Scar_treatments

Hypertrophic Scarring and Keloids

Hypertrophic scarring and keloids occur due to an abnormal response to trauma or injury. After a wound or an incision from surgery has occurred to the epidermis, both skin cells and connective tissue cells called fibroblasts begin multiplying to repair the damage. All scars are made up of “connective tissue” and fibroblasts to help close the wound. The hypertrophic scar is one that is widened, but yet does not extend beyond the original boundaries of the wound or incision. Hypertrophic scars tend to reach a certain size in which they eventually stabilize or revert and eventually they might fade with time. Hypertrophic scars normally do not get as big as keloids either, and can be present in all racial groups. Whereas keloids tend to target racial groups which have a lot of melatonin in their skin, such as African American, Asian or Pacific Islander. Treatments for hypertrophic scars include Silicone Sheeting and creams that seem to help with the appearance of the scar, and it usually takes 3 months or more to see an improvement.

Keloids on the other hand are not as common as hypertrophic scars and only affect 10% of the people are considered benign tumors. These keloids appearance is raised red growths above the surface of the epidermis and form large mounds of scar tissue. Keloids are nothing more than abnormal scar tissue that grows beyond the boundaries of the original site of the skin injury – the fibroblasts continue to multiply even after the wound is filled in. The upper chest area, shoulders, and upper back are all areas where keloids tend to form. Some of the symptoms associated with keloids include pigmentation of the skin, pain, itchiness and redness. Keloids are raised dome shaped shiny scars ranging in color from pink, red or purple. Treatments include cryosurgery (freezing), excision, laser, x-rays, and steroid injections.

Difference Between Hypertrophic and Keloid Scarring

Hypertrophic Scars	Keloid scars
Develop soon after injury	May have delayed development after injury
Subside with time	Rarely subside with time
Limited boundary	Overgrows wound boundary
Size proportional to injury	Minor injury may produce a large scar
Occurs across areas of motion/tension	Occurs in any areas
Improve with surgery	Often worsened by surgery

Keloid Scarring

Keloid Scarring

Treatments:

The best and first line treatment of a keloid is to inject long-acting cortisone (steroid – such as Kenalog or Celestone Soluspan) once a month. After several injections with cortisone, the keloid usually becomes less noticeable and flattens out within three to six months time.

Excision or scar revision surgery: This can be risky with a patient that is prone to keloids. If surgery with a scar revision is considered, some surgeons like to inject steroids or apply a pressure dressing to the wound site after cutting away the affected keloid. Radiation is also considered after the excision of the affected area, so the keloid will not grow back.

Cryosurgery: Liquid Nitrogen is used to destroy tissue of both benign and malignant lesions by the freezing and re-thawing process. Applying liquid nitrogen does flatten out the keloid scar and is effective, but the side effect of this treatment is hyper-pigmentation after the fact.

Interferon: is being used with some success with keloid scars. Interferon has been evaluated for efficacy in managing many diseases that involve the immune system. Injections of interferon into the actual keloid have shown promise in reducing the size of keloids, though it's not yet certain whether that effect will be a permanent result.

Pulse-dye Lasers: are also another method of reducing the sign of the keloid scar. These lasers tend to soften up the excessive scar tissue with making the scar flattened and less red. This treatment is very safe and not very painful; however it might take several treatments to see an improvement.

Silicone Sheeting (ReJuveness): has helped many patients with their keloid scarring, however this method of treatment takes several months of wearing a sheet of silicone gel. Some doctors prefer “compression bandages” which have helped some see a positive end result. Both methods require a lot of time and patience on the part of the patient. Silicone Sheeting has been around since the early 1980’s, and some patients have seen a remarkable difference in the appearance of keloid or hypertrophic scarring. Silicone sheeting is soft and pliable and will mold to any part of the body. ReJuveness Silicone Sheets can also last up to 6 months or has been proven effective on old raised red scars (up to 20 years old) as well as newly formed scars.

Silicone Sheeting

ReJuveness Silicone Sheeting: ReJuveness silicone sheets are made of USP medical grade six-silicone which can be cut to any size and shape. ReJuveness is soft and pliable and easily conforms to any body part. ReJuveness is proven effective at healing and preventing hypertrophic and keloid scars resulting from burns, plastic surgery procedures, surgeries, acne, cuts and abrasion.

Silon Silicone Sheeting: Oleeva Clear® Transparent Silicone Sheeting is a silicone sheeting offering transparency and remarkable stretch and conforming characteristics. Oleeva Fabric® Silicone Sheeting with Fabric Backing is a silicone sheeting with a fabric backing. The silky fabric backing makes it easy to wear under clothing, it also reduces shear force and edge roll-up when used under pressure garments. Oleeva Scar Shapes® Precut Shapes for Scar Management Following Surgery are made from Oleeva Fabric and shaped specifically to treat scarring from breast, abdominal and other surgical procedures. The designs of these products ensure proper placement and coverage.

Syprex Silicone Sheeting: Syprex scar treatment sheet is the most cost effective scar care product available when compared to other scar management methods. Made in the USA of pure medical grade silicone, 0.6mm thick (the thickness of a credit card), soft and flexible.

PMT Corp Silicone Sheeting: Soft, reinforced silicone gel shapes that have been developed to soften and lighten hypertrophic and keloid scars. The GelShapes are specifically designed for the treatment of scars resulting from breast reduction, abdominoplasty, TRAM flap and C-section procedures.

ScarEase Silicone Sheeting & Gel: ScarEase Sheets and ScarEase Gel are indicated for use in the management of hypertrophic and keloid scars. When used following surgical procedures, ScarEase may prevent hypertrophic and keloid scarring. ScarEase Sheets may work better in certain cases, but have use limitations. vSince ScarEase Sheeting is self adhering, it supplies gentle mechanical pressure on the skin surface. This is a benefit!

Neosporin Scar Solution: The thin, flexible layer of silicone in NEOSPORIN^® SCAR SOLUTION^® Silicone Scar Sheets covers and protects your scar like normal, healthy skin, significantly improving the appearance of scars.

Curad Scar Therapy : Clinically proven. Reduces raised, colored and keloid scars. Virtually invisible. Curad Scar Therapy Clear Pads are virtually invisible. They are perfect for any skin color as they blend with your natural skin tone.

Scar Gels and Creams

Scar Guard: Scar Guard offers four different treatments for the management of scars (old and new) – and is the most powerful and effective treatment developed. It is a clear liquid that forms a fine flexible film within a few seconds after painting it onto the scar. This film helps to protect the scar from irritation while delivering silicone cortisone and vitamin E throughout the day.

Kelocote: Kelo-cote^® is a patented topical silicone gel for the management and prevention of abnormal scars in the form of hypertrophic scars and keloids.

ScarFade: In 1998, Scarfade was introduced in the form of a topical silicone gel which is applied like a cream. It forms a micro-thin layer of silicone on the scar.

ScarEase: ScarEase Gel can be used to manage both old and new scars resulting from burns, surgical procedures and traumatic events. Most people like ScarEase Gel better than ScarEase Sheets because it is "easier to use."

Syprex Scar Cream: Syprex scar cream works to help flatten, even, and fade dark or discolored skin while providing healing qualities for scars - old or new, caused by acne, surgery or trauma to the skin and stretch marks. Results are permanent and may be seen in as little as 4-6 weeks with full results in 3-9 months.

ReJuveness Scar Cream: ReJuveness cream is a combination of recent advancements in lipid and transdermal technology. Post surgical patients and clinicians are reporting accelerated healing and in many a near scar-less appearance at the lesion site.

Other Topical Treatments:

Mederma : Mederma comes as a silicone gel and also a new cream, which has a SPF-30 in it to protect the scar from the sun. The main ingredient is Cepalin, which is a proprietary botanical extract which comes from onions. According to a small Pilot study evaluating topical onion extract as treatment for post-surgical scars – published by PubMed – August 25, 1999, authors B.A. Jackson and A.J. Shelton, found that this main ingredient in Mederma concluded the following: “Topical onion gel extract was ineffective in improving scar erythema and pruritus in our patients.” Most patients who have tried Mederma have suffered some sort of allergic reaction to it because of the onion extract, making the scars more angry looking than before treatment.”

Vitamin E: helps by working on the collagen fibers and makes a scar softer and more pliable. However, in a double blind study, found that Vitamin E was indeed ineffective in reducing the symptoms of a hypertrophic scar or keloid.

Bio-Oil: Bio-Oil is a specialist skin care product that is recommended for scars, stretch marks, uneven skin tone, aging, and dehydrated skin. It is formulated for use on both the face and body. product has improved the appearance of regular scars tremendously; however has very little effect on hypertrophic scars or keloids.

Retin-A: Retinoic Acid or Tretinoin is derived from Vitamin A. Retinol, which is a less potent form of Retin-A also has some very strong medical studies backing the effectiveness of this type of topical cream to help with scar formation. This is a prescription formulation of Vitamin A, and is marketed under the brand names of Retin-A Micro, Renova, Avage, and Tazorac. There is also the less potent over the counter products called Retinol. After your surgical wound has closed up completely, applying Retin-A to the scar fades out the redness it might have and helps with exfoliating the area. At first, Retin-A can actually make the area look worse with redness, flakiness and peeling, for up to eight weeks. But by 24 weeks, patients will see dramatic marked improvements. Retin-A along with the application of steri-strips helps with keeping tension off of the incision site, so a thin scar will form.