Abnormal scars, management options.

Scar management has always been important but never as much as today. People are now more aware of their scars, given the hype in the media about looking good. They are more likely than ever to seek treatment for scars from the cosmetic point of view. But scars can be problematic, they can itch and be uncomfortable and painful, they can be disfiguring and aesthetically unpleasant, and may cause sleep disturbance, anxiety, depression and disruption of daily activities. If they lay over the bone joint they can limit its function, so we should not always look at scars from the cosmetic point of view. This article aims to provide a physiological overview of wound repair, describing the options of therapy.

Epidermal Keratinocytes May Have an Important role in Hypertrophic Scarring Pathogenesis: an Immunohistochemical Study (Using P63 and Ki-67 Staining).

The role of epidermal keratinocytes in the early phase of normal unimpaired wound healing has been extensively studied. However, little is known of the cell biological process in the epidermis and the role of keratinocytes in hypertrophic scar formation. This study investigated the possible role of p63 in the early phase of hypertrophic scarring pathogenesis. Nine skin samples were taken from nine patients during plastic surgery operations, as follows: 1. six samples from patients who on account of thyroid disease or other reasons presented risk factors (RFs) for hypertrophic scarring; 2. one sample from a healthy young person (as control); and 3. one sample from the upper eyelid during blepharoplasty and one sample from an elderly patient during breast reduction. All the patients were women, and were followed up clinically for 12 months. Skin specimens were cultured and sectioned, and analysed by histology and immunohistochemistry. In normal skin, nuclear p63 was abundantly expressed by the basal cells, but expressed by very low levels of transient amplifying (TA) keratinocytes covering the surface. TA keratinocytes, immediately after their withdrawal from the stem cell compartment, reduced p63, even though they possessed a proliferative capacity. In some skin, samples with RFs possessed a high level of p63 expression - not only basal stem cells but also four to five rows of parabasal cells. Four of the six skin samples with RFs showed significant epidermal abnormalities through the expression of both p63 and ki-67. Staining for ki-67, a marker for cell proliferation, revealed more increase in the suprabasal than in the basal keratinocyte proliferation rate. These results suggest that the epidermal keratinocytes may have an important role in hypertrophic scarring pathogenesis, using paracrine or epithelial-mesenchymal signalling. At 3, 6, and 12 months post-operation this finding clinically appeared in four patients with RFs.

Management of keloid and hypertrophic scars.

Scar management for the prevention of excessive scar formation has always been important but never so important as it is today. Optimal management continues to be an enigma for surgeons, and the best modality of treatment has been debated for many years. However, most studies have unfortunately been either retrospective or case report descriptions. Advances in scar management have been hampered by confusing or ambiguous terminology. There is no consensus on what amount of post-traumatic skin scar formation is "normal" and what should be considered "hypertrophic". In the World Health Organization's ICD-9, there is no diagnostic code for hypertrophic scar - only keloid is listed. Yet the medical and scientific literature distinguishes them as different conditions. This confusion results in inappropriate management of scar formation, and occasionally contributes to decision making related to elective or cosmetic surgery. Our experience suggests that there is no single treatment for scars that is adequate and that clinical judgement is very important when considering treatment and balancing the potential benefits of the various treatments available. The goal of treating scars is to restore functionality, provide relief of symptoms, enhance cosmetics, and prevent recurrence. This article is based on our scientific and clinical experiences and focuses on over-the-counter options to manage keloid and hypertrophic scars.