As we studied the specifics of keloid scar formation, their structure and features, specialists invented new technologies to get rid of them.
Imiquimod 5% cream
Imiquimod 5% cream, a topical immunomodulator, is recommended for the treatment of genital warts, basal cell carcinomas and solar keratosis. Imiquimod enhances the action of interferon, an anti-inflammatory cytokine that enhances collagen breakdown. Plus, imiquimod alters the expression of genes responsible for apoptosis and is effective in reducing the rate of recurrence of keloids when used after surgery. However, more research is needed on this rather expensive way to reduce the frequency of relapses after keloid surgery for side effects (for example, pigmentation, prolonged inflammation, etc.).
Botulinum toxin A
Botulinum toxin A immobilizes local muscles, reduces skin tension caused by muscle traction, thus reducing microtrauma and subsequent inflammation. Reducing the force of tension during the course of wound healing and effectively regulating the balance between fibroblast growth and cell loss may become a new therapeutic approach for the aesthetic improvement of postoperative scars. Indeed, Gassner and colleagues injected botulinum toxin into muscles near the wound within 24 hours of wound closure, resulting in faster wound healing and less scarring than with placebo. The introduction of botulinum toxin 4-7 days before the operation gave the same encouraging results (the dose of the administered drug depends on the place where the operation is performed).
Existing treatments for hypertrophic and keloid scars
Most of the following approaches are generally used to treat both hypertrophic and keloid scars. However, clinical assessment of scar types is essential before starting any treatment, especially before any of the surgical or laser procedures listed below.
Intra-scar corticosteroid injections
Intrascar corticosteroids have been known as one of the most commonly used treatments for hypertrophic scars and keloids since the mid-1960s. The effect achieved by corticosteroids is explained by their ability to suppress inflammatory processes in the wound, as well as a decrease in the synthesis of collagen and glycosaminoglycan, a slowdown in the growth of fibroblasts, and an increased degeneration of collagen and fibroblast. In general, 3-4 injections of TAC ((triamcinolone acetate) 10-40 mg/ml) are sufficient, although in some cases injections continue up to 6 months or more. The results are mixed. By themselves, intrascarring corticosteroid injections are most effective on more recent keloids and may provide symptomatic relief. For longer lasting hypertrophic scars and keloids, their use together with cryotherapy is suitable, which is the most popular method today. Cryotherapy is recommended immediately prior to the administration of TAS injections, since the success rate of the procedure depends on the amount of TAS administered, which is facilitated by the edema formed as a result of cryotherapy. Side effects include atrophy, telangiectasia, and pain at the injection site. The latter can be avoided with local anesthesia.
Side effects include atrophy, telangiectasia, and pain at the injection site. The latter can be avoided with local anesthesia.Side effects include atrophy, telangiectasia, and pain at the injection site. The latter can be avoided with local anesthesia.
Cryotherapy
Cryotherapy is believed to cause vascular damage, which can lead to hypoxia and tissue death. The success rate of liquid nitrogen spray cryosurgery varies between 32% and 74% after two or more sessions, with greater success in treating hypertrophic scars than keloids. A break of 3-4 weeks between sessions is necessary to recover from surgery and detect side effects such as hyperpigmentation, blistering and post-operative pain. Needle cryoprobe insertion into diseased tissues is used to treat hypertrophic scars and keloids, while providing higher efficacy and shorter re-epithelialization periods than contact/spray methods.
Surgery
The treatment of keloids involves surgical removal, however, removal of keloids without accompanying procedures (corticosteroid injections, 5-FU or radiation) has a high recurrence rate (45% to 100%). Cutting out can also cause an even larger scar, and re-occurrence in this area of the injury can lead to an even larger keloid. The treatment of hypertrophic scars differs in that the time of the surgical operation is the main factor influencing its outcome. Hypertrophic scars that have existed for more than a year may improve on their own without any intervention.
Radiation therapy
Surface X-rays, electron beam and low or high dose close focus radiation therapy are used to reduce scarring, usually as an adjunct to surgical removal of keloids, with good results. The reason for this is believed to be the effect of radiation on keloids by slowing down neovascular primordia and fibroblast growth, which leads to a decrease in collagen production. Side effects: hypo- and hyperpigmentation, redness of the skin, telangiectasia and atrophy. Since radiation therapy carries the risk of oncogenesis, especially in the breast and thyroid gland, it is worth being very careful in its use.
Laser Therapy
The 585nm dye lasers are the most effective in our time, known as an excellent therapeutic option for the treatment of recent hypertrophic scars and keloids. The laser selectively targets small blood vessels, thereby leading to collagen modifications and the release of histamine and other factors that affect fibroblast activity. Side effects: Temporary hypo- and hyperpigmentation, blistering and sometimes recurrence of keloids.
There are many different lasers for the treatment of atrophic scars. Ablative lasers have resulted in swelling, burns, skin redness, pigmentation changes, and even scarring. This was the reason for the invention of a new laser device - fractional photothermolysis. Fractional photothermolysis sends out a laser beam divided into thousands of microscopic zones of influence, which fall on a specific part of the skin at a time. Both non-ablative and ablative fractional lasers are available today. Fractional lasers have been successfully used to safely treat acne scars while improving their texture, atrophy and overall appearance. While patchy, superficial and medium depth scars respond well to these lasers, deep and fine scars only improve at the margins. Deep scars may require additional procedures such as chemical peels, surgical dermabrasion or subcision. Although fractional lasers are considered safe, they can cause temporary redness or swelling of the skin, dryness, crusting, milia or acne, pigmentation changes, infection, or delayed healing. That is why patients should undergo a full consultation and accompanying medical treatment before the procedure.
infection or delayed healing. That is why patients should undergo a full consultation and accompanying medical treatment before the procedure.> infection or delayed healing. That is why patients should undergo a full consultation and accompanying medical treatment before the procedure. According to Prime magazine.Share:
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