METHODS FOR HYPERTROPHIC SCAR AND KELOID TREATMENT
- Surgical excision
- Radial therapy
- Silicone Sheets
- Liniment therapy
- Laser treatment
70-90% of patients with keloid suffer a relapse after surgical excision. Unlike keloid, hypertrophic cicatrix is successfully treated by this method.
Photo: Keloid recurrence within 5 days (left) and 4 months (right) after surgical excision.
Radial therapy (X-ray therapy).
The efficiency of this method is still open to dispute. 50-100% of patients suffer a relapse. Because of carcinogenic effect this method is not widely used. It is not applied on head, face and bust zones.
Permanent compression of 20-40mm of mercury column is applied 12-24 hours a day within 3-12 months. On one hand, such method prevents cicatrix tissue vegetation by retaining it automatically in restrictive space. On the other hand, it blockades scar nutrition by squeezing its vessels and restrains the cicatrix from vegetation and partial regression.
Silicone sheets therapy.
This method works by cicatrix hydration alongside with squeezing capillaries, reducing the delivery of inflammation mediators, reducing synthesis of collagen due to oxygen starvation.
Photo: Hypertrophic scar before and after silicone therapy.
Liniments are used according to their functional purpose. They are divided into the following groups: antibacterial, for normalization of blood circulation, increasing or reducing collagen synthesis, diluting injury medium, strengthening immunity in cicatrix region etc. The following liniments are to be applied: Cordran, Dermatix, Medgel, Kelophibrasa, Scarguard, Contractubex, Aldara etc. As some drugs can make cicatrix condition worse advice is necessary in this case or another. As a rule, liniment therapy is used along with the other methods or after them.
70-90% of patients with hypertrophic scar and/or keloid suffer a relapse after laser therapy. The efficiency of vascular (non-ablative) laser therapy estimate to 75-95% for hypertrophic scar, 60-70% for keloid. The chief task of this method is to put the vessels inside the cicatrix together.
Photo: Postoperational active keloid before and after 2 vascular laser procedures.
Steroids are used locally (to prevent formation of keloid) alongside with intercicatrix injections with crystalline suspension for keloid and old hypertrophic cicatrix treatment. These injections reduce collagen synthesis due to fibroblasts (collagen synthesizing cells) dividing oppression. Besides, steroids are anti-inflammatory.
Photo: Bust keloid before and after injections of corticosteroids.
Mechanism of tissue damage by cryogen is conditioned by affection of micro rotational channel and cytoplasm and cells destruction which is induced by formation of crystals of ice inside cells and vessels. While thawing concentration of electrolytes in cells is increasing and after another tissue chilling is followed by greater crystallization that accelerates their destruction. As mono method cryotherapy results in complete disappearance of keloid and hypertrophic scar without relapse in 51% and 74% of cases accordingly. Along with the other methods the result is 76-90% after 30-month observation.
Photo: Keloid before and after cryotherapy.