Hypertrophic scar

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Hypertrophic scar
Hypertrophic scar -4 months after incident- 2013-04-05 00-46.jpg
Hypertrophic scar (4 months after incident)
Specialty Dermatology

A hypertrophic scar is a cutaneous condition characterized by deposits of excessive amounts of collagen which gives rise to a raised scar, but not to the degree observed with keloids. [1] Like keloids, they form most often at the sites of pimples, body piercings, cuts and burns. They often contain nerves and blood vessels. They generally develop after thermal or traumatic injury that involves the deep layers of the dermis and express high levels of TGF-β.[ citation needed ]

Contents

Cause

Mechanical tension on a wound has been identified as a leading cause for hypertrophic scar formation. [3]

When a normal wound heals, the body produces new collagen fibers at a rate which balances the breakdown of old collagen. Hypertrophic scars are red to brown and thick and may be itchy or painful. They do not extend beyond the boundary of the original wound, but may continue to thicken for up to six months. Hypertrophic scars usually improve over one or two years, but may cause distress due to their appearance or the intensity of the itching; they can also restrict movement if they are located close to a joint.[ citation needed ][ dubious ]

Some people have an inherited tendency to hypertrophic scarring, for example, those with Ehlers–Danlos syndrome.[ citation needed ]

Prevention

It is not possible to completely prevent hypertrophic scars, so those with a history of them should inform their doctor or surgeon if they need surgery. Pressure garment therapy is a commonly used approach used to try and prevent hypertrophic scarring, for example, after a burn, however, the effectiveness of this approach is not clear. [4]


Management

Early hypertrophic scars should be treated with applied pressure and massage in the first 1.5–3 months. [5] If necessary, silicone therapy should be applied later. Ongoing hypertrophy may be treated with corticosteroids injections. [5] Surgical revision may be considered after 1 year. [6]

Silicone gel sheeting

Silicone gel sheeting is sometimes used to treat hypertrophic scars. Silicone gel sheets may improve the appearance of scars slightly compared with applying onion extract, and may reduce pain compared with no treatment with silicone gel sheets or pressure garments. [7] It is uncertain whether silicone gel sheets are more effective than other treatment approaches. [7]

Laser therapy

Laser therapy is an approach that has been studied for treating hypertrophic scars. [8] There is not enough evidence to determine if laser therapy is more effective than other treatments or if laser therapy leads to more harm than benefits compared with no treatment or different kinds of treatment. [8]

Cryosurgery

Cryosurgery, using extreme cold to remove dead tissue, may speed up the healing process from a hypertrophic scar to a flatter, paler one. [9] [ needs update ]

See also

Related Research Articles

<span class="mw-page-title-main">Scar</span> Area of fibrous tissue that replaces normal skin after an injury

A scar is an area of fibrous tissue that replaces normal skin after an injury. Scars result from the biological process of wound repair in the skin, as well as in other organs, and tissues of the body. Thus, scarring is a natural part of the healing process. With the exception of very minor lesions, every wound results in some degree of scarring. An exception to this are animals with complete regeneration, which regrow tissue without scar formation.

<span class="mw-page-title-main">Keloid</span> Medical condition

Keloid, also known as keloid disorder and keloidal scar, is the formation of a type of scar which, depending on its maturity, is composed mainly of either type III (early) or type I (late) collagen. It is a result of an overgrowth of granulation tissue at the site of a healed skin injury which is then slowly replaced by collagen type I. Keloids are firm, rubbery lesions or shiny, fibrous nodules, and can vary from pink to the color of the person's skin or red to dark brown in color. A keloid scar is benign and not contagious, but sometimes accompanied by severe itchiness, pain, and changes in texture. In severe cases, it can affect movement of skin. In the United States keloid scars are seen 15 times more frequently in people of sub-Saharan African descent than in people of European descent. There is a higher tendency to develop a keloid among those with a family history of keloids and people between the ages of 10 and 30 years.

<span class="mw-page-title-main">Burn</span> Injury to flesh or skin, often caused by excessive heat

A burn is an injury to skin, or other tissues, caused by heat, cold, electricity, chemicals, friction, or ultraviolet radiation. Most burns are due to heat from hot liquids, solids, or fire. Burns occur mainly in the home or the workplace. In the home, risks are associated with domestic kitchens, including stoves, flames, and hot liquids. In the workplace, risks are associated with fire and chemical and electric burns. Alcoholism and smoking are other risk factors. Burns can also occur as a result of self-harm or violence between people (assault).

<span class="mw-page-title-main">Plantar wart</span> Medical condition

A plantar wart, or verruca vulgaris, is a wart occurring on the bottom of the foot or toes. Its color is typically similar to that of the skin. Small black dots often occur on the surface. One or more may occur in an area. They may result in pain with pressure such that walking is difficult.

<span class="mw-page-title-main">Wound healing</span> Series of events that restore integrity to damaged tissue after an injury

Wound healing refers to a living organism's replacement of destroyed or damaged tissue by newly produced tissue.

<span class="mw-page-title-main">Basal-cell carcinoma</span> Most common type of skin cancer

Basal-cell carcinoma (BCC), also known as basal-cell cancer, basalioma or rodent ulcer, is the most common type of skin cancer. It often appears as a painless raised area of skin, which may be shiny with small blood vessels running over it. It may also present as a raised area with ulceration. Basal-cell cancer grows slowly and can damage the tissue around it, but it is unlikely to spread to distant areas or result in death.

<span class="mw-page-title-main">Pressure ulcer</span> Skin ulcer (bed sore)

Pressure ulcers, also known as pressure sores, bed sores or pressure injuries, are localised damage to the skin and/or underlying tissue that usually occur over a bony prominence as a result of usually long-term pressure, or pressure in combination with shear or friction. The most common sites are the skin overlying the sacrum, coccyx, heels, and hips, though other sites can be affected, such as the elbows, knees, ankles, back of shoulders, or the back of the cranium.

<span class="mw-page-title-main">Triamcinolone acetonide</span> Medicinal chemical compound, steroid

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<span class="mw-page-title-main">Venous ulcer</span> Medical condition

Venous ulcer is defined by the American Venous Forum as "a full-thickness defect of skin, most frequently in the ankle region, that fails to heal spontaneously and is sustained by chronic venous disease, based on venous duplex ultrasound testing." Venous ulcers are wounds that are thought to occur due to improper functioning of venous valves, usually of the legs. They are an important cause of chronic wounds, affecting 1% of the population. Venous ulcers develop mostly along the medial distal leg, and can be painful with negative effects on quality of life.

A chronic wound is a wound that does not heal in an orderly set of stages and in a predictable amount of time the way most wounds do; wounds that do not heal within three months are often considered chronic. Chronic wounds seem to be detained in one or more of the phases of wound healing. For example, chronic wounds often remain in the inflammatory stage for too long. To overcome that stage and jump-start the healing process, a number of factors need to be addressed such as bacterial burden, necrotic tissue, and moisture balance of the whole wound. In acute wounds, there is a precise balance between production and degradation of molecules such as collagen; in chronic wounds this balance is lost and degradation plays too large a role.

A glaucoma valve is a medical shunt used in the treatment of glaucoma to reduce the eye's intraocular pressure (IOP).

<span class="mw-page-title-main">Negative-pressure wound therapy</span> Therapeutic technique

Negative-pressure wound therapy (NPWT), also known as a vacuum assisted closure (VAC), is a therapeutic technique using a suction pump, tubing, and a dressing to remove excess exudate and promote healing in acute or chronic wounds and second- and third-degree burns. The therapy involves the controlled application of sub-atmospheric pressure to the local wound environment using a sealed wound dressing connected to a vacuum pump. The use of this technique in wound management started in the 1990s and this technique is often recommended for treatment of a range of wounds including dehisced surgical wounds, closed surgical wounds, open abdominal wounds, open fractures, pressure injuries or pressure ulcers, diabetic foot ulcers, venous insufficiency ulcers, some types of skin grafts, burns, sternal wounds. It may also be considered after a clean surgery in a person who is obese.

A hydrocolloid dressing is an opaque or transparent dressing for wounds. A hydrocolloid dressing is biodegradable, breathable, and depending on the dressing selected, may adhere to the skin, so no separate taping is needed.

<span class="mw-page-title-main">Trabeculectomy</span> Surgical procedure used in the treatment of glaucoma

Trabeculectomy is a surgical procedure used in the treatment of glaucoma to relieve intraocular pressure by removing part of the eye's trabecular meshwork and adjacent structures. It is the most common glaucoma surgery performed and allows drainage of aqueous humor from within the eye to underneath the conjunctiva where it is absorbed. This outpatient procedure was most commonly performed under monitored anesthesia care using a retrobulbar block or peribulbar block or a combination of topical and subtenon anesthesia. Due to the higher risks associated with bulbar blocks, topical analgesia with mild sedation is becoming more common. Rarely general anesthesia will be used, in patients with an inability to cooperate during surgery.

<span class="mw-page-title-main">Contracture</span> Permanent shortening of a muscle or joint

In pathology, a contracture is a shortening of muscles, tendons, skin, and nearby soft tissues that causes the joints to shorten and become very stiff, preventing normal movement. A contracture is usually permanent, but less commonly can be temporary, or resolve over time but reoccur later in life.

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<span class="mw-page-title-main">Silicone gel sheeting</span> Scar treatment therapy

Silicone gel sheeting (SGS) has been an effective reduction and preventive scar therapy since 1980. It was first discovered to be used in treating scars by Perkins in Australia and New Zealand, and first discussed in the thesis of Karen Quinn, a British biomedical engineering student, in 1985.

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References

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  4. Harris, Isobel M.; Lee, Kwang Chear; Deeks, Jonathan J.; Moore, David J.; Moiemen, Naiem S.; Dretzke, Janine (2024-01-08). "Pressure-garment therapy for preventing hypertrophic scarring after burn injury". The Cochrane Database of Systematic Reviews. 1 (1): CD013530. doi:10.1002/14651858.CD013530.pub2. ISSN   1469-493X. PMC  10772976. PMID   38189494.
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  6. Cooper JS, Lee BT (December 2009). "Treatment of facial scarring: lasers, filler, and nonoperative techniques". Facial Plastic Surgery. 25 (5): 311–315. doi:10.1055/s-0029-1243079. PMID   20024872. S2CID   260136591.
  7. 1 2 Jiang Q, Chen J, Tian F, Liu Z, et al. (Cochrane Wounds Group) (September 2021). "Silicone gel sheeting for treating hypertrophic scars". The Cochrane Database of Systematic Reviews. 2021 (9): CD013357. doi:10.1002/14651858.CD013357.pub2. PMC   8464654 . PMID   34564840.
  8. 1 2 Leszczynski, Rafael; da Silva, Carolina AP; Pinto, Ana Carolina Pereira Nunes; Kuczynski, Uliana; da Silva, Edina MK (2022-09-26). Cochrane Wounds Group (ed.). "Laser therapy for treating hypertrophic and keloid scars". Cochrane Database of Systematic Reviews. 2022 (9): CD011642. doi:10.1002/14651858.CD011642.pub2. PMC   9511989 . PMID   36161591.
  9. Zouboulis CC, Blume U, Büttner P, Orfanos CE (September 1993). "Outcomes of cryosurgery in keloids and hypertrophic scars. A prospective consecutive trial of case series". Archives of Dermatology. 129 (9): 1146–1151. doi:10.1001/archderm.1993.01680300074011. PMID   8363398.