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Wound Healing, Ulcers, and Scars
Published in Ayşe Serap Karadağ, Lawrence Charles Parish, Jordan V. Wang, Roxburgh's Common Skin Diseases, 2022
Saloni Shah, Christian Albornoz, Sherry Yang
Clinical findings: Keloids will specifically grow beyond the border of the initial wound and will typically present with similar pigmentation of the patient’s skin (Figure 17.10). In contrast, hypertrophic scars are always confined to the region of the presenting wound and will typically present as erythematous lesions with variable pigmentation.
Chronic erythematous rash and lesions on trunk and limbs
Published in Richard Ashton, Barbara Leppard, Differential Diagnosis in Dermatology, 2021
Richard Ashton, Barbara Leppard
Hypertrophic scars are an overgrowth of scar tissue confined to the site of injury, while keloid scars grow out beyond the original site of injury. The commonest sites for keloid scarring are on the front of chest, around the shoulders, on the ear lobes (see p. 120) and at the back of the scalp (see p. 68).
Scar Care after Surgical Treatment in Oncology Patients
Published in Paloma Tejero, Hernán Pinto, Aesthetic Treatments for the Oncology Patient, 2020
Hypertrophic scar formation is a complex problem, causing both aesthetic and physical difficulties. Hypertrophic scars are the result of an abnormal wound healing process where an excessive amount of collagen is deposited within the wound area, causing the scar to become raised above the skin surface. Both normal and pathological scars are the result of deposition of collagen types I and III, although collagen synthesis in hypertrophic scar is two to three times as great as in normotrophic scars [13]. These scars often appear red and shiny and cause pain, itching, and sometimes even restriction of motion when positioned above a joint, thereby causing significant morbidity (Figures 31.10 and 31.11). Hypertrophic scars are caused by a prolonged inflammatory phase and a delayed onset of epithelialization, which interferes with the resolution of granulation tissue, as reflected by the higher amount of myofibroblasts and collagen present in hypertrophic scars. In addition, remodeling is impaired in excessive scar formation, reflected by a higher amount of immature-type collagen [14]. Hypertrophic scars mostly develop within 1–3 months after deep skin injury [13]. They may stay within the boundaries of the original lesion and may spontaneously regress with time [15]. Studies concerning risk factors for hypertrophic scar formation are young age, bacterial colonization, and skin subjected to stretch. Chemotherapy, statins, and smoking seem to play a protective role in hypertrophic scar formation [14].
Could hyperbaric oxygen be an effective therapy option for pathological scars? A systematic review and meta-analysis
Published in Journal of Plastic Surgery and Hand Surgery, 2023
Ruxin Xie, Ai Zhong, Junliang Wu, Ying Cen, Junjie Chen
The wound healing process involves numerous biological processes, including hemostasis inflammation, cell proliferation, and scar formation remodeling. Pathological scars, including keloids and hypertrophic scars, and hypertrophic scars tend to soften over time, but keloids propend to expand beyond the original wounds. These mainly occur after surgery, burns, and trauma and are characterized by continuous local inflammation and excessive collagen deposition [1,2]. In addition, excessive development of pathological scarring often causes pain, pruritus, contracture, and other dysfunction, which are detrimental to physical and mental health [3–6]. Multiple studies on pathological scar formation have been conducted for decades. Scholars have recently identified many therapeutic strategies for preventing or reducing excessive scarring, such as surgery, radiotherapy, steroid injection, pressure therapy, cryotherapy, and laser therapy and so on [7,8]. However, most treatments remain clinically unsatisfactory; owing to the poor efficacy of conventional approaches, new therapeutic strategies are critically needed [9–11].
MiR-486-5p inhibits the hyperproliferation and production of collagen in hypertrophic scar fibroblasts via IGF1/PI3K/AKT pathway
Published in Journal of Dermatological Treatment, 2021
Hypertrophic scar (HS) is an abnormal repair of cutaneous wounds caused by fibroblastic hyperproliferation and deposition of collagen (1). A recent study revealed that as normal scar usually has increased collagenase activity, lower TGF-β level, and Th1 phenotype macrophages, HS shows increased deposition of collagen, TGF-β expression, Th2 phenotype macrophages, myofibroblasts and PDGF, moreover, HS also has fibrocytes and is more easily to be grafted (2). Among the above features of HS, transition of fibroblasts is one of the crucial events (3). Under normal physiological conditions, fibroblasts play a positive role in wound healing and tissue regeneration (4). Collagens, which are main extracellular matrixes (ECM) components in skin tissue (5), are secreted by fibroblasts to provide physiological support to cells, and also regulate cell movements and proliferation (6,7), thus playing an important role in wound healing. However, under pathological conditions, hyperproliferation of fibroblasts and excessive production collagens by fibroblasts cannot be timely degraded, and thus forms HS (8). Therefore, suppression of hyperactive fibroblasts and collagen production may be two critical aspects of HS treatment. So far, therapeutic strategies for treating HS are limitedly available due to a lack of deep understanding of the molecular mechanisms in HS (9). Therefore, it is necessary to discover new and efficient targets for HS treatment.
Association between MeCP2 and Smad7 in the pathogenesis and development of pathological scars
Published in Journal of Plastic Surgery and Hand Surgery, 2021
Dan Li, E. Yang, Juan Zhao, Hengshu Zhang
The experimental specimens were all collected from the Department of Plastic and Burn Surgery, the First Affiliated Hospital of Chongqing Medical University. There were 33 normal skin tissue samples and 118 scar tissue samples, which were confirmed by pathological examination. Based on the pathological examination results, the scar tissues were divided into three groups: (i) normal scar group (n = 32), (ii) hypertrophic scar group (n = 51) and (iii) keloid group (n = 35). The morphological characteristics of normal scars were flat, slightly rough, slight pigmentation and no adverse effects on body function, and the scar growth time was typically 1–20 years. Hypertrophic scars were obviously higher than the surrounding normal skin, accompanied by abnormal thickness, irregular shape, a color of red or purple, hard texture and obvious itching symptoms, and the scar growth time was 3 months to 8 years. The clinical manifestations of keloids are that the scar was more obvious than the surface of the normal skin, along with uneven, pink or purplish red, hard texture, obvious pain, burning and itching, and the scar growth time was 1–20 years.