Brief Note on Hypertrophic Scars and Keloids

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.

Leave a Reply

This site uses Akismet to reduce spam. Learn how your comment data is processed.