Hypertrophic scar

It is important to obtain details regarding isotretinoin (Accutane, Roacutane) treatment and history of keloid or hypertrophic scar formation. Isotretinoin use necessitates a delay period of 6-12 months (depending on the skin thickness and oiliness) until chemical peel is performed. Active acne is not a contraindication for chemical peel. In these cases the peel is combined with systemic antibiotics for 2-3 weeks. It is always advisable to consider isotretinoin treatment after the peel to avoid acne flare and scar reappearance. 

Atrophic scars (icepick, rolling, boxcar) Hypertrophic scars (keloids)... 

Much less commonly, acne scarring may become thickened (hypertrophic or keloidal) rather than atrophic. Hypertrophic scars represent the presence of excessive fibrous tissue with marked vascularization. While hypertrophic scars tend to maintain the same size as the initial inflammatory lesion, keloids extend beyond the dimension of the original acne lesion. 

Before treating a patient with acne scars always obtain information regarding oral isotretinoin use in the last year, history of keloids or hypertrophic scars. This will avoid further scarring and side effects. 

Dermatology Topical steroids are useful in keloids, hypertrophic scars, other localised hypertrophic, infiltrated, inflammatory lesions of lichen planus, psoriatic plaques, granuloma annulare and lichen simplex chronicus discoid lupus erythematosus, necrobiosis lipoidica diabeticorum and alopecia areata. 

Cubison TC, Pape SA, Parkhouse N (2006) Evidence for the link between healing time and the development of hypertrophic scars (HTS) in paediatric bums due to scald injury. Burns... 

Tredget E, Nedelec B, Scott P, Ghahary A (1997) Hypertrophic scars, keloids, and contractures the cellular and molecular basis for therapy. Surg Clin North Am 77 701-730... 

Machesney M, Tidman N, Waseem A, Kirby L, Leigh 1 (1998) Activated keratinocytes in the epidermis of hypertrophic scars. Am J Pathol 152 1133-1141... 

Glycosaminoglycan synthesis, in culture, using fibroblasts from human skin,97,98 human normal and hypertrophic scar,99 and embryonic chick... 

M. R. Shetlar, C. L. Shetlar, C. W. Kischer, and J. Pindur, Implants of keloid and hypertrophic scars into the athymic nude mouse Changes in the glycosaminoglycans of the implants. Connect. Tissue Res., 26... 

H. G. Gaig, E. W. Lippay, and P. J. Neame, Proteoglycans in human bum hypertrophic scars from a patient with Ehlers-Danlos Syndrome. Carbohydr. Res., in press. 

Colwell AS, Phan TT, Kong W, Longaker MT, Lorenz PH. Hypertrophic scar fibroblasts have increased connective tissue growth factor expression after transforming growth factor-P stimulation. Plastic and Reconstructive Surgery 2005, 116, 1387-1390 discussion 1391-1392. 

The influence of mechanical forces on skin structure and remodeling has been studied extensively in an attempt to do the following to understand wound healing and reduce hypertrophic scarring, to increase the skin surface area using balloon expanders, to study the reorganization and... 

Ramos, M.L., Gragnani, A., Ferreira, L.M. (2008). Is there an ideal animal model to study hypertrophic scarring J. Bum Care Res. 29 363-8. 

A 50-year-old woman experienced a second-degree burn after applying a heated mustard compress to her chest to relieve pulmonary congestion associated with a recent episode of pneumonia (3). The injury resulted in permanent hyperpigmentation and hypertrophic scarring. 

As mast cells are normally found in skin, this recruitment of mast cells may simply reflect the restoration of normal tissue homeostasis, although they may play an intermediate role. Mast cells are also found in keloids and hypertrophic scars (Smith etal., 1987), both of which are considered to be abnormal typ>es of wound healing, and it has been su ested that this provides further evidence of their involvement in fibrotic responses. 

Smith, C.J., Smith, J.C. and Finn, M.C. (1987). The possible role of mast cells (allergy) in the production of keloid and hypertrophic scarring. J. Burn Care Rehabil. 8, 126-131. 

Dasu MR, Hawkins HK, Barrow RE, Xue H, Herndon DN. Gene expression profiles from hypertrophic scar fibroblasts before and after IL-6 stimulation. J Pathol 2004 202 476-85. 

Peels are not indicated for hypertrophic scars. Some fine facial scars (from a face-Kft, for example) improve vastly after local application of some phenol peels others are improved by a combination of abrasion and peeling. Body peels produce fewer results and more problems that facial peels. 

Dermal fibroplasia causes hypertrophic scarring, scar adhesions and keloids. Black or dark skins are more likely to develop this type of reaction. The shoulder girdle and the lower thorax are both high-risk areas, as is the jaw area on the face. This type of scarring does not occur when necrosis goes no further than the upper reticular dermis. 

Apart from a few exceptional cases (e.g. Ehlers-Danlos syndrome), the destruction of the papillary dermis does not cause hypertrophic scarring. 

Hypertrophic scars are extremely rare after a chemical peel. 

Publications often present this molecule as being the most likely to penetrate too deeply and cause scars. Books and journals about peels are full of photographs of complications and scars resulting from peels with TCA-SAS (Figures 37.42 and 37.43). According to Litton and Stone, deep TCA has a natural tendency to cause hypertrophic scars. In reality, it must be used in accordance with precise rules, and practitioners must be aware of and respect its symptomatology and TCA should never leave any scars. 

Scars usually - but not always - occiu in patients with dry and thin skins that have been treated with too much TCA-SAS with an inappropriate concentration or quality and when monitoring and post-peel care have been neglected or inadequate. They can also occiu in patients with thicker skin, with a history of hypertrophic scars. 

Chitosan derivatives have also been studied for possible utilization in wound dressings. For example, three kinds of chitosan derivative (oligochitosan, N,0-carboxymethyl-chitosan, and Al-carboxymethyl-chitosan) are used to form sheets and pastes, all of which exhibit appropriate cytocompatibility to the fibroblasts isolated from normal human dermis and hypertrophic scars [179]. 

Figure 5 Section of human postburn hypertrophic scar tissue, stained with Cuprolinic blue and uranyl acetate, showing thin collagen fibrils embedded in an abundant interfibrUlar matrix. Clumps of densely stained amorphous materials are probably biglycan and/or versi-can. Note the paucity of periodically attached decorin DS chains on the collagen fibrils (contrast with Fig. 4). The scale bar represents 100 nm.

Deep second- and third-degree burns often heal with hypertrophic scarring, a condition that presents some months after the original injury as red, raised, inelastic... 

There are abnormalities in the amounts and nature of the GAGs in hypertrophic scars, which has been recognized for more than 30 years. Chondroitin 4 sulfate, which is barely detectable in normal skin, can be readily demonstrated in hypertrophic scars (98), where it is especially elevated in the characteristic nodular structures (99). DS, in contrast, is absent from all but the more normal appearing parallel-fibered areas of the scars (100). 

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