In this article, we will discuss Brief Note on Hypertrophic Scars and Keloids. So, let’s get started.
Hypertrophic Scars and Keloids
Thene are due to aceumulationof excessive extracelular matrix.
Causes
• Prolonged intlammatory phase during wound healing and infeotion (more than 14 days to heal is more likely to develop hypertrophy).
• Tight bandaging
• More commonly happens in child
• Black skin people are more prone to hypertrophy
• Repeated harvesting ot skin predisposes the donor area for hypertrophy.
Problems in Hypertrophic Scars and Keloids
• Elevation due to excessive extracellular matrix production
• Deficient extracellular matrix degradation
• Increased tissue turgidity
• Itching due to excessive histamine production
• Redness due to increased vascularity
• Growth of keloids due to proliferation of fibroblasts
• Randomly oriented collagen (like decorin, versican)
Prevention
Hypertrophy of scar can be prevented by:
• Split skin grafting of burn is very effective, because it reduces the time taken for healing thereby, prevents hypertrophy.
• Pressure garments: It is needed if the wound takes more than 14 days to heal.
• Skin gel sheeting applied in the early itching sensation of a matured wound.
• By placement of scars in relaxed position.
• By avoiding wound tension, haematoma and infection.
Management
1. Pressure therapy
• Normal pressure used: 25-40 mmHg.
• Materials used elastic pressure garment orthoplast (thermolabile).
• Used continuously for 24 hrs up to 6- 9 months duration.
• Pressure therapy accelerates scar maturation process and remodelling of collagen fibres.
• Scar older than 6-12 months responds poorly.
2. Silicone gel sheet
• It is eflective in older scars also
• Topical silicon used in the form of silicone gel sheet
– Silicone gel sheet
– Silicone adhesive gel sheet
– Vitamin E added gel sheet
– Silicone gel and cream
• Applied for 12-24 hours for 2-4 months
• Adverse reaction – Contact dermatitis
• Mode of action – Silicone gel sheet inereases the collagenase activity due to increased skin temperature
3. Intra lesional injection
• Triamcinolone injection is used.
• Dose 40-120 mg/month for 4-6 times.
• Triamcinolone reduces production of extracellular matrix and inereases collagenase activity.
• Other injections are gamma-interferon, caleium channel blockers (verapmil, trifluperazine).
4. Surgery
• Split skin gratting is used normally.
5. Laser therapy
• The 585 nm flash lamp – Pumped pulsed dye laser has been used in the treatment.
• Absorption of light by haemoglobin leads to ischaemia, which in turn affects collagen formation.
6. Cryotherapy
• Newly formed scars respond quickly.
7. Radiotherapy
• X-ray therapy
• Electron beam therapy are used.
8. Combination therapy
• Pressure therapy+ triamcinolone injection
• Surgery + triamcinolone injection
• Surgery, postoperative radiation, pressure
therapy, injection and silicone gel sheeting may be tried.