What are the emerging therapies for scar prevention?. A detailed look at the latest treatments and techniques to minimize scar formation.

Emerging Therapies for Scar Prevention

Scar formation is a common and often challenging consequence of various medical procedures, injuries, and skin conditions. As researchers and clinicians continue to explore new and innovative approaches, several emerging therapies have gained attention for their potential in scar prevention. This comprehensive article will provide an overview of the latest advancements in this field.

Understanding Scar Formation

Scars are the body’s natural response to tissue injury, resulting from the complex process of wound healing. When the skin is damaged, the body initiates a cascade of events that culminates in the formation of a scar. While scars are an essential part of the healing process, they can often be unsightly, uncomfortable, and, in some cases, functionally limiting.

The factors that contribute to scar formation are multifaceted, including the extent and severity of the initial injury, the individual’s genetic predisposition, and the body’s own wound healing response. Understanding these underlying mechanisms is crucial in developing effective scar prevention strategies.

Emerging Therapies for Scar Prevention

Mechanical Scar Reduction Devices

One of the promising emerging therapies for scar prevention is the use of mechanical scar reduction devices, such as the embrace Advanced Scar Therapy device. These devices apply gentle mechanical tension to the skin, which has been shown to reduce the formation of hypertrophic and keloid scars. A randomized controlled trial found that the embrace device significantly reduced the incidence of scar formation compared to a control group.

Topical Treatments

Topical treatments have long been a mainstay in scar management, and new formulations are continually being developed. Some of the emerging topical therapies include silicone gels, onion extract-based products, and imiquimod cream. These treatments have demonstrated varying degrees of effectiveness in reducing the appearance and severity of scars, with some studies showing promising results in the prevention of keloid and hypertrophic scar formation.

Intralesional Injections

Intralesional injections, such as those with corticosteroids or mitomycin C, have been used to manage existing scars. However, emerging evidence suggests that these treatments may also have a role in scar prevention. Studies have shown that the combination of intralesional triamcinolone acetonide and onion extract gel can be effective in reducing the formation of hypertrophic scars and keloids.

Radiation Therapy

Radiation therapy, particularly when used in combination with surgical excision, has been explored as a potential scar prevention strategy. The rationale behind this approach is that the radiation can inhibit the excessive proliferation of fibroblasts, which play a key role in scar formation. While the use of radiation therapy for scar prevention is still an emerging field, some studies have reported promising results in the management of keloids.

Combination Therapies

As scar formation is a complex process, the use of combination therapies has gained attention. By targeting multiple pathways involved in scar development, these multimodal approaches aim to enhance the efficacy of scar prevention. For example, the combination of surgical excision, mitomycin C application, and radiotherapy has shown promising results in the management of keloids.

Factors to Consider in Scar Prevention

Effective scar prevention requires a comprehensive approach that takes into account various factors, including the type and severity of the injury, the individual’s risk factors, and the timing and coordination of treatment interventions. Healthcare providers must carefully evaluate each patient’s unique situation and tailor the treatment plan accordingly.

It is important to note that while these emerging therapies hold promise, their long-term efficacy and safety profiles are still being evaluated. Ongoing research and clinical trials will continue to shed light on the most effective strategies for scar prevention.

Conclusion

The field of scar prevention is rapidly evolving, with a range of emerging therapies offering new hope for individuals affected by scarring. From mechanical devices to novel topical treatments and combination approaches, the landscape of scar management is continuously expanding. As research continues to unravel the complexities of scar formation, healthcare providers and patients can look forward to even more advanced and effective scar prevention strategies in the future.

Emerging Therapies for Scar Prevention

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Scar Prevention and the Stages of Wound Healing

Skin surgery, wounds, and scar tissue are common concerns that bring patients in to see their dermatologist. According to Dr. Daniel Condie of U.S. Dermatology Partners in Plano, Grapevine, and Sherman, Texas, “Patients frequently visit me to discuss scar prevention as they undergo surgery and the process of wound healing. While it’s not possible to completely prevent scar formation, there are numerous steps patients can take during wound healing to improve the appearance of scars. Most importantly, they are seeking my help in wound healing, which is an essential step in preventing the formation of unattractive scars.” In this blog, Dr. Condie walks through his top recommendations for scar prevention, the stages of wound healing, and when it’s time to see a dermatologist.

How Wounds & Scars Happen

There are numerous reasons wounds occur, including accidents, injuries, cuts, burns, allergic responses, and bug bites. Wounds may also occur as a result of intentional procedures like surgeries, tattoos, and piercings. Whatever the underlying cause of wounds, unattractive scars can develop if the wound doesn’t heal properly. While anyone can develop a scar after their skin is injured, some factors increase the risk for poor wound healing, including:

• Age – those who are older are more likely to develop scars because they have thinner skin, cells are produced more slowly, and collagen and elastin production is diminished.
• Race – certain ethnicities and races may be more prone to scarring. For example, individuals with dark skin are more likely to develop keloid scars after an injury.
• Health – people with heart disease, diabetes, or poor circulation, are more likely to experience poor wound healing as their immune system is overtaxed from maintaining healthy overall function.

Stages of Wound Healing

Everyone heals differently following a wound. Dr. Condie says, “There are numerous factors that impact the body’s ability to heal, which means no one will take the same amount of time to recover from an injury to their skin, but there are four main phases of healing that should be expected: hemostasis, inflammation, proliferation, and remodeling. ” Below, Dr. Condie describes each of these four stages and what to expect:

1. Hemostasis – this is the body’s natural response that occurs immediately after a wound. It includes blood clotting, scab formation, and other healing responses.
2. Inflammation – as the immune system kicks into gear, inflammation occurs. This may include swelling and redness as the body replaces damaged cells and fights off infection.
3. Proliferation – this is the process of creating new skin, blood vessels, and other tissues as the wound closes over.
4. Remodeling – this is the final stage of wound healing, at which point, scarring may occur. If the wound was severe enough or other factors were present, the healthy skin may not match the surrounding tissue. This stage may take many months or even a year to complete.

Warning Signs of Improper Wound Healing

According to Dr. Condie, “The most obvious signs that a wound is improperly healing are any symptoms that get worse instead of better with time. If you notice increasing severity of symptoms, it’s essential to contact your dermatologist or other medical professional immediately.” Common signs that a wound is healing improperly include:

• Pain – if pain increases or doesn’t improve within a few days of receiving the wound.
• Bleeding – if the wound continues to bleed after the first 24 to 48 hours, this may be a sign that it isn’t healing as expected.
• Redness – reddened skin around the wound, especially if the redness is spreading, can be an early warning sign of infection.
• Warmth – heat on or around the wound is one of the most common signs of infection.
• Discharge or smell – if the wound produces a discharge or bad smell, this may be indicative of an advanced infection that requires immediate treatment.

Tips to Heal More Quickly

When it comes to the time it takes for wounds to heal, Dr. Condie recommends, “Your body knows how best to heal itself, so it’s important to allow yourself the time you need to heal. However, there are some steps you can take to promote faster, more comfortable wound healing, and minimize scarring. Perhaps the easiest and most obvious is to follow your dermatologist’s aftercare instructions to the letter.” In addition to following aftercare instructions, some other tips to ensure quick and comfortable wound healing include:

• Clean the wound daily – this includes general cleaning like showering or washing your face, and you should also apply any topical ointments or other healing products as directed by your dermatologist.
• Get plenty of rest – our bodies heal and cells regenerate as we sleep, so it’s important to give yourself plenty of rest while your wound is healing.
• Stay hydrated – Proper hydration allows your body’s circulation to deliver oxygen and nutrients to the injured tissue. For that reason, it’s essential to drink plenty of water as you heal.
• Eat a nutrient-rich diet – the vitamins and nutrients in food allow the body to heal and produce new, healthy skin cells. A healthy diet helps with a healthy immune response.
• Avoid harmful substances – smoking, vaping, tobacco in any form, and drinking to excess can impede immune function, slowing down healing and increasing the risk of infection and scarring.

How to Minimize the Risk of Scarring

Scarring is always a possibility after injury, but there are some ways to reduce the risk of unattractive scar tissue formation. According to Dr. Condie, “The best way to optimize scar formation is to follow your dermatologist’s recommended aftercare plan. This should promote healing and prevent discomfort during the healing process. It is important to keep the wound clean during all stages of healing. Initially, I usually recommend a bland ointment such as petrolatum to apply to wounds. After the top layer of skin has healed, sunscreen and minimizing sun exposure are necessary. New skin developed during healing is extremely sensitive to sun damage. Additionally, you may want to incorporate medical-grade silicone gels and/or sheets into your skincare routine. If you want to combine the two treatments, Silagen 100% Pure Silicon +SPF 30 is a great option. It’s an innovative silicon scar-prevention gel with built-in sunscreen. There are many other brands of silicone scar products that also work well.” Below, Dr. Condie goes through some of the top scar prevention dos and don’ts:

• Do – keep the wound clean throughout healing.
• Don’t – skip your moisturizer. Dry skin is prone to scarring and may take longer to heal. Apply petroleum jelly or other protective barrier creams to the wound and protect it with non-stick bandaging.
• Do – massage the wound as directed by your physician. After skin surgery, we typically recommend waiting approximately one month before starting scar massage. You can use a bland ointment, scar gel, or healing serum and massage it into the skin. The massage combined with the hydrating product helps the scar improve during the remodeling phase of wound healing.
• Don’t – spend a lot of time in the sun. We already mentioned this above, but it bears repeating. Sun damage will only worsen scar tissue formation.
• Do – be patient and allow skin the time it needs to heal. You can find countless accelerated healing products or recommendations online, but many of these are not backed by research and may even lead to a worse outcome.
• Don’t – pick just any scar prevention cream. Choose dermatologist-developed treatments like the silicone gel described above.

Scar Removal Options

Despite best efforts to heal skin quickly and minimize scar formation, scarring happens. If you’re concerned about the appearance of scar tissue, Dr. Condie recommends seeing a dermatologist for evaluation and recommendations before starting treatment, even with over-the-counter products. There are several dermatologic products and procedures available for improving the appearance of scars, including:

• Pigmentation correction– for skin discoloration that appears after wound healing, professional bleaching treatments or at-home creams may be a good solution. Cyspera Intensive Pigment Corrector V2 is a skin-lightening product that utilizes safe and effective ingredients to lighten skin. Your dermatologist may recommend other products that have a similar effect.
• Chemical peels – these treatments remove the outer layers of skin to reduce the appearance of discoloration and uneven skin tone or texture.
• Fillers – dermal fillers and soft tissue fillers may be recommended for scarring that causes the skin to cave in. Called atrophic scars, these are common results of acne and chickenpox.
• Laser treatment – can be used to address almost any aspect of skin irregularity that results from scarring, including raised skin, discoloration, uneven tone or texture, and contracture.
• Radiofrequency technology – radiofrequency technology with or without microneedling may be recommended to reduce the appearance of scar tissue and other cosmetic irregularities of the skin.
• Steroids – for raised and contracture scar tissue, injectable corticosteroids can help to reduce the amount of raised and contracted tissue for a smoother appearance.
• Dermabrasion – to improve the appearance and contours of scars, especially following skin surgery. This involves creating a thin wound around the scar and allowing the area to heal inward.

Ready to Talk to a Dermatologist?

If you’re ready to schedule a visit with your dermatologist to develop a skincare plan during wound healing, address issues that arise, and prevent or treat scarring, the U.S. Dermatology Partners team has made it easy. Just take a few minutes to fill out our online scheduling request form. Once our local U.S. Dermatology Partners team hears from you, they’ll reach out to schedule your appointment.

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Disclaimer

The Fermencol blog is for informational purposes only and cannot replace an individual consultation with a medical practitioner. All articles inform about skin problems, but are not a guide to action. Be sure to consult your doctor before using the above-mentioned remedies and applying medical techniques!

All about scars – Rustam Ilyasovich Khalilullin

This is not the first time I write about scars and their prevention.
But, as it turns out, even if I duplicate this post once a week, it still won’t be enough.

So, important points:
1. Scar care
2. Control examinations after surgery after 1, 3, 6, 12 months. after operation. I have to look, evaluate the scar and determine if something needs to be done about it.
3. If you need to do something with it, and these are, as a rule, injection and hardware techniques, then I recommend you either cosmetologists we have verified who work with scars, or I write a diagram for your cosmetologist how to work with a scar.

I have repeatedly said and will not tire of repeating: someone has a scar and without care and therapy heals almost without a trace, but more often scars require care. And they definitely need prevention!
If you want to get a good scar, you need to work with it.

Life and course of the wound process.

Immediately after tissue damage, our defense systems are activated:

• vessels expand, their walls become more permeable, changes in microvascular permeability increase during the first 2-3 days;
• the army of cellular agents moves to the area of ​​damage, the main soldier in this phase is a macrophage;
• releasing special substances, our cells tend to isolate the wound from the surrounding intact elements.

For us, who observe their active work from the outside, this is manifested in an increase in edema. And this is called the inflammatory phase. Not to be confused with bacterial inflammation.

• The first phase lasts for 1-3 days after the operation. It is characterized by an increase in edema. By about the third day, you will see the maximum swelling.

The inflammatory phase is followed by the proliferative phase.

• In this phase, the fibroblast becomes the main active cell in the area of ​​injury.
• Fibroblast is a hard worker in our integumentary tissues, it synthesizes collagen of various types, and also synthesizes hyaluronic acid known to everyone.
• Fibroblasts, like microspiders, weave a collagen network, closing and strengthening damaged tissues from the inside.
• New vessels and nerve endings are sprouting.

The maximum level of collagen synthesis and its accumulation is reached within approximately 2 months. (sometimes up to 100 days). Sometimes this process is delayed and for a longer time.

What happens?

• Over the next two to three months we will see how the scar becomes denser, it becomes reddish in color.
• In this period, the scars are most sensitive.
• Scars may itch a little.

Gradually, from the third month, the phase of scar tissue restructuring begins. Vessels sprouted for nutrition are mostly sclerosed by the body. The tissues shrink, the scar “settles”. Decreases in size, brightens, and sometimes turns white. This process takes up to 12-18 months.

This happens normally, and such scars are called normotrophic.

Normotrophic scar is characterized by:

• small visualization in the first days after the operation;
• slight increase, dilation and redness within two to three months;
• gradual lightening and reduction occurs, as a rule, by the 8th-18th month;
• no special treatment required;
• care and prevention.

Hypertrophic and keloid scars are a condition of “overhealing”.

In the case of hypertrophic scars, their growth is more intensive, stopping at sizes slightly larger than normotrophic scars. The important thing is that a hypertrophic scar always stops in the zone of primary damage (unlike a keloid scar – see below). This is connected with a genetic predisposition, with the reactivity of the body, the level of tissue tension, scar trauma during the healing process and other factors.

Hypertrophic scar is characterized by:

• small visualization in the first days after the operation;
• enlargement, dilation, protrusion and redness;
• the period of increase and stretching of the scar in width can be about 6-8 months;
• the period of clarification and reduction of the scar can be delayed up to several years;
• scar remains, as a rule, protruding above the skin, dense, skin-colored, somewhat lighter or somewhat darker;
• longer itching, hypersensitivity/tenderness of the scar;
• specialized treatment possible;
• care and prevention.

Keloid scars are the most aggressive type of scarring.

The division and growth of cells inside occurs at a high rate and in large numbers. Keloid scars do not follow the general rules for the formation of scar tissue. Their development is almost endless, since their proliferative (the one where fibroblasts actively work) phase goes on constantly, without stopping. Fibroblasts tirelessly weave fibers, blood vessels and new connective tissue grow. Keloid scars do not stop within the primary damage and involve surrounding tissues in their growth. The formation of keloid scars is a multifactorial process, triggered by the body itself. Among the factors for the occurrence of keloid scars are genetic prerequisites, and hormonal, and localization, etc. It is impossible to understand whether you have a tendency to keloid scars until they occur. Moreover, even if you already have scars, for example, after the removal of appendicitis, and they are normotrophic, then there is no guarantee that in the future, with a new injury, a keloid scar will not develop.

• It is believed that the main areas of localization of keloid scars are the upper chest, backs, shoulders, ears.

These scars are the most difficult to treat, but effective techniques and algorithms have been developed and are successfully applied in the practice of specialists.

With regard to plastic surgery, the incidence of keloid scarring is extremely low, since, as a rule, accesses are made in natural folds, and postoperative care and scar control prevent the growth of scar tissue.

Keloid scars

• The first days are similar to normal scars.
• The first month, as a rule, may not manifest itself in any way, except for more active itching.
• From month to month, the scar continues to itch, grow, periodically hurt, involve surrounding tissues, rise above the surface.
• The scar goes beyond the boundaries of the primary damage and continues to grow.
• Specialized treatment required.

Before you start treating hypertrophic or keloid scars, you need to make sure that they are. People often confuse old “stretched” atrophic scars with hypertrophic or even keloid scars.

I am often sent photos of scars – there is nothing wrong with that if you are not sure which scar you are the owner of.

You can send photos by email. email [email protected] or direct my Instagram account @doctor.rust. It is completely free of charge, and if necessary, you can start specialized therapy in a timely manner.

Now that you’ve learned what scars are and how they grow, we’ll get to where you started this chapter.

Care and prevention

The very first and most important thing is to protect the scar from external factors of trauma, such as:

– scar stretching due to movement;

– thermal effects.

Stitches and stickers during the first month

If it is a blepharoplasty, special flesh-colored “strips” are glued onto a thin suture. They perfectly protect the wound from external damaging agents. An alternative is a special glue. Glue is one of the best protective agents, but glue can be uncomfortable in the eyelid area. Protective stickers are used within a week. From the 14th day, Hydrocortisone (cream) is used on the scar area for 7 days (no more).

After that – means to reduce the activity of scars. For example, Imoferaza, Dermatix or Kelokot – 1-3 months.

• If endoscopic lifting was performed: accesses for endoscopic lifting are located in the scalp and, as a rule, are not sutured with suture material, but special staples are used, which are removed in the clinic for 10-14 days. During this time, accesses should be treated daily with antiseptic agents (for example, Betadine or Chlorhexidine). As a rule, the subsequent maintenance of accesses is not required.
• If a facelift has been performed, stitches should usually be removed after 10-14 days. It is possible to use special Omnistrip stickers on accesses in the anterior and occipital region; in the temporal region, as a rule, additional means are not used.
• If operations were performed in the body area, the accesses are protected for the first month with a special adhesive and Omnistrip stickers. This is more than enough after the operation to protect the access area.

During operations on the body and limbs, I use the “seamless” technology.

What it consists of: during the operation, accesses are sutured with several rows of internal sutures using the most modern inert absorbable materials, special skin glue and special protective stickers (strips) are applied on top of the access area.

The technology of using skin glue instead of external sutures greatly simplifies the postoperative period.

“Seamless” is the ability to wash within a few hours after the operation, unlike the old “suture” technologies, where instead of washing, patients had to wipe themselves with a damp towel for a week (or even two) – just go to the shower.

“Seamless” means that in 97% of cases there is no need for dressings, which means that there is no unnecessary pain.

“Seamless” is without seams: they do not need to be removed, the threads do not stick out and are not an entrance gate for infection.

3-4 weeks after the operation, the patient can peel off this plaster on his own – it is completely painless and elementary. Just as elementary as peeling off a band-aid.

After peeling off the plaster, if all accesses have healed and there are no wounds, I recommend to let the scars “rest” for 3-5 days, and then start the care.

So, care after removing stickers.

Body: strips, gels, patches.

After removing the stickers, carefully inspect the access area – in rare cases, there may be small wounds or crusts in the access area. You should not worry: if this happens, your doctor will prescribe therapy for you, and everything will pass quickly.

If everything is clean, then I recommend a 3-4 days rest without additional funds. You can wash, remove all the glue, but do not rub the seams with a washcloth.

From 3-4 days after removing the stickers – scar care.

Various care options are available. Here are the main ones:

• The use of special creams and ointments that reduce the activity of scar growth phases (see the beginning of the chapter).

Among the most popular products:

• Kelo-Cote (Kelo-Cote) – silicone protective gel. Minimum duration of use – 60-90 days, then efficiency control.
• Dermatix is ​​a protective silicone gel. The minimum duration of the prophylactic course is at least 2 months.
• Imopherase is a hyaluronidase preparation (decreased activity). Duration – 4-8 weeks
• Contractubex – onion extract, heparin, allantoin. Duration of application – at least 3-4 months.

Topical use of one protective gel with a possible combination with a gel to reduce scar activity.

Example: Dermatix + Imoferase, Kelo-kot + Imoferase, Contractubex + Dermatix, etc.

1. Silicone protective patches.

Among the most popular:

– Dermatix.

– Mepiform.

– Cica Care.

– Scarfix (ScarFX).

The patches are worn during the day and night, removed for hygiene procedures and reapplied. Gels can be alternated with patches.

1. Use of protective strips for a long time.

Strips – they are also protective stickers. Were glued immediately after the operation. The same stickers (only new ones) can be used for prolonged scar protection.

Lately I’ve been recommending more and more to focus on strips (with which we protect access during the first month).

Instructions: remove our strips in a month, process if there is no reaction to the strip, 3-4 days of rest, then re-glue the new strips and continue to wear (without removing) 2-3 weeks. The procedure can be repeated several times and strips can be used for up to 4-6 months (if there are no unwanted reactions to the sticker).

Why strips:

– they are extremely inert and rarely irritate the skin;

– they can be worn all the time without taking them off, and you can wash with them;

– if there is a need to remove them, they can be easily peeled off, and you can stick them on the next day and continue to wear them without removing them;

– they will protect the scars from trauma and irritation from clothing;

– they are much cheaper than silicone patches;

– there is no need to use other means.

Watch out for scars for years!

Pay attention to the following:

• whether the scar is itchy and how long it lasts;
• did itching start in the area of ​​the scar a few months after the operation;
• whether the scar has a constant growth trend;
• whether the scar is coarsening and turning into a blue tint;
• whether there is a constant traumatization of the scar with underwear, clothes;
• scars should not be rubbed with a sponge;
• scars should not be constantly touched by hands.

The treatment of hypertrophic and keloid scars is a complex and multi-stage process.

However, with a rational and multifaceted approach, therapeutic agents are highly effective.

Basic products for scar therapy

– Botulinum toxin preparations (Botox, Dysport, etc.).

– Hormonal preparations (Diprospan, Kenalog).

– Hyaluronidase preparations (Longidase – injections, suppositories, ultraphonophoresis).