Correlation between dermal thickness and scar formation in female patients after thyroidectomy

BACKGROUND: Minimizing scarring has long been a challenge in plastic surgery. Factors affecting scar formation are well known, but the effect of some patient-specific factors such as dermal thickness remains unverified. Management of factors predictive of scarring can improve postoperative patient satisfaction and scar treatment. METHODS: For 3 years, we used ultrasonography to measure dermal thickness in female patients who had undergone thyroidectomy for cancer at our hospital. We confirmed the influence of dermal thickness on hypertrophic scar formation and the Patient and Observer Scar Assessment Scale scar score 6 months after surgery. RESULTS: There was a positive correlation between dermal thickness and scar score (p < 0.05), and dermal thickness appears to be a cause of hypertrophic scar formation (p < 0.05). CONCLUSION: Thick dermis was found to cause poor scar formation and hypertrophic scarring. Prediction of factors that can influence scar formation can be used to educate patients before surgery and can help in scar management and improvement in patient satisfaction.

Pilot Study of the Efficacy of 578 nm Copper Bromide Laser Combined with Intralesional Corticosteroid Injection for Treatment of Keloids and Hypertrophic Scars

BACKGROUND: Treatments including intralesional corticosteroid injection, pressure therapy, cryotherapy, and various laser therapies have had limited success for keloids and hypertrophic scars. OBJECTIVE: This trial evaluated the efficacy of a combination of 578 nm copper bromide laser and the more traditional intralesional corticosteroid injection for the treatment of keloids and hypertrophic scars with respect to scar color. METHODS: Keloids or hypertrophic scars of 12 Korean patients were treated five times by the combined treatment at 4-week intervals. Clinical improvement was assessed by the physicians' global assessment (PGA) comparing pre- and post-treatment photographs, as well as 4 weeks after the last treatment. Erythema intensity was quantified using a mexameter. RESULTS: Most scars showed significant clinical improvement in PGA and decreased erythema intensity after 5 treatments. All patients showed improvements in symptoms like pruritus. CONCLUSION: The combined treatment is effective for keloids and hypertrophic scars, especially when the telangiectatic portion of the scars is prominent. The adjunctive use of 578 nm copper bromide laser decreased the telangiectatic side effects of an intralesional corticosteroid injection by reducing the vascular components of scars.

Notch Intracellular Domain Expression in Various Skin Fibroproliferative Diseases

BACKGROUND: The effects of the Notch signaling pathway in fibroproliferative skin diseases have not been fully elucidated. OBJECTIVE: The aim of this study was to investigate the expression of activated Notch signaling molecules in various skin fibroproliferative diseases. METHODS: Immunohistochemical analysis of Notch intracellular domain (NICD) expression in keloid, hypertrophic scar, morphea, dermatofibroma, and normal control skin specimens was performed, and the clinical characteristics of patients with various skin fibroproliferative diseases were analyzed. RESULTS: NICD was highly expressed in fibroblasts of keloids and moderately to highly expressed in hypertrophic scars and dermatofibromas, whereas low or no expression was detected in the fibroblasts of normal skin specimens and morpheas. NICD was constitutively expressed in keratinocytes, endothelial cells, and immune cells in normal skin specimens. CONCLUSION: NICD was significantly expressed in human fibroproliferative skin disorders, especially keloids, suggesting that an activated Notch signaling pathway is involved in the pathogenesis of skin fibrosis.

Keloids and Hypertrophic Scars: Characteristic Vascular Structures Visualized by Using Dermoscopy

BACKGROUND: Keloids and hypertrophic scars represent excessive scarring. They require different therapeutic approaches, which can be hampered because of an apparent lack of morphologic difference between the two diseases. OBJECTIVE: This study investigated the clinical and dermoscopic features of keloids and hypertrophic scars in order to help dermatologists distinguish these lesions better. METHODS: A total of 41 keloids and hypertrophic scars in 41 patients were examined clinically and by performing dermoscopy with a digital imaging system. Lesions were evaluated for vascular structures. RESULTS: Dermoscopy revealed vascular structures in most keloid lesions (90%) but in only 27% of hypertrophic scar lesions. The most common dermoscopic vascular structures in keloids were arborizing (52%), followed by linear irregular (33%) and commashaped (15%); these features were present but less evident in hypertrophic scars (9% for all types). The distribution frequency of the vascular structures differed significantly between diseases (p<0.001). CONCLUSION: A strong association of vascular structures with keloids was observed on dermoscopic examination. The results suggest dermoscopic examination of vascular structures is a clinically useful diagnostic tool for differentiating between keloids and hypertrophic scars.

Management of Hypertrophic Scar after Burn Wound Using Microneedling Procedure (Dermastamp(R))

PURPOSE: Hypertrophic scars after burn wound management remain a difficult problem for many burn surgeons despite of new treatment option is developed. After burn wound healed with scarring or pigmentation, the patient suffer in daily life with the cosmetic results and scar symptoms. Dermastamp(R) is new treatment modality on burn scar management in our burn center. Dermastamp(R) is stamp shaped and it contains 0.8 mm or 2.1 mm long multiple stainless steel needles. Dermastamp(R) was simply pressed down on the scar 3~4 times and makes 200~300 holes on 1 cm2 scar area. Dermastamping breaks the dense collagen fiber and fibroblast in the scar tissue and rearranges collagen fiber and fibroblast in the scar tissue. METHODS: The 51 patients were selected. The group consisted of 26 male and 25 female patients. 21 patients were adult and 30 patients were children. Stamping area of the 18 patients was below 25 cm2, 6 patients were in 25 to 100 cm2, and 27 patients were above 100 cm2, stamping area. They received Dermastamp(R) treatment 3 to 23 times in every 1 or 2 weeks interval at least 2 months. The 33 patients received Dermastamp(R) under local anesthesia and other 18 patients received under volatile induction anesthesia. Hypertrophic scar is evaluated with Vancouber Scar Scale (VSS) score by two surgeons and scar height using Sonography (17 patients). And pathologic study (17 patients) was done on volunteer cases. RESULTS: Clinically improvements with VSS score (1 to 6 points down) were noted in all patients group. Scar height was lowered (0.8 to 3.6 mm) on sonography and pathologic report revealed collagen fiber rearrangement and scar height thinning in examined group. CONCLUSION: Microneedling procedure is a effective modality of management on hypertrophic scarring and pigmentation. Microneedling induces collagen fiber rearrangement on scar tissue and thinner the scar height in pathology and improves clinical evaluating with VSS score and patients symptoms.