Scar formation is normal during the wound healing process but not many people know that scar removal is one of the most difficult cosmetic procedures. Hypertrophic scarring is a skin condition in which an excessive amount of collagen is deposited that results in the formation of thick and raised scars on the skin. There is limited information available on scar formation, which is why the researchers decided to study hypertrophic scarring and its prevention.
The complete study findings are published in Burns & Trauma by OUP volume 8 in the first issue of this year.
Three phases are involved in the process of skin wound healing:
The hypertrophic scars form due to the occurrence of any abnormality in these three phases. The frequency of scar formation after burn injuries ranges from 30% to 91% and after surgery from 40% to 94%. The incidence rate in poor countries is greater which shows that the rate of burn injuries is high in these countries.
The risk factors responsible for the formation of hypertrophic scars are age, gender, wound size and depth, genetic predisposition, mechanical tension on the wound and anatomical site. These scars disturb the normal functioning of the body and cause many psychological, physical and aesthetic problems in the patients.
Time for the complete healing of the wound is the major factor that predicts the development of hypertrophic scars. If the healing of wounds occurs within 14 to 21 days, then the development of scars is only seen in one-third of the wounds. If healing occurs after 21 days, then the rate of scar development increases to 78% at different sites.
Out of all established therapies for severe skin scarring, Pressure therapy is the most accepted treatment for hypertrophic scarring. It is a non-invasive treatment used for many years. This method is a widely used method across the world as its effectiveness has been established. The treatment seems to be the most effective if it is given in between the two months after the injury.
Steroids, silicone, and laser therapy are the other interventions used for treating hypertrophic scars. The efficiency of silicone therapy is not well understood. Researchers reported that the topical administration of steroids is beneficial and effective for treating burn injuries. Laser therapy is used as an early intervention because it prevents scar formation. Moreover, it reduces the speed of scar development showing the therapeutic response.
In addition to primary treatment and therapies, radiation and resection can be used sometimes. These surgical approaches vary according to the type of scar. Scientists argue that long term results will be needed for deciding to perform the radiation or resection as a medical intervention.
Botulinum toxin A (btxA) is a typical part of cosmetic procedures and is typically used to treat pains. It is also widely used to heal these hypertrophic scars. The drug showed some beneficial and therapeutic effects for scar prevention, but researchers are not confirmed about its optimal concentration that is being used for treatment. The concentration may depend on the severity and size of the wound. More research is needed to know about the more promising features of the drug that will be used for treating the scars in the future.
For the potential treatment of hypertrophic scars in the future, the therapies used might include fat grafting, stem cell therapy and angiogenesis therapy (it prohibits the formation of new blood vessels). However, it requires many experimental investigations on these therapies to understand and reduce the abnormalities during tissue formation.