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KELOIDS and HYPERTROPHIC SCARS Treatment and Correction

KELOIDS and HYPERTROPHIC SCARS Treatment and Correction

Surgical excision of keloids. Surgical excision of keloid as an independent method results in 70-90%  recurrence (Fig.1.). Therefore surgery in the treatment of keloids is not applied without combinations with other methods. Surgical excision produces an acceptable result in treating hypertrophic scars.

Fig.1. Chest keloid recurrence after surgical excision

Radiation therapy for keloids (X-ray therapy). Efficacy is quite disputable. This method results to high percent recurrences of keloid when applied as monotherapy. Carcinogenic effect has not been fully proven, but radiation therapy for keloids is seldom applied in view of inefficacy, usually in combination with other methods. Radiation therapy is not applied in children with keloids or hypertrophic scars as well in adults as pilar regions of the head, face and breast.

Compression therapy for keloidsThe 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 sheetings. 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).

Fig.2. Post burn keloid before and after treatment with silicone sheeting

Cream for keloid scar. 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. But there is a scars treatment cream that stands out among others. It called Elicina and consists of 80% of the snail mucus extract. This cream accelerates the regeneration process and can change the structure of scar tissue. Therefore Elicina snail cream can be apply for all types of scars: atrophic and hypertrophic after injuries and ugly scars after surgery. 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.

Laser treatment for keloids. 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.3. Post-injury scars before and after treatment (cryodestruction, non-ablative laser treatment)

Intralesional corticosteroids for keloids. Corticosteroids are administered locally (to prevent keloid formation) by intralesional injections of triamcinolone acetonide injection (Kenalog crystalline suspension) to treat active keloids and old hypertrophic scars. Intralesional 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.4. Hypertrophic C-Section scar before and after steroid injections

Cryosurgery for keloids and hypertrophic scars. 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 (Dr. Igor Safonov: Cryotherapy of ear keloid).

Fig.5. Earlap keloid before and after cryotherapy

Microneedling (dermaroller) or Collagen Induction Therapy for keloid and hypertrophic scars. Collagen fibers of keloids are located differently compared to regular scars. They are located relatively in parallel to the skin surface in regular scars (Fig.6), while chaotically and node-like, resembling a fingerprint in keloids (Fig.7).

                               Fig.6.  Normotrophic scar             Fig.7. Keloid

 

 Fig.8.  Microneedling for pathological scar. Scheme

To improve the pathological scar appearance and reduce its height, the chaotically located collagen fibres are to be destroyed, creating new fibres that would be maximally parallel to the skin surface. This task can be performed by means of microneedle therapy (Fig.8).

Miconeedles penetrate into dermis and destroy callous collagen fibres. The more punctures are produced, the more collagen fibres will be destroyed. New collagen fibres are formed at the point of punctures, being parallel to the skin surface. This leads to reduction of scar size and improvement of its elasticity

 Fig.9. Pathological scar right thigh. Treatment with Dermaroller before and after