Scarring

Question 1

How can you treat a scar that is at risk developing hypertrophic/or keloid scar immediately after you closed the wound? (Prevention method)

Answer 1

Pulse dye laser (585nm/595nm)(Fitz 1-3):
- Reduce expression TGF-Beta1 = decreases fibroblast proliferation and collagen deposition (process)

• Reduce local microcirculation = impair proliferation of fibroblast = decrease hypertrophic/keloid scar formation

Question 2

Types of scars? (3 atrophic 1 hypertrophic)

Answer 2

• Ice pick
• Boxcar
• Rolling
• Hypertrophic

Question 3

How to treat ice pick scar?

Answer 3

TCA Peel (65%-100%): severe deep scar

Question 4

How to treat rolling scar?

Answer 4

Interventions: Fractional laser; non-ablative fractional, ablative fractional and skin needling

Question 5

Pathophysiology of rolling scar?

Answer 5

• Fibrous bands pulling the base of the scar (subcutis) down to dermis (pulling down)
• Must target and break bands to improve appearance

Question 6

How to treat a wound immediately postoperative period? (Prevention method)

Answer 6

Diode (810nm) (Fitz 1- 3/caution with 4):
- Dermal heating = elevates heat shock protein 70 = reduce protein synthesis = temporary shuts down cell proliferation = better scar

Question 7

How to treat a wound just after a suture removal? (Prevention method)

Answer 7

Non-Ablative Fractional Laser (NAFL) (Er: Glass 1550nm) (fitz 1-3/4 with caution)
- Increase in rete ridges, mucin deposition, neocollageneisis and myofibroblast

Question 8

Other prevention method?

Answer 8

• Silicone gel sheeting post injury: for hypertrophic scars, pre existing scar, hydrates scar SC = better healing, reduce itching (reduce collagen production), dry healing = potential activation of fibroblast
• Massage therapy: stretch collagen = improve scar appearance
• Compression therapy: pressure reduce growth and reduce blood oxygen in that area = reduce collagen production for scar growth
• Topical therapy e.g. Topical tretinoin

Question 9

How to treat hypertrophic/or keloid scar? (Revision method)

Answer 9

Pulse dye laser (585nm/595nm) (Fitz 1-3):
- decrease fibroblast and collagen fibres = improve pliability

Question 10

How to treat normotrophic scar?

Answer 10

Diode (810nm) (Fitz 1-3/4 with caution):
- Dermal heating = elevates heat shock protein 70 = reduce protein synthesis = temporary shuts down cell proliferation = better scar

Non-ablative Fractional Laser (NAFL - attracted to water) Er: Glass:
- Improve scar formation, thickness and pliability (but not vascular). for immature scar

Question 11

What is Normotrophic scar?

Answer 11

Flat (same level) smooth skin, can be pink (vascularisation), brown (hyperpigmentation), white (hypopigmentation)

Question 12

How to treat persistent erythema in mature scar?

Answer 12

Frequency doubled Nd:YAG (532nm):
- Absorbs haemoglobin: selective coagulation and destruction to abnormal capillaries = reduce erythema

Red erythema immature scar:
- Create coagulation in vessel = reduce redness

Question 13

What scars can Ablative fractional Laser (ER: YAG/2940nm) treat and how?

Answer 13

• Hypertrophic, depresses and burn scars
• Thermal damages = increase exporession of health shock protein and upregulate of tgf-beta (Transforming growth factor beta) = increase collagen synthesis
  (highest affinity to water than CO2)

Question 14

What scar can CO2 treat?

Answer 14

• Elevated scar, pigmented and hyper-vascular scars

Question 15

Other Revision Methods?

Answer 15

• RF (radiofrequency)
• Surgical
• Dermal fillers
• Collagen induction therapy - skin needling
• Chemical peels - TCA, Phenol, SA
  Microdermabrasion