Podsumowanie

1. Blizny stanowią istotny czynnik pogarszający jakość życia pacjentów.

2. Obecnie istnieje szeroki wachlarz dostępnych metod terapeutycznych.

3. Wybór odpowiedniej metody jest uzależniony od rodzaju blizny.

4. Stosowanie technik łączonych przynosi lepsze efekty.

5. Najważniejszym czynnikiem pozostają działania profilaktyczne wdrażane od momentu powstania rany.

ABSTRACT
A scar results from damage to the dermis and its replacement with fibrous connective tissue when wound healing has been disrupted. Wound healing involves the stages of hemostasis, inflammation, proliferation and tissue remodeling. Atrophic scars are more common and occur as a result of reduced collagen levels, leading to visible defects on the skin. Hypertrophic scars form due to uncontrolled proliferation of fibroblasts and an excess of extracellular matrix, the overproduction of which is determined by genetic predisposition, location and prolonged wound healing, incorrect surgical techniques and the African race. They are clinically manifested as protruding lesions and, unlike keloids, remain within the limits of the original wound. The dynamic development of esthetic medicine procedures has considerably increased the accessibility of therapeutic methods. The most frequently used methods in the treatment of scars, as described in the present paper, include dermabrasion, laser therapy, radiofrequency, subcutaneous incisions, skin needling, the punch technique, chemical peeling, tissue filling, injection pharmacotherapy, cryotherapy and radiotherapy. Many of these methods are successfully used in combination therapies. The choice of a suitable treatment option should be determined by the type of scar and consideration of adverse effects.
Despite the multitude of therapeutic methods available, the most significant area is prevention. Preventive measures include proper cleaning and suturing of the wound, counteracting the development of inflammation and avoiding sun exposure of new scars. Available methods used in the prevention of scar formation include the application of silicone dressings, medications with an onion extract, compression therapy and type A botulinum toxin procedures.

KEYWORDS: scar, treatment, prevention.

Zdjęcia: dr hab. Beaty Bergler-Czop – Tomasz Jodłowski, pozostałych autorów – archiwum prywatne (3), przypadków – Skin Laser Lubelscy Medycyna Estetyczna i Dermatologia (3)

Piśmiennictwo

1. Rabello FB, Souza CD, Farina Jr JA. Update on hypertrophic scar treatment. Clinics. 2014;69(8):565-73

2. Heppt MV, Breuninger H, Reinholz M, et al. Current Strategies in the Treatment of Scars and Keloids. Facial Plast Surg. 2015; Aug; 31(4):386-95

3. Rivera AE. Acne scarring: a review and current treatment modalities. J Am Acad Dermatol. 2008;59:659-76

4. Ogawa R, Akaishi S, Kuribayashi S, et al. Keloids and Hypertrophic Scars Can Now Be Cured Completely: Recent Progress in Our Understanding of the Pathogenesis of Keloids and Hypertrophic Scars and the Most Promising Current Therapeutic Strategy. J Nippon Med Sch. 2016;83(2)

5. Kuzański W, Gawłowska A, Niedzielski J. Long-term results after surgical treatment and rehabilitation of children with complete posttraumatic lesion of tendons of hand and wrist. Chirurgia Polska 2004;6,3,155-64

6. Nast A, Eming S, Fluhr J, et al. German Society of Dermatology. German S2k guidelines for therapy of pathological scars (hypertrophic and keloids). J Dtsch Dermatol Ges 2012; 10(10):747-62

7. Frank W. Therapeutic dermabrazion. Back to the future. Arch Dermatol. 1994;171:130: 1187-9

8. Levy LL, Zeichner JA. Management of acne scarring, part II: a comparative review of non-laser-based, minimally invasive approaches. Am J Clin Dermal. 2012;13:331-40

9. Christophel JJ, Elm C, Endrizzi BT, et al. A randomized controlled trial of fractional laser therapy and dermabrasion for scar resurfacing. Dermal Surg. 2012;38:595-602

10. Lanouge J, Goldenberg G. Acne Scarring: A Review of Cosmetic Therapies. Cosmetic Dermatology. Cutis. 2015;95:276-281

11. Alster TS, West TB. Resurfacing of atrophic facial acne scars with a high-energy, pulsed carbon dioxide laser. Dermatol Surg. 1996;22:151-5

12. Sobanko JF, Alster TS. Managment of acne scarring, part I: a comparative review of lasser surgical approaches. Am J Clin Dermatol. 2012;13:319-30

13. Cho SB, Lee SJ, Oh SH, et al. Non ablative 1550nm erbium-glass and ablative 10,600nm carbon dioxide fractional lasers for acne scar: a randomized split-face study with blinded response evoluation. J Eur Acad Dermatol Venereol. 2010;24:921-5

14. Shin JU, Gantsetseg D, Young Jung J, et al. Comparison of Non-Ablative and Ablative Fractional Laser Treatments in a Postoperative Scar Study. Lasers in Surgery and Medicine. 2014;46:741-9

15. Rkein A, Ozog D, Weibel JS. Treatment of atrophic scars with fractionated CO2 laser fracilitating delivery of topically applied poly-L-lacid acid. Dermal Surg. 2014;40:624-31

16. Weibel JS, Wulkan AJ, Shumaker PR. Treatment of hypertrophic scars using laser and laser assised corticosteroid delivery. Laser Surg Med. 2013;45:135-40

17. Alster TS, McMeekin TO. Iprovement of facial acne scars by the 585-nm flashlamp-pumped pulsed dye laser. J Am Acad Dermatol 1996;35:79-81

18. Simmons BJ, Griffith RD, Falto-Aizpurua LA, et al. Use of radiofrequency in cosmetic dermatology: focus on nonablative treatment of acne scars. Clin Cosmet Investig Dermatol. 2014;7:335-9

19. Hession MT, Graber EM, MBA Department of Dermatology, Boston University Medical Center, Boston, Massachusetts. January 1 2015r.; http:www.jcadonline.com/2015/01/atrophic-acne-scarring-a-review-of-treatment-options

20. Alam M, Omura N, Kaminer MS. Subcision for acne scarring: technique and outcomes in 40 patients. Dermatol Surg. 2005;31:310-7

21. Sage R, Lopiccolo M, Liu A, et al. Subcuticular incision versus naturally sourced porcine collagen filler for acne scars: a randomized split-face comparison. Dermal Surg. 2011;37:426-31

22. Fabbrocini G, Annunziata MC, D’arco V, et al. Acne scars: pathogenesis, classification and treatment. Dermatol Res Pract. 2010;2010:893080

23. Bryan CP. Ancient Egyptian medicine; the Papyrus Ebers (translation), Chicago 1976; Ares,158-61

24. Brody HJ. Peelingi i resurfacing skóry. Lublin, 2001; wydawnictwo Czelej, 1

25. Hession MT, Graber EM. Atrophic acne scarring: a review of treatment options. J Clin Aesthet Dermatol 2015;8:50-8

26. Wang F, Garza LA, Kang S, et al. In vivo stimulation of de novo collagen production caused by cross-linked hyaluronic acid dermal filler injections in photodamaged human skin. Arch Dermatol. 2007;147:155-63

27. Maunavalli GS, Smith S, Maslowski JM, et al. Successful treatment of depressed, distensible acne scars using autologous fibroblasts: a multi-site, prospective, double blind, placebo-controlled clinical trial. Dermal Surg 2013;39:1226-36

28. Leventhal D, Furr M, Reiter D. Treatment of keloids and hypertrophic scars: a meta-analysis and review of the literature. Arch Facial Plast Surg. 2006;8:362-8

29. Darzi MA, Chowdri NA, Kaul SK, et al. Evaluation of various methods of treating keloids and hypertrophic scars: a 10-years follow-up study. Br J Plast Surg.1992;45:374-9

30. Ledon JA, Savas J, Franca K, et al. Intralesional treatment for keloids and hypertrophic scars: a review. Dermatol Surg. 2013;39:1745-57

31. Khan MA, Bashir MM, Khan FA. Intralesional triamcinolone alone and in combination with 5-fluorouracil for the treatment of keloid and hypertrophic scars. J Pak Med Assoc 2014;64(9):1003-7

32. Huang L, Cai YJ, Lung I, et al. A study of the combination of triamcinolone and 5-fluorouracil in modulating keloid fibroblasts in vitro. J Plast Reconstr Aesthet Surg 2013;66(9):e251–e259

33. Wu XL, Gao Z, Song N, et al. Clinical study of auricular keloid treatment with both surgical excision and intralesional injection of low-dose 5-fluorouracil and corticosteroids. Zhonghua Yi Xue Za Zhi 2009;89(16):1102-5

34. Manuskiatti W, Fitzpatrick RE. Treatment response of keloidal and hypertrophic sternotomy scars: Comparison among intralesional corticosteroid, 5-fluorouracil, and 585-nm flashlamp- pumped pulsed-dye laser treatments. Arch Dermatol 2002;138(9):1149-55

35. Block L, Gosain A, King TW. Emerging Therapies for Scar Prevention. Advances in wound care 2015;(4), 10

36. Ogawa R, Yoshitatsu S, Yoshida K, et al. Is radiation therapy for keloids acceptable? The risk of radiationinduced carcinogenesis. Plast Reconstr Surg. 2009;124:1196-201

37. Gauglitz GG. Management of keloids and hypertrophic scars: current and emerging options. Clin Cosmet Investig. Dermatol 2013;6:103-14

38. Van Leeuwen MC, Bulstra AE, Ket JC, et al. Intralesional Cryotherapy for the Treatment of Keloid Scars: Evaluating Effectiveness. we2’fffffv57jnyu4xkh7yun33n65g 4. 2015 Jun;3(6): e437

39. Aarabi S, Bhatt KA, Shi Y et al. Mechanical load initiates hypertrophic scar formation through decreased cellular apoptosis. FASEB J. 2007;21(12):3250-61

40. Puri N, Talwar A. The efficacy of silicone gel for the treatment of hypertrophic scars and keloids. J Cutan Aesthet Surg. 2009;2:104-6

41. Mustoe TA. Evolution of silicone therapy and mechanism of action in scar management. Aesthetic Plast Surg 2008;32(1):82-92

42. Cho JW, Cho SY, Lee SR, et al. Onion extract and quercetin induce matrix metalloproteinase-1 in vitro and in vivo. Int J Mol Med 2010;25(3):347-52

43. Chanprapaph K, Tanrattanakorn S, Wattanakrai P, et al. Effectiveness of onion extract gel on surgical scars in Asians. Dermatol Res Pract 2012;2012:212945

44. Ho WS, Ying SY, Chan PC, Chan HH. Use of onion extract, heparin, allantoin gel in prevention of scarring in Chinese patients having laser removal of tattoos: A prospective randomized controlled trial. Dermatol Surg. 2006;32(7):891-6

45. Gauglitz GG, Korting HC, Pavicic T, et al. Hypertrophic scarring and keloids: pathomechanisms and current and emerging treatment strategies. Mol Med 2011;17(1-2):113-125

46. Linares HA, Larson DL, Willis-Galstaun BA. Historical notes on the use of pressure in the treatment of hypertrophic scars or keloids. Burns 1993;19(1)

47. Renò F, Sabbatini M, Lombardi F, et al. In vitro mechanical compression induces apoptosis and regulates cytokines release in hypertrophic scars. Wound Repair Regen 2003;11(5):331-6

48. Anzarut A, Olson J, Singh P, et al. The effectiveness of pressure garment therapy for the prevention of abnormal scarring after burn injury: a meta-analysis. J Plast Reconstr Aesthet Surg 2009;62(1):77-84

49. Shaarawy E, Hegazy RA, Abdel Hay RM. Intralesional botulinum toxin type A equally effective and better tolerated than intralesional steroid in the treatment of keloids: a randomized controlled trial. J Cosmet Dermatol 2015;14(2):161-6

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