A (p value = 3e−4). No major side effects were noticed in Group A.ConclusionsTSSgo scar innovative treatment showed long-term efficacy in comparison with silicon gel in terms of improved scar tissue texture, pigmentation, pliability and height. It is easy to set up, cost-effective and safe. Further studies are necessary to better assess efficacy and validity of TSSgo, but it appears to be promising as the new treatment of reference for scar management after top surgery in transmen.Level of Evidence IVThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
... The skin, comprised of the epidermis, dermis, and deeper subcutaneous tissue, is the largest organ of the body, and functions as the first line of defense from external assaults (Proksch et al., 2008). Surgery and trauma in adults often result in wounds, which can cause the formation of refractory scars [i.e., hypertrophic scars and keloids, which are specific to humans (Baker et al., 2009)] with significant functional and psychological consequences (Bayat et al., 2003) that reduce the quality of life of individuals (Brown et al., 2008). Compared to the normal scars that can be much smaller than the original wound, keloids are defined as pathologic scars that extend beyond the area of the original wound, while hypertrophic scars are restricted to the wound borders ( Figure 1) (Atiyeh et al., 2005;Baker et al., 2009;Naylor and Brissett, 2012). ...
... Surgery and trauma in adults often result in wounds, which can cause the formation of refractory scars [i.e., hypertrophic scars and keloids, which are specific to humans (Baker et al., 2009)] with significant functional and psychological consequences (Bayat et al., 2003) that reduce the quality of life of individuals (Brown et al., 2008). Compared to the normal scars that can be much smaller than the original wound, keloids are defined as pathologic scars that extend beyond the area of the original wound, while hypertrophic scars are restricted to the wound borders ( Figure 1) (Atiyeh et al., 2005;Baker et al., 2009;Naylor and Brissett, 2012). Consequently, annual spending on managing unwanted scarring exceeds $20 billion in the United States (Block et al., 2015). ...
Healing of cutaneous wounds is a complex and well-coordinated process requiring cooperation among multiple cells from different lineages and delicately orchestrated signaling transduction of a diversity of growth factors, cytokines, and extracellular matrix (ECM) at the wound site. Most skin wound healing in adults is imperfect, characterized by scar formation which results in significant functional and psychological sequelae. Thus, the reconstruction of the damaged skin to its original state is of concern to doctors and scientists. Beyond the traditional treatments such as corticosteroid injection and radiation therapy, several growth factors or cytokines-based anti-scarring products are being or have been tested in clinical trials to optimize skin wound healing. Unfortunately, all have been unsatisfactory to date. Currently, accumulating evidence suggests that the ECM not only functions as the structural component of the tissue but also actively modulates signal transduction and regulates cellular behaviors, and thus, ECM should be considered as an alternative target for wound management pharmacotherapy. Of particular interest are small leucine-rich proteoglycans (SLRPs), a group of the ECM, which exist in a wide range of connecting tissues, including the skin. This manuscript summarizes the most current knowledge of SLRPs regarding their spatial-temporal expression in the skin, as well as lessons learned from the genetically modified animal models simulating human skin pathologies. In this review, particular focus is given on the diverse roles of SLRP in skin wound healing, such as anti-inflammation, pro-angiogenesis, pro-migration, pro-contraction, and orchestrate transforming growth factor (TGF)β signal transduction, since cumulative investigations have indicated their therapeutic potential on reducing scar formation in cutaneous wounds. By conducting this review, we intend to gain insight into the potential application of SLRPs in cutaneous wound healing management which may pave the way for the development of a new generation of pharmaceuticals to benefit the patients suffering from skin wounds and their sequelae.
... [16,17] Scars are dermal fibrous replacement tissue from a wound that healed by resolution rather than regeneration. [18,19] Cutaneous scarring is said to be inevitable following damage to more than 33.1% of the thickness of the skin either through trauma or surgery. [18][19][20] Suture type and wound closure technique are significant factors known to affect wound closure outcomes. ...
... [18,19] Cutaneous scarring is said to be inevitable following damage to more than 33.1% of the thickness of the skin either through trauma or surgery. [18][19][20] Suture type and wound closure technique are significant factors known to affect wound closure outcomes. [21] Studies on the post-operative outcome of the common wound closure techniques in a paediatric population in our environment are limited [21] and those assessing the scar outcome with respect to closure and non-closure of the subcutaneous fat during wound closure in children are either scarce or non-existent. ...
Background: Scars are inevitable sequelae of any surgical procedure. Wound closure method has been
shown to affect the post-operative scar outcome. This study compared the post-operative scar of two
wound closure techniques in paediatric groin surgeries. Methods: This was a prospective comparative
analytical study involving 60 paediatric surgical patients randomized into two groups. After a groin
procedure in patients who met the inclusion criteria, patients in Group A had only the skin layer closed
whereas both skin and subcutaneous tissue were closed in Group B. Scar assessment was done using the
Patient and Observer Scar Assessment Scale (POSAS) at 1 week, 3 weeks and 6 weeks after surgery. Results:
The mean POSAS score was 108.44 ± 20.32 and 113.91 ± 26.18 for groups A & B respectively (P=0.379)
while the overall opinion score for groups A & B were 19 (IQR=4) and 21(IQR=10) (P=0.392) respectively.
The average duration of surgery was 35 minutes in each group. There was equal distribution of seroma
formation among the two wound closure groups. Among the patients that developed wound dehiscence,
25% were in group A, while 75% were in group B. Ninety-five percent of the wounds healed with fine linear
scar. Conclusion: Majority of paediatric groin wounds heal with fine linear scars. Although no statistically
significant association exists between wound closure technique and scar assessment scores, patients who
had two-layer wound closure recorded worse scar assessment scores compared to those who had one-layer
closure
... 20 Scar: It is defined as a fibrous tissue that replaces the normal tissue resulting from a wound that has healed by resolution rather than regeneration such scars related to oral soft tissue biopsy ( Figure 18). 21 Interestingly, healing of mucosal wounds occurs faster than skin wounds and clinical observations have indicated that mucosal wounds rarely scar. 22 ...
