When a patient's own tissues are damaged as a result of operations or the action of various traumatic factors, a scar is formed in the process of wound healing. Most often, over time, the scars become invisible, but sometimes the damaged tissue is replaced by a rough connective tissue. Such scars become a serious cosmetic defect, lead to social maladaptation and psycho-emotional discomfort of the patient, reduce the quality of his life.
Why does a keloid scar form on the skin
Typically, when the skin is damaged, the formation of the scar goes through several stages:
- epithelialization (on the 7-10th day after the injury, the edges of the wound are connected by a thin granulation tissue);
- formation of a young scar (10-30 days after injury, a scar of saturated pink color);
- formation of a “mature” scar (1-3 months after injury, the scar is light and dense);
- final transformation of the scar 4-12 months after injury.
If the wound becomes inflamed, the skin tightens, a secondary infection joins, local immunity decreases, then excessive formation of fibrous tissue may occur. Fibroblasts are activated by biologically active substances, the formation of collagen begins to prevail over its decay. As a result, powerful tissue fibrosis develops in the form of a keloid scar.
As a rule, keloids are the most severe form of scars, they form against the background of a decrease in immunity - general and tissue. Due to the extremely high activity of fibroblasts, a lot of immature collagen is synthesized, which is located in the wound area in the form of loose wide bundles and nodules, but elastin is absent. Thus, a keloid scar is formed with an uneven wrinkled surface and an elastic consistency.
Keloid scar is sometimes classified into true and false, although etiologically they do not differ. True occurs, as a rule, spontaneously - on the skin of the chest, upper third of the shoulder, and false - in any place where the skin has ever been injured. At the site of an abrasion or scratch, a keloid scar looks like an elevation of a bright pink color, although it may be pale. It is characterized by pulsating development, the scar tissue does not regress on its own, goes beyond the boundaries of the original wound and often recurs after excision. Keloid scars disturb the patient with subjectively unpleasant sensations - pain, itching, a feeling of tightness).
More often keloid scars develop at puberty, because in youth the skin is more traumatized than in elderly patients, besides, collagen synthesis in young people is more active, and the skin is more elastic and easily stretched. The average age of patients with keloid scars is 25 years, although keloid can form at any age.
Treatment of keloid scar - means and methods
Keloid scar treatment methods are divided into several groups:
• medical (corticosteroids, immunomodulators, drugs that affect collagen formation);
• physical and physiotherapy (use of occlusive dressings and compression therapy, excision, cryosurgery, laser therapy , electrophoresis, etc.);
• radiation therapy;
• cosmetic procedures aimed at external correction of the defect.
Medications
Corticosteroids, when administered intra-scar, reduce scarring by reducing the synthesis of collagen, glycosaminoglycans, inflammatory mediators, and fibroblast proliferation during wound healing. Topical corticosteroids are also widely used, which are applied daily directly to the formation. Complications of corticosteroid treatment include atrophy, telangiectasias, and pigmentation disorders.
Immunomodulators such as interferon, when injected into the suture line after excision of a keloid scar, can prophylactically prevent recurrences.
The classic treatment for keloid scars is hyaluronidase, which breaks down hyaluronic acid, which is the cementing substance of the connective tissue, and thus increases tissue and vascular permeability,
The enzyme preparation Fermencol performs an anti-scar action based on the reduction of excess extracellular matrix in the scar tissue.
Physical and physiotherapeutic methods
Silicone plates and silicone obturating dressings are used with varying success in the treatment of keloid scars.
A promising method is the combined effect of cryotherapy and corticosteroids. Liquid nitrogen is applied for 5-15 seconds, without bringing the skin to freezing, before the injection of the drug. This technique allows better distribution of the drug in the keloid tissue and minimizes its penetration into the surrounding tissues.
Excision yields recurrence in 45-100% of cases and should very rarely be used as a stand-alone therapy model. After excision, long-term anti-relapse therapy is necessary. When possible, pressure bandages are applied to the wound immediately after surgery. Reduced recurrence is achieved by combining excision with other methods such as interferon or corticosteroids.
After operations or skin injuries, it is necessary to take preventive measures that will reduce the risk of keloid formation: occlusive dressings, compression therapy, external applications or intradermal administration of corticosteroids, use of contractubex, immunotherapy.
Cosmetic procedures (peelings, mesotherapy, dermabrasion) do not have any therapeutic purpose when exposed to scars. It is better not to expose a keloid scar to irritating methods, since it is likely to provoke its further growth.
Thus, the therapy of keloid scars, with all the variety of treatment methods, requires a strictly individual approach, taking into account the main parameters of the scar: the size and duration of its existence.
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