Hypertrophic Scars

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Hypertrophic scars are limited to the wound edges and tend to regress over the first year. The treatment of both keloid and hypertrophic scars is similar, except hypertrophic scars have better outcomes. Genetic expression of various cytokines and inflammatory pathways may affect the myofibrocytes in granulation tissue to continue producing scar; the exact causes are being investigated. Pressure dressings and colloidal silicone placed on scars after suture removal or on burn scars may reduce the incidence of both keloids and hypertrophic scars, whereas onion-skin extract (Mederma) alone is not effective (Karagoz et al., 2009).

Hypertrophic scar fibroblasts exhibit resistance to a specific form of apoptosis, or cell death, elicited by contraction of collagen matrix gels. This phenomenon depends on excess activity of cell surface tissue transglutaminases (Linge et al., 2005).

KEY TREATMENT

Cryotherapy is useful for smaller lesions such as acne and keloids (SOR: B).

Pressure dressings in burns help prevent hypertrophic scars (SOR: B). Intralesional corticosteroid injections are first-line primary care therapies for keloids; surgery is a second-line option (SOR: B).

Juckett and Hartman-Adams, 2009.

Figure 28-7 Skin keloid.

(From HabifTP. Clinical Dermatology, 5th ed. Elsevier, Philadelphia, 2010.)

Figure 28-7 Skin keloid.

(From HabifTP. Clinical Dermatology, 5th ed. Elsevier, Philadelphia, 2010.)

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