Approach and management of hypertrophic scars and keloids
Keywords:
Hypertrophic scars, keloids, managementAbstract
Wound healing is a dynamic, continuous and complex process where different cells, extracellular matrix and chemical mediators such as cytokines interact together, in addition to the influence of local and systemic factors. The process is conducted through three sequential steps including the inflammatory phase and haemostasis, the proliferative phase and, finally, the maturation and remodeling phase. Hypertrophic scars and keloids are part of the spectrum of abnormal wound healing, its physiopathology is unclear but several theories are proposed to be discussed in this article. Additionally, we will address a practical approach to their management taking into account the therapeutic options available in our environment as well as experimental therapies.
Author Biography
Claudia Andrea Hernández
Médica, residente de Dermatología, Universidad Pontificia Bolivariana, Medellín, Colombia
References
1. Teller P, White TK. The physiology of wound healing: Injury through maturation. Surg Clin North Am. 2009;89:599-610.
2. Guo S, Dipietro LA. . Factors affecting wound healing. J Dent Res. 2010;89:219-29.
3. Singer AJ, Thode HCJ, McClain SA. Development of a histomorphologic scale to quantify cutaneous scars after burns. Acad Emerg Med. 2000;7:1083-8.
4. Dasgeb B, Phillips T. What are scars? In: Arndt KA, editor. Scar revision. First edition. Philadelphia: Saunders; 2006. p. 1-16.
5. Rumsey N, Clarke A, White P. Exploring the psychosocial concerns of outpatients with disfiguring conditions. J Wound Care. 2003;12:247-52.
6. Kirsner RS. Wound healing. En: Bolognia JL, Jorizzo JL, Rapini RP. Elsevier. Dermatology. 2ª edición. España; 2008:2147-58
7. Broughton G, Janis JE, Attinger CE. Wound healing: An overview. Plast Reconstr Surg. 2006;117:1eS-32eS.
8. Baum CL, Arpey CJ. Normal cutaneous wound healing: Clinical correlation with cellular and molecular events. Dermatol Surg. 2005;31:674-86.
9. Xue H, McCauley RL, Zhang W. Elevated interleukin-6 expression in keloid fibroblasts. J Surg Res. 2000;89:74-7.
10. Price R, Myers S, Leigh I, Navsaria HA. The role of hyaluronic acid in wound healing. Assesment of clinical evidence. Am J Clin Dermatol. 2005;3:393-402.
11. van der Veer WM, Bloemen MC, Ulrich MM, Molema G, van Zuijlen PP, Middelkoop E, et al. Potential cellular and molecular causes of hypertrophic scar formation. Burns. 2009;35:15-29.
12. Wang R, Ghahary A, Shen Q, Scott PG, Roy K, Tredget EE. Hypertrophic scar tissues and fibroblasts produce more transforming growth factor beta1 mRNA and protein than normal skin and cells. Wound Rep Reg. 2000;8:128-37.
13. Stavrou D, Weissman O, Winkler E, Yankelson L, Millet E, Mushin OP, et al. Silicone-based scar therapy: A review of the literature. Aesthetic Plast Surg. 2010;34:646-51.
14. Marneros AG, Norris JEC, Olsen BR, Reichenberger E. Clinical genetics of familial keloids. Arch Dermatol. 2001;137:1429-34.
15. Robles DT, Berg D. Abnormal wound healing: Keloids. Clin Dermatol. 2007;25:26-32.
16. Alster T, Tanzi E. Hypertrophic scars and keloids. Am J Clin Dermatol. 2003;4:235-43.
17. Burton CS, Escaravage V. Dermal hypertrophies. En: Bolognia JL, Jorizzo JL, Rapini RP, editors. Dermatology. Second edition. España: Elsevier; 2008. p. 1497-504.
18. Mullinax K, Cohen JB. Carcinoma en cuirasse presenting as keloids of the chest. Dermatol Surg. 2004;30:226-8.
19. Barzilai A, Lyakhovitsky A, Horowitz A, Trau H. Keloid-like scleroderma. Am J Dermatopathol. 2003;25:327-30.
20. Edwards R, Harding KG. Bacteria and wound healing. Curr Opin Infect Dis. 2004;17:91-6.
21. Bishop A. Role of oxygen in wound healing. J Wound Care. 2008;17:399-402.
22. Emery CF, Kiecolt-Glaser JK, Glaser R, Malarkey WB, Frid DJ. Exercise accelerates wound healing among healthy older adults: A preliminary investigation. J Gerontol Med Sci. 2005;60:1432-6.
23. Gilliver SC, Ashworth JJ, Ashcroft GS. The hormonal regulation of cutaneous wound healing. Clin Dermatol. 2007;25:56-62.
24. Godbout JP, Glaser R. Stress-induced immune dysregulation: Implications for wound healing, infectious disease and cancer. J Neuroimmune Pharmacol. 2006;1:421-7.
25. Szabo G, Mandrekar P. A recent perspective on alcohol, immunity and host defense. Alcohol Clin Exp Res. 2009;33:220-32.
26. Karukonda SR, Flynn TC, Boh EE, McBurney EI, Russo GG, Millikan LE. The effects of drugs on wound healing-part II. Specific classes of drugs and their effect on healing wounds. Int J Dermatol. 2000;39:321-33.
27. Price P, Fogh K, Glynn C, Krasner DL, Osterbrink J, Sibbald RG. Why combine a foam dressing with ibuprofen for wound pain and moist wound healing? Int Wound J 2007;4:1-3
28. Abdelmalek M, Spencer J. Retinoids and wound healing. ermatol Surg 2006;32(10):1219-30 Baumann LS, Spencer J. The effects of topical vitamin E on the cosmetic appearance of scars. Dermatol Surg. 1999;25:311-5.
29. Baumann LS, Spencer J. The effects of topical vitamin E on the cosmetic appearance of scars. Dermatol Surg 1999;25:311-5
30. Ogawa R. The most current algorithms for the treatment and prevention of hypertrophic scars and keloids. Plast Reconstr Surg. 2010;125:557-68.
31. Suetak T, Sasai S, Zhen YX, Tagami H. Effects of silicone gel sheet on the stratum corneum hydration. Br J Plast Surg. 2000;53:503-7.
32. Berman B, Perez OA, Konda S, Kohut BE, Viera MH, Delgado S, et al. Review of the biologic effects, clinical efficacy, and safety of silicone elastomer sheeting for hypertrophic and keloid scar treatment and management. Dermatol Surg. 2007;33:1291-303.
33. Kelly P. Medical and surgical therapies for keloids. Dermatol Ther. 2004;17:212-8.
34. Baur PS, Larson L, Stacey TR, et al. Burn scar changes associated with pressure. In: Lengacie JJ, editor. The ultrastructure of colagen. Springfield, IL: Charles C. Thomas; 1976 p. 369-76.
35. Reish RG, Eriksson E. Scars: A review of emerging and currently available therapies. Plast Reconstr Surg. 2008;122:1068-78.
36. Manuskiatti W, Fitzpatrick RE. Treatment response of keloidal and hypertrophic sternotomy scars: Comparison among intralesional corticosteroid, 5- fluorouracil and 585- nm flashlamp-pumped pulsed-dye laser treatment. Arch Dermatol. 2002;138:1149-55.
37. Nouri K, Rivas MP, Ballard CJ. Treatment of scars with lasers and other energy sources. In: Arndt KA, editor. Scar revision. First edition. Philadelphia: Saunders; 2006. 67-87.
38. Nouri K, Jiménez GP, Harrison-Balestra C, Elgart GW. 585-nm pulsed dye laser in the treatment of surgical scars starting on the suture removal day. Dermatol Surg. 2003;29:65-73.
39. Decker RH, Wilson LD. Effect of radiation on wound healing and treatment of scarring. In: Arndt KA, editor. Scar revision. First edition. Philadelphia: Saunders; 2006. 89-103.
40. Haurani MJ, Foreman K, Yang JJ, Siddiqui A. 5-fluorouracil treatment of problematic scars. Plas Reconstr Surg. 2009;123:139.
41. Espana A, Solano T, Quintanilla E. Bleomycin in the treatment of keloid and hypertrophic scars by multiple needle punctures. Dermatol Surg. 2001;27:23-7.
42. Naeini FF, Najafian J, Ahmadpour K. Bleomycin tattoing as a promising therapeutic modality in large keloids and hyperthrophic scars. Dermatol Surg. 2006;32:1023-9.
43. Shridharani SM, Magarakis M, Manson PN, Singh NK, Basdag B, Rosson GD. The emerging role of antineoplastic agents in the treatment of keloids and hypertrophic scars: A review. Ann Plast Surg. 2010;64:355-61.
44. Xi-Qiao W, Ying-Kai L, Chun Q, Shu-Liang L. A review of the effectiveness of antimitotic drug injections for hypertrophic scars and keloids. Ann Plast Surg. 2009;63:688-92.
45. Berman B, Kaufman J. Pilot study of the effect of postoperative imiquimod 5% cream on the recurrence rate of excised keloids. J Am Acad Dermatol. 2002;47:S209.
46. Berman B, Flores F. Recurrence rates of excised keloids treated with post-operative triamcinolone acetonide injections or interferon alfa-2b injections. J Am Acad Dermatol 1997:137:755–757
47. Berman B, Zell D. Medical treatment of scarring. En: Arndt K. Elsevier. Scar revision. 1ª edición. Philadelphia;2006: 17-43
48. V. LeroyYoung, Bush J, O’Kane S. A New Approach for the Prophylactic Improvement of Surgical Scarring: Avotermin (TGFb3). Clin Plastic Surg 2009;36:307–313
49. Nizet J-L, Piérard G, Quatresooz P. Revisiting biothermal effects on erythematosus hypertrophic scars during pregnancy. J Cosmet Dermatol 2009;8:27–31
50. Draelos ZD. The ability of onion extract gel to improve the cosmetic appearance of surgical scars. J Cosmet Dermatol 2008;7:101–104
51. Prasad V, Dorle AK. Evaluation of ghee based formulation for wound healing activity. J Ethnopharmacol 2006;107:38–47
52. Tiedea S, Ernsta N, Bayat A, Paus R, Tronnier V, Zechel C. Basic fibroblast growth factor: A potential new therapeutic tool for the treatment of hypertrophic and keloid scars. Ann Anat 2009;191:33-44
53. Occleston NL, O’Kane S, Goldspink N, Ferguson M. New therapeutics for the prevention and reduction of scarring. Drug Discov Today 2008;13:973-981
2. Guo S, Dipietro LA. . Factors affecting wound healing. J Dent Res. 2010;89:219-29.
3. Singer AJ, Thode HCJ, McClain SA. Development of a histomorphologic scale to quantify cutaneous scars after burns. Acad Emerg Med. 2000;7:1083-8.
4. Dasgeb B, Phillips T. What are scars? In: Arndt KA, editor. Scar revision. First edition. Philadelphia: Saunders; 2006. p. 1-16.
5. Rumsey N, Clarke A, White P. Exploring the psychosocial concerns of outpatients with disfiguring conditions. J Wound Care. 2003;12:247-52.
6. Kirsner RS. Wound healing. En: Bolognia JL, Jorizzo JL, Rapini RP. Elsevier. Dermatology. 2ª edición. España; 2008:2147-58
7. Broughton G, Janis JE, Attinger CE. Wound healing: An overview. Plast Reconstr Surg. 2006;117:1eS-32eS.
8. Baum CL, Arpey CJ. Normal cutaneous wound healing: Clinical correlation with cellular and molecular events. Dermatol Surg. 2005;31:674-86.
9. Xue H, McCauley RL, Zhang W. Elevated interleukin-6 expression in keloid fibroblasts. J Surg Res. 2000;89:74-7.
10. Price R, Myers S, Leigh I, Navsaria HA. The role of hyaluronic acid in wound healing. Assesment of clinical evidence. Am J Clin Dermatol. 2005;3:393-402.
11. van der Veer WM, Bloemen MC, Ulrich MM, Molema G, van Zuijlen PP, Middelkoop E, et al. Potential cellular and molecular causes of hypertrophic scar formation. Burns. 2009;35:15-29.
12. Wang R, Ghahary A, Shen Q, Scott PG, Roy K, Tredget EE. Hypertrophic scar tissues and fibroblasts produce more transforming growth factor beta1 mRNA and protein than normal skin and cells. Wound Rep Reg. 2000;8:128-37.
13. Stavrou D, Weissman O, Winkler E, Yankelson L, Millet E, Mushin OP, et al. Silicone-based scar therapy: A review of the literature. Aesthetic Plast Surg. 2010;34:646-51.
14. Marneros AG, Norris JEC, Olsen BR, Reichenberger E. Clinical genetics of familial keloids. Arch Dermatol. 2001;137:1429-34.
15. Robles DT, Berg D. Abnormal wound healing: Keloids. Clin Dermatol. 2007;25:26-32.
16. Alster T, Tanzi E. Hypertrophic scars and keloids. Am J Clin Dermatol. 2003;4:235-43.
17. Burton CS, Escaravage V. Dermal hypertrophies. En: Bolognia JL, Jorizzo JL, Rapini RP, editors. Dermatology. Second edition. España: Elsevier; 2008. p. 1497-504.
18. Mullinax K, Cohen JB. Carcinoma en cuirasse presenting as keloids of the chest. Dermatol Surg. 2004;30:226-8.
19. Barzilai A, Lyakhovitsky A, Horowitz A, Trau H. Keloid-like scleroderma. Am J Dermatopathol. 2003;25:327-30.
20. Edwards R, Harding KG. Bacteria and wound healing. Curr Opin Infect Dis. 2004;17:91-6.
21. Bishop A. Role of oxygen in wound healing. J Wound Care. 2008;17:399-402.
22. Emery CF, Kiecolt-Glaser JK, Glaser R, Malarkey WB, Frid DJ. Exercise accelerates wound healing among healthy older adults: A preliminary investigation. J Gerontol Med Sci. 2005;60:1432-6.
23. Gilliver SC, Ashworth JJ, Ashcroft GS. The hormonal regulation of cutaneous wound healing. Clin Dermatol. 2007;25:56-62.
24. Godbout JP, Glaser R. Stress-induced immune dysregulation: Implications for wound healing, infectious disease and cancer. J Neuroimmune Pharmacol. 2006;1:421-7.
25. Szabo G, Mandrekar P. A recent perspective on alcohol, immunity and host defense. Alcohol Clin Exp Res. 2009;33:220-32.
26. Karukonda SR, Flynn TC, Boh EE, McBurney EI, Russo GG, Millikan LE. The effects of drugs on wound healing-part II. Specific classes of drugs and their effect on healing wounds. Int J Dermatol. 2000;39:321-33.
27. Price P, Fogh K, Glynn C, Krasner DL, Osterbrink J, Sibbald RG. Why combine a foam dressing with ibuprofen for wound pain and moist wound healing? Int Wound J 2007;4:1-3
28. Abdelmalek M, Spencer J. Retinoids and wound healing. ermatol Surg 2006;32(10):1219-30 Baumann LS, Spencer J. The effects of topical vitamin E on the cosmetic appearance of scars. Dermatol Surg. 1999;25:311-5.
29. Baumann LS, Spencer J. The effects of topical vitamin E on the cosmetic appearance of scars. Dermatol Surg 1999;25:311-5
30. Ogawa R. The most current algorithms for the treatment and prevention of hypertrophic scars and keloids. Plast Reconstr Surg. 2010;125:557-68.
31. Suetak T, Sasai S, Zhen YX, Tagami H. Effects of silicone gel sheet on the stratum corneum hydration. Br J Plast Surg. 2000;53:503-7.
32. Berman B, Perez OA, Konda S, Kohut BE, Viera MH, Delgado S, et al. Review of the biologic effects, clinical efficacy, and safety of silicone elastomer sheeting for hypertrophic and keloid scar treatment and management. Dermatol Surg. 2007;33:1291-303.
33. Kelly P. Medical and surgical therapies for keloids. Dermatol Ther. 2004;17:212-8.
34. Baur PS, Larson L, Stacey TR, et al. Burn scar changes associated with pressure. In: Lengacie JJ, editor. The ultrastructure of colagen. Springfield, IL: Charles C. Thomas; 1976 p. 369-76.
35. Reish RG, Eriksson E. Scars: A review of emerging and currently available therapies. Plast Reconstr Surg. 2008;122:1068-78.
36. Manuskiatti W, Fitzpatrick RE. Treatment response of keloidal and hypertrophic sternotomy scars: Comparison among intralesional corticosteroid, 5- fluorouracil and 585- nm flashlamp-pumped pulsed-dye laser treatment. Arch Dermatol. 2002;138:1149-55.
37. Nouri K, Rivas MP, Ballard CJ. Treatment of scars with lasers and other energy sources. In: Arndt KA, editor. Scar revision. First edition. Philadelphia: Saunders; 2006. 67-87.
38. Nouri K, Jiménez GP, Harrison-Balestra C, Elgart GW. 585-nm pulsed dye laser in the treatment of surgical scars starting on the suture removal day. Dermatol Surg. 2003;29:65-73.
39. Decker RH, Wilson LD. Effect of radiation on wound healing and treatment of scarring. In: Arndt KA, editor. Scar revision. First edition. Philadelphia: Saunders; 2006. 89-103.
40. Haurani MJ, Foreman K, Yang JJ, Siddiqui A. 5-fluorouracil treatment of problematic scars. Plas Reconstr Surg. 2009;123:139.
41. Espana A, Solano T, Quintanilla E. Bleomycin in the treatment of keloid and hypertrophic scars by multiple needle punctures. Dermatol Surg. 2001;27:23-7.
42. Naeini FF, Najafian J, Ahmadpour K. Bleomycin tattoing as a promising therapeutic modality in large keloids and hyperthrophic scars. Dermatol Surg. 2006;32:1023-9.
43. Shridharani SM, Magarakis M, Manson PN, Singh NK, Basdag B, Rosson GD. The emerging role of antineoplastic agents in the treatment of keloids and hypertrophic scars: A review. Ann Plast Surg. 2010;64:355-61.
44. Xi-Qiao W, Ying-Kai L, Chun Q, Shu-Liang L. A review of the effectiveness of antimitotic drug injections for hypertrophic scars and keloids. Ann Plast Surg. 2009;63:688-92.
45. Berman B, Kaufman J. Pilot study of the effect of postoperative imiquimod 5% cream on the recurrence rate of excised keloids. J Am Acad Dermatol. 2002;47:S209.
46. Berman B, Flores F. Recurrence rates of excised keloids treated with post-operative triamcinolone acetonide injections or interferon alfa-2b injections. J Am Acad Dermatol 1997:137:755–757
47. Berman B, Zell D. Medical treatment of scarring. En: Arndt K. Elsevier. Scar revision. 1ª edición. Philadelphia;2006: 17-43
48. V. LeroyYoung, Bush J, O’Kane S. A New Approach for the Prophylactic Improvement of Surgical Scarring: Avotermin (TGFb3). Clin Plastic Surg 2009;36:307–313
49. Nizet J-L, Piérard G, Quatresooz P. Revisiting biothermal effects on erythematosus hypertrophic scars during pregnancy. J Cosmet Dermatol 2009;8:27–31
50. Draelos ZD. The ability of onion extract gel to improve the cosmetic appearance of surgical scars. J Cosmet Dermatol 2008;7:101–104
51. Prasad V, Dorle AK. Evaluation of ghee based formulation for wound healing activity. J Ethnopharmacol 2006;107:38–47
52. Tiedea S, Ernsta N, Bayat A, Paus R, Tronnier V, Zechel C. Basic fibroblast growth factor: A potential new therapeutic tool for the treatment of hypertrophic and keloid scars. Ann Anat 2009;191:33-44
53. Occleston NL, O’Kane S, Goldspink N, Ferguson M. New therapeutics for the prevention and reduction of scarring. Drug Discov Today 2008;13:973-981
How to Cite
1.
Hernández CA. Approach and management of hypertrophic scars and keloids. rev. asoc. colomb. dermatol. cir. dematol. [Internet]. 2019 Mar. 5 [cited 2024 Jul. 3];19(3):218-2. Available from: https://revista.asocolderma.org.co/index.php/asocolderma/article/view/364
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2019-03-05
How to Cite
1.
Hernández CA. Approach and management of hypertrophic scars and keloids. rev. asoc. colomb. dermatol. cir. dematol. [Internet]. 2019 Mar. 5 [cited 2024 Jul. 3];19(3):218-2. Available from: https://revista.asocolderma.org.co/index.php/asocolderma/article/view/364
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