Existing therapeutic methods for the treatment of scars

Scars and their types

Genetic predisposition, structural specificity, prolonged inflammation and untimely epithelialization increase the risk of excessive or atrophic scarring.

1. Excessive scarring
Excessive scarring was first described in the Smith Papyrus around 1700 BC. Many years later, Mancini (1962) and Peacock (1970) divided excessive scarring into two groups - hypertrophic and keloid scars. According to their definitions, both types of scars exceed the level of the skin, but hypertrophic scars do not extend beyond the original site of the lesion, while keloids protrude beyond the edges of the original wound. Both types of damage are violations of the fundamental processes of wound healing, while there is an obvious imbalance between its anabolic and catabolic phases. However, keloids are more persistent and serious fibrotic disorders than hypertrophic scars.

2. Atrophic scarring
Atrophic scarring is usually formed after prolonged inflammation of the deep layers of the dermis or subcutaneous tissue, and therefore often remains after acne on the cheeks, shoulders and back. Atrophic scars are usually depressed and form an indentation or hole in the skin. Depending on the type, there are thin (less than 2 mm), medium (1.5-4 mm) and wide (4-5 mm) scars.

Prevention of excessive scarring

It goes without saying that avoiding scarring is more effective than curing it. A particularly important task is the treatment of scars on the face due to their greater visibility. An obvious but not very effective solution is to prevent unnecessary wounds in patients prone to keloids and hypertrophic scars. Untimely epithelialization with a delay of 10-14 days greatly increases the incidence of hypertrophic scarring. In particular, wounds that have been subjected to stress due to movement, body position, or tissue loss are at greater risk of hypertrophy and scarring. Therefore, in the case of tissue damage, the importance of rapid wound healing with the least stress cannot be overestimated. It is also very important to properly clean infected wounds, to obtain good hemostasis,

Available treatments for scars and scars

Pressotherapy

Since 1970, both hypertrophic scars and keloids have been treated with pressotherapy. Nowadays, it is used to prevent the formation of burn scars. The mechanism of action of pressure therapy is still poorly understood. There are theories of decreased collagen synthesis due to limited blood, oxygen and nutrient supply to scar tissue, and increased apoptosis (cell loss).

Silicone gel

Topical silicone gel has been used since the 1980s, mainly for the treatment of hypertrophic scars. Clogging and hydration is thought to be the most likely cause of silicone gel's therapeutic effect, rather than silicone's inherent anti-scarring properties. Nowadays, silicone gels are recommended for patients who are prone to excessive scarring or have specific anatomical features. It is recommended to use it twice a day, starting from the third week after surgery or injury. However, the effect of silicone gel on mature hypertrophic scars and keloids remains controversial.

Flavonoids

Flavonoids (quercetin and kaempferol) are part of well-known topical anti-scar creams. Quercetin, a food bioflavonoid, slows fibroblast growth, collagen production, and shrinkage of keloid and hypertrophic fibroblasts. Creams containing onion extract and allantoin (and heparin) are effective in removing scarring and preventing scarring in patients undergoing laser tattoo removal.