Part I: Keloid and Hypertrophic scars before and after treatment
For the treatment, removal and correction of hypertrophic scars and keloids (pathological scars) the following methods are used:
Keliods: surgical excision as an independent method results in 70-90% relapse. Therefore it is not applied in the treatment of keloids. Excision produces an acceptable result in treating hypertrophic scars.
Fig.1. Dynamics keloid recurrence after surgical excision. One week after surgery (left), ten weeks (medium) and 4 months (right)
Radial therapy (X-ray therapy)
Efficacy is quite disputable. This method results in 50-100% relapse when applied as monotherapy. Carcinogenic effect has not been fully proven, but this method is seldom applied in view of inefficacy, usually in combination with other methods. Radiation therapy is not applied in children as well as pilar regions of the head, face and breast in adults.
The continuous compression of 20-40 mm of mercury is applied for 12-24 hours per day in course of 3-12 months. On the one hand, it resists the scar tissue growth, holding it mechanically within limited space, on the other, by putting pressure on the scar vessels blocks its nutrition, which results in termination of its growth or partial regression.
Silicone scar sheets
Mechanism of action of silicone sheeting has not been fully investigated. It is assumed that silicone sheetings moisten (hydrate) the scar, compress capillaries, block the delivery of inflammation mediators, reduce collagen synthesis due to oxygen starvation.
Fig.2. Post-burn keloids. Treatment with silicone scar sheets
Fig.3. Hypertrophic scar before and after treatment with silicone scar sheets
Creams and gels for scars
Different ointments are applied depending on functional purpose: antibacterial, normalizing blood circulation, reducing or stimulating collagen synthesis, diluting wound environment, boosting immunity of the wound area, etc. To this end Kelo-cote, Dermatix, Strataderm, MedGel, Kelofibrase, Scarguard, Contractubex, Aldara, among others are applied. Each individual case surely requires a consultation with the attending physician to select the necessary cream or ointment, because some products are capable of not only improving, but as well as of worsening the scar condition. Topical therapy is usually applied either in parallel to, or after mechanical treatment methods.
Treatment and removal of keloids by laser
Ablative lasers produce a high relapse rate (90-100%) when applied in hypertrophic scars and keloids treatment. Clinical efficacy with vascular (non-ablative) laser applied in hypertrophic scars treatment constitutes 75-95%, keloids – 60-70%. Primary task of laser treatment is to fuse the vessels providing nutrition to the scar.
Fig. 4. Postoperative active keloid on the right arm before and after 2 vascular laser procedures
Fig.5. Post-traumatic scars before and after vascular laser treatment and cryoablation
Corticosteroids are administered locally (to prevent keloid formation) by intralesional injections of crystalline suspension to treat active keloids and old hypertrophic scars. Corticosteroid injections reduce collagen synthesis not only by inhibiting fibroblast mitosis (cells synthesizing collagen), but along with collagenase (collagen-resolving enzyme) concentration increase. Besides, steroids possess a strong anti-inflammatory action.
Fig.6. Hypertrophic scar of the pubic area before and after corticosteroid injections
Fig.7. Removal of chest keloids with corticosteroid injections
Cryotherapy / cryoablation
Mechanism of tissue damage by cryogen is conditioned by affection of microvasculature, destruction of cytoplasm and cell organelles caused by intracellular and intravascular formation of ice crystals. Concentration of electrolytes in cells is increased when thawing, accompanied by greater crystallization after repeated freezing which accelerates their destruction. When applied as a monomethod, cryotherapy results in complete elimination of keloids and hypertrophic scars with 51 and 74% relapse-free of cases, correspondingly. When combined with other methods – 76-90% after 30 month follow-up period.