FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W2593414596> ?p ?o ?g. }

• W2593414596 endingPage "24" @default.
• W2593414596 startingPage "13" @default.
• W2593414596 abstract "The evidence base underpinning most traditional scar reduction approaches is limited, but some of the novel strategies are promising and accumulating. We review a number of commonly adopted strategies for scar reduction. The outlined novel agents are paradigmatic of the value of translational medical research and are likely to change the scenery in the much neglected but recently revived field of scar reduction therapeutics. The evidence base underpinning most traditional scar reduction approaches is limited, but some of the novel strategies are promising and accumulating. We review a number of commonly adopted strategies for scar reduction. The outlined novel agents are paradigmatic of the value of translational medical research and are likely to change the scenery in the much neglected but recently revived field of scar reduction therapeutics. CME InstructionsThe following is a journal-based CME activity presented by the American Academy of Dermatology and is made up of four phases:1.Reading of the CME Information (delineated below)2.Reading of the Source Article3.Achievement of a 70% or higher on the online Case-based Post Test4.Completion of the Journal CME EvaluationCME Information and DisclosuresStatement of Need:The American Academy of Dermatology bases its CME activities on the Academy's core curriculum, identified professional practice gaps, the educational needs which underlie these gaps, and emerging clinical research findings. Learners should reflect upon clinical and scientific information presented in the article and determine the need for further study.Target Audience:Dermatologists and others involved in the delivery of dermatologic care.AccreditationThe American Academy of Dermatology is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.AMA PRA Credit DesignationThe American Academy of Dermatology designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credits™.Physicians should claim only the credit commensurate with the extent of their participation in the activity.AAD Recognized CreditThis journal-based CME activity is recognized by the American Academy of Dermatology for 1 AAD Recognized CME Credit and may be used toward the American Academy of Dermatology's Continuing Medical Education Award.Disclaimer:The American Academy of Dermatology is not responsible for statements made by the author(s). Statements or opinions expressed in this activity reflect the views of the author(s) and do not reflect the official policy of the American Academy of Dermatology. The information provided in this CME activity is for continuing education purposes only and is not meant to substitute for the independent medical judgment of a healthcare provider relative to the diagnostic, management and treatment options of a specific patient')s medical condition.DisclosuresEditorsThe editors involved with this CME activity and all content validation/peer reviewers of this journal-based CME activity have reported no relevant financial relationships with commercial interest(s).AuthorsThe authors of this journal-based CME activity have reported no relevant financial relationships with commercial interest(s).PlannersThe planners involved with this journal-based CME activity have reported no relevant financial relationships with commercial interest(s). The editorial and education staff involved with this journal-based CME activity have reported no relevant financial relationships with commercial interest(s).Resolution of Conflicts of InterestIn accordance with the ACCME Standards for Commercial Support of CME, the American Academy of Dermatology has implemented mechanisms, prior to the planning and implementation of this Journal-based CME activity, to identify and mitigate conflicts of interest for all individuals in a position to control the content of this Journal-based CME activity.Learning ObjectivesAfter completing this learning activity, participants should be able to describe the variety of approaches commonly used by the practicing dermatologist for scar reduction; delineate the scientific evidence for currently available antiscarring agents; discuss novel and promising antiscarring agents; correlate the mechanism of action of these innovative agents and some of the conventional modalities with the molecular pathophysiology of cutaneous scarring; and discuss the value of translational research and describe the rationale for further work in this area.Date of release: January 2012Expiration date: January 2015Capsule Summary•“Will there be a scar?” From minor operative procedures to trauma-related surgery, this question is often at the center of patient-related concerns.•In order to address the aforementioned common clinical question, this review aims at critically reviewing conventional and innovative strategies that may be adopted to minimize scarring following dermatologic procedures.•Identifying high risk is paramount to hypertrophic scar prophylaxis, as is clean surgery and good wound care.•Nonsurgical scar reduction strategies include numerous over-the-counter products, such as onion extracts and Vitamin E -based remedies, not supported by a sufficient evidence base.•Intralesional corticosteroids, 5-fluorouracil, bleomycin, and lasers are commonly used in clinical practice, while radiation and surgical revision are only seldom-used modalities.•Human recombinant interleukin-10 and, to a lesser extent, mammose-6-phosphate, are innovative and promising products of translational research that are currently under development for cutaneous scar reduction.•More extensive and better trials are essential for numerous other agents that have shown promise but have been tested only sporadically.Antiscarring strategiesA cutaneous scar results from overgrowth of fibrous tissue after damage to the skin after injury or surgery and represents an exuberant healing response.1Juckett G. Hartman-Adams H. Management of keloids and hypertrophic scars.Am Fam Physician. 2009; 80: 253-260PubMed Google Scholar The type of scar depends on how exuberant the healing response is, with hypertrophic scars not extending beyond the wound borders and keloids extending. The former are clinically more favorable than the latter because they are more amenable to treatment and often even regress spontaneously.2Leventhal D. Furr M. Reiter D. Treatment of keloids and hypertrophic scars.Arch Facial Plast Surg. 2006; 8: 362-368Crossref PubMed Scopus (197) Google Scholar Both types of cutaneous scarring are underpinned by similar pathobiologic processes, and it is not surprising that they respond to the same physical or pharmacologic interventions. They are managed similarly and we therefore refer to the two terms interchangeably in this article.Hypertrophic and keloid scars can be associated with physical and psychological symptoms, yet no major advances have been achieved so far in scar reduction therapeutics. This is probably because of the limited commercial interest and subsequently insufficient research investment in the field. Little research investment entails little product return and little evidence basis for any conventional treatment modality.In Part II of this review, we aim to recap and evaluate management steps that can be taken to reduce the risk of hypertrophic or keloid scarring and to treat such scars if they develop (please see Table I for an overview), and also to look to the future for therapies that may give a better result profile for skin surgery. The value of translational research will become apparent, and we recommend consulting part I of this review for a better appreciation of the molecular basis of scar therapeutics.Table IProposed mechanisms of action and comments on evidence base for commonly used and innovative scar-reducing modalitiesModalityMechanism of actionCommentsLevel of evidenceSilicone dressingsTemperature, oxygen tension, and hydration regulation6Berman B. Perez O.A. Konda S. Kohut B.E. Viera M.H. Delgado S. et al.A review of the biologic effects, clinical efficacy, and safety of silicone elastomer sheeting for hypertrophic and keloid scar treatment and management.Dermatol Surg. 2007; 33: 1291-1303Crossref PubMed Scopus (140) Google ScholarIntermittent reports; discouraging Cochrane review21O’Brien L. Pandit A. Silicon gel sheeting for preventing and treating hypertrophic and keloid scars.Cochrane Database Syst Rev. 2006; 1: CD003826PubMed Google Scholar; still widely used (good safety profile)IIIPressure dressingsPressure-induced hypoxic effects leading to collagen and fibroblast degeneration26Kelly A.P. Medical and surgical therapies for keloids.Dermatol Ther. 2004; 17: 212-218Crossref PubMed Scopus (160) Google Scholar; MMP-9 activation27Renò F. Grazianetti P. Stella M. Magliacani G. Pezzuto C. Cannas M. Release and activation of matrix metalloproteinase-9 during in vitro mechanical compression in hypertrophic scars.Arch Dermatol. 2002; 138: 475-478Crossref PubMed Scopus (28) Google ScholarEquivocal clinical significance in 2009 meta-analysis28Anzarut A. Olson J. Singh P. Rowe B.H. Tredget E.E. 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: 77-84Abstract Full Text Full Text PDF PubMed Scopus (166) Google Scholar; still commonly used (good safety profile)—Onion extractsAffects fibroblasts and mast cells in the inflammatory cascade and by decreasing inflammation29Dorsch W. Schneider E. Bayer T. Breu W. Wagner H. Antiinflammatory effects of onions: inhibition of chemotaxis of human polymorphonuclear leukocytes by thiosulfinates and cepaenes.Int Arch Allergy Appl Immunol. 1990; 92: 39-42Crossref PubMed Scopus (48) Google Scholar, 30Johri R.K. Zutshi U. Kameshwaran L. Atal C.K. Effect of quercetin and Albizzia saponins on rat mast cell.Indian J Physiol Pharmacol. 1985; 29: 43-46PubMed Google Scholar, 31Pawlikowska-Pawlega B. Gawron A. Effect of quercetin on the growth of mouse fibroblast cells in vitro.Pol J Pharmacol. 1995; 47: 531-535PubMed Google Scholar, 32Ross Z.M. O’Gara E.A. Hill D.J. Sleightholme H.V. Maslin D.J. Antimicrobial properties of garlic oil against human enteric bacteria: evaluation of methodologies and comparisons with garlic oil sulfides and garlic powder.Appl Environ Microbiol. 2001; 67: 475-480Crossref PubMed Scopus (252) Google Scholar, 33Augusti K.T. Therapeutic values of onion (Allium cepa L.) and garlic (Allium sativum L.).Indian J Exp Biol. 1996; 34: 634-640PubMed Google Scholar, 34Elnima E.I. Ahmed S.A. Mekkawi A.G. Mossa J.S. The antimicrobial activity of garlic and onion extracts.Pharmazie. 1983; 38: 747-748PubMed Google Scholar; decreased proliferation rates of fibroblasts35Cho J.W. Cho S.Y. Lee S.R. Lee K.S. Onion extract and quercetin induce matrix metalloproteinase-1 in vitro and in vivo.Int J Mol Med. 2010; 25: 347-352PubMed Google ScholarSmall, nonrandomized, not well controlled clinical studies; still commonly used OTC productIIBVitamin E–based remediesAntioxidant properties40Baumann L.S. Spencer J. The effects of topical vitamin E on the cosmetic appearance of scars.Dermatol Surg. 1999; 25: 311-315Crossref PubMed Scopus (128) Google ScholarSome negative data; little support (small clinical studies); not very commonly usedIIB/IIICorticosteroidsInhibit fibroblast growth proliferation collagen synthesis; cause vasoconstriction, thereby limiting wound oxygenation and nutrition; have effects on TGFβ1 TGFβ2 and collagen in keratinocytes; promote collagen degeneration45Fässler R. Sasaki T. Timpl R. Chu M.L. Werner S. Differential regulation of fibulin, tenascin-C, and nidogen expression during wound healing of normal and glucocorticoid-treated mice.Exp Cell Res. 1996; 222: 111-116Crossref PubMed Scopus (87) Google Scholar, 46Pérez P. Page A. Bravo A. Del Río M. Giménez-Conti I. Budunova I. et al.Altered skin development and impaired proliferative and inflammatory responses in transgenic mice overexpressing the glucocorticoid receptor.FASEB J. 2001; 15: 2030-2032PubMed Google Scholar, 47Stojadinovic O. Lee B. Vouthounis C. Vukelic S. Pastar I. Blumenberg M. et al.Novel genomic effects of glucocorticoids in epidermal keratinocytes: inhibition of apoptosis, interferon-gamma pathway, and wound healing along with promotion of terminal differentiation.J Biol Chem. 2007; 282: 4021-4034Crossref PubMed Scopus (152) Google Scholar, 48Wu W.S. Wang F.S. Yang K.D. Huang C.C. Kuo Y.R. Dexamethasone induction of keloid regression through effective suppression of VEGF expression and keloid fibroblast proliferation.J Invest Dermatol. 2006; 126: 1264-1271Crossref PubMed Scopus (110) Google Scholar, 49Alster T.S. West T.B. Treatment of scars: a review.Ann Plast Surg. 1997; 39: 418-432Crossref PubMed Scopus (132) Google ScholarNumerous positive case studies (albeit lack of well controlled trials) for intralesional corticosteroids; topical agents not recommended; intralesional agents advocated by many as first-line; often used in combination with other modalitiesIII5-FluorouracilInhibit human fibroblast growth63de Waard J.W. de Man B.M. Wobbes T. van der Linden C.J. Hendriks T. Inhibition of fibroblast collagen synthesis and proliferation by levamisole and 5-fluorouracil.Eur J Cancer. 1998; 34: 162-167Abstract Full Text Full Text PDF PubMed Scopus (38) Google ScholarCase series; used by some in practiceIIIBleomycinDirect or indirect TGFβ-mediated, inhibitory effects on collagen69Hendricks T. Martens M.F. Huyben C.M. Wobbes T. Inhibition of basal and TGF beta-induced fibroblast collagen synthesis by antineoplastic agents. Implications for wound healing.Br J Cancer. 1993; 67: 545-550Crossref PubMed Scopus (53) Google Scholar, 70Yeowell H.N. Marshall M.K. Walker L.C. Ha V. Pinnell S.R. Regulation of lysyl oxidase mRNA in dermal fibroblasts from normal donors and patients with inherited connective tissue disorders.Arch Biochem Biophys. 1994; 308: 299-305Crossref PubMed Scopus (44) Google ScholarSupport for intralesional application by case studies/preliminary clinical trial; used by some in practice but associated with adverse reactionsIIILasersEffect wound contraction and collagen remodelling by thermal necrosis79Lee K.K. Mehrany K. Swanson N.A. Surgical revision.Dermatol Clin. 2005; 23: 141-150Abstract Full Text Full Text PDF PubMed Scopus (32) Google Scholar; activates release of bFBG and inhibits TGFβ180; altered levels of TGFβ by a heat shock response81Capon A. Mordon S. Can thermal lasers promote skin wound healing?.Am J Clin Dermatol. 2003; 4: 1-12Crossref PubMed Scopus (171) Google ScholarSome support for PDLs by systematic review (2011); several types are widely used in practiceIA(for PDL)SurgeryScar revision, reorientation, and tension releaseZ- and W-plasty supported by case studies, but additional modalities recommended in combination; not used as first-line because of high recurrence rates; adjuvant treatment is recommendedIIICryosurgeryDirect cell freezing effects and by inferring vascular stasis after thawing75Zouboulis C.C. Cryosurgery in dermatology.Eur J Dermatol. 1998; 8: 466-474PubMed Google ScholarSupport from review of numerous case studies; lack of level I evidence but widely used; often in combination with intralesional corticosteroidsIIIRadiationInduction of apoptosis in fibroblasts; restoration of balance between formation and breakdown of scar collagen; altered gene expression and connective tissue stem cell damage87Alster T.S. Cutaneous resurfacing with CO2 and erbium: YAG lasers: preoperative, intraoperative, and postoperative considerations.Plast Reconstr Surg. 1999; 103: 619-634Crossref PubMed Scopus (198) Google Scholar, 88Manstein D. Herron G.S. Sink R.K. Non-ablative fractional laser: a new concept for cutaneous remodeling using microscopic patterns of thermal injury.Lasers Surg Med. 2004; 34: 426-438Crossref PubMed Scopus (1167) Google Scholar, 89Tierney E. Mahmoud B.H. Srivastava D. Ozog D. Kouba D.J. Treatment of surgical scars with nonablative fractional laser versus pulsed dye laser: a randomized controlled trial.Dermatol Surg. 2009; 35: 1172-1180Crossref PubMed Scopus (62) Google Scholar, 90Botwood N. Lewanski C. Lowdell C. The risks of treating keloids with radiotherapy.Br J Radiol. 1999; 72: 1222-1224PubMed Google ScholarReported success in reports and case series; not widely used because of questionable safety profileIIIAvoterminTherapeutic application of recombinant TGFβ3 (receptor antagonist reducing scarring)Intradermal formulation in development; shown to provide an accelerated and permanent improvement in scarring with transient and clinically insignificant adverse effects in early studies (three double-blind, placebo-controlled, phase I/II studies)95Wagner W. Alfrink M. Micke O. Schäfer U. Schüller P. Willich N. Results of prophylactic irradiation in patients with resected keloids—a retrospective analysis.Acta Oncol. 2000; 39: 217-220Crossref PubMed Scopus (62) Google ScholarIBHuman recombinant IL-10Intradermal application of human recombinant IL-10, antiinflammatory cytokine that reduces scarringA single-center, double-blind, standard care– and placebo-controlled, randomized phase II clinical trial reported a statistically significant reduction of scarring99Ferguson M.W.J. Duncan J. Bond J. Bush J. Durani P. So K. et al.Prophylactic administration of avotermin for improvement of skin scarring: three double-blind, placebo-controlled, phase I/II studies.Lancet. 2009; 373: 1264-1274Abstract Full Text Full Text PDF PubMed Scopus (213) Google ScholarIBMannose-6-phosphatePotent inhibitor of TGFβ1 and TGFβ2 signaling101Cordeiro M.F. Mead A. Ali R.R. Alexander R.A. Murray S. Chen C. et al.Novel antisense oligonucleotides targeting TGF-beta inhibit in vivo scarring and improve surgical outcome.Gene Ther. 2003; 10: 59-71Crossref PubMed Scopus (168) Google ScholarPositive phase I clinical trial results101Cordeiro M.F. Mead A. Ali R.R. Alexander R.A. Murray S. Chen C. et al.Novel antisense oligonucleotides targeting TGF-beta inhibit in vivo scarring and improve surgical outcome.Gene Ther. 2003; 10: 59-71Crossref PubMed Scopus (168) Google Scholar but unmet primary endpoints thereafter; in development as topical formulationIB; topical formulation not testedInsulinInhibitor of myofibroblast105US National Institutes of Health, ClinicalTrials.gov web site. A trial to investigate the clinical safety, local toleration, and systemic pharmacokinetics of repeated, escalating concentrations of intradermal RN1004 to wounds of healthy subjects. Available from: http://www.clinicaltrials.gov/ct2/show/NCT00984854. Accessed February 18, 2010.Google ScholarSmall pilot study with encouraging results104US National Institutes of Health, ClinicalTrials.gov web site. An exploratory, single centre, randomized, placebo controlled, assessor blind clinical trial to assess the effects of intradermal administrations of Prevascar on scarring in human subjects of African continental ancestral origin. Available from: http://www.clinicaltrials.gov/ct2/show/NCT01115868. Accessed February 18, 2010.Google Scholar; not widely usedIB (small-scale study)bFBG, basic fibroblast growth factor; IL-10, interleukin-10; MMP-9, matrix metalloproteinase; OTC, over the counter; PDL, pulsed-dye laser; TGFβ, transforming growth factor–beta. Open table in a new tab Practical prophylactic considerationsKey points•Identifying high risk is paramount to preventing hypertrophic scarring after dermatologic procedures•Certain high-pressure body sites are more likely to show exaggerated scarring, and patients of Afro-Caribbean descent and those with personal or family history of scarring are at increased risk of engaging in such a response•Minimizing skin tension and the inflammatory response after surgery by using the appropriate materials and ascertaining clean surgery and good wound care are simple practical prophylactic measuresAn individual at increased risk of developing a thickened scar may benefit from certain prophylactic measures to reduce this risk when skin surgery is contemplated. If surgery is urgent or if the procedure is of medical importance, such as skin cancer therapy, then a detailed approach to scar minimization measures may seem irrelevant.Identify high riskInjury to the dermis and dermoepidermal junction, either related to cutting injury or intense inflammation, triggers a repair process that will usually result in a scar. In only a minority of patients does the scar become thickened and hypertrophic.The risk of a thickened scar after surgery is higher in certain body sites; the shoulder and scapular area, anterior chest, lower abdomen, earlobe, and any other cutaneous region overlying a bony prominence is more prone to an exaggerated scarring response.3Ogawa R. Keloid and hypertrophic scarring may result from a mechanoreceptor or mechanosensitive nociceptor disorder.Med Hypotheses. 2008; 71: 493-500Abstract Full Text Full Text PDF PubMed Scopus (78) Google ScholarThere is evidence to suggest that this natural tendency is explained by the increased mechanical tension that characterizes these body sites.4Aarabi S. Bhatt K.A. Shi Y. Paterno J. Chang E.I. Loh S.A. et al.Mechanical load initiates hypertrophic scar formation through decreased cellular apoptosis.FASEB J. 2007; 21: 3250-3261Crossref PubMed Scopus (349) Google Scholar Patients of Afro-Carribean descent and those with a personal or family history of thickened scars are more likely to produce this response. Young age (<30 years of age) is also a risk factor, especially for keloids,5Kelly A.P. Keloids and hypertrophic scars.in: Parish L.C. Lask G.P. Aesthetic Dermatology. McGraw-Hill, New York, NY1991: 8-69Google Scholar, 6Berman B. Perez O.A. Konda S. Kohut B.E. Viera M.H. Delgado S. et al.A review of the biologic effects, clinical efficacy, and safety of silicone elastomer sheeting for hypertrophic and keloid scar treatment and management.Dermatol Surg. 2007; 33: 1291-1303Crossref PubMed Scopus (140) Google Scholar and while little can be done to change the innate tendency of certain individuals or body sites, the dermatologic surgeon can take extra measures to reduce risk.Of course, the dermatologic surgeon may well decide to adopt an approach whereby all patients are offered prophylactic treatment, especially when the latter is characterized by a safe adverse reaction profile or when cosmesis is of paramount importance to the patient.Reduce skin tensionBased on the aforementioned increased mechanical tension hypothesis, it makes sense to minimize mechanical forces after surgery. Surgical excision scars should be positioned, whenever possible, along rather than across relaxed skin tension lines. Appropriate strength, depth, and number of sutures should ensure that the risk of dehiscence is minimized. Using materials such as paper tape would be expected to facilitate this, and there is some evidence (albeit limited) in support of this idea.7Atkinson J.A. McKenna K.T. Barnett A.G. McGrath D.J. Rudd M. A randomized, controlled trial to determine the efficacy of paper tape in preventing hypertrophic scar formation in surgical incisions that traverse Langer’s skin tension lines.Plast Reconstr Surg. 2005; 116: 1648-1658Crossref PubMed Scopus (134) Google Scholar, 8Reiffel R.S. Prevention of hypertrophic scars by long-term paper tape application.Plast Reconstr Surg. 1995; 96: 1715-1718Crossref PubMed Scopus (66) Google Scholar Avoiding movements after surgery that cause excessive stretching and protecting the wound from friction would therefore be expected to be helpful.Minimize inflammationInflammation is also known to contribute to hypertrophic scarring,9Wang J. Hori K. Ding J. Huang Y. Kwan P. Ladak A. et al.Toll-like receptors expressed by dermal fibroblasts contribute to hypertrophic scarring.J Cell Physiol. 2011; 226: 1265-1273Crossref PubMed Scopus (110) Google Scholar and every attempt to minimize the inflammatory response should be made by ascertaining clean surgery and good wound care to prevent infection thereafter. Using inert suture materials would also be important in this context.Skin closure considerationsWith regard to skin closure after excision, a 2010 Cochrane review reported sutures to be significantly better than tissue adhesives for minimizing dehiscence.10Coulthard P. Esposito M. Worthington H.V. van der Elst M. van Waes O.J. Darcey J. Tissue adhesives for closure of surgical incisions.Cochrane Database Syst Rev. 2010; 5: CD004287PubMed Google Scholar The suture should be strong to avoid wound dehiscence, but it should also accommodate wound edema by allowing adequate stretching. Good eversion of the skin edges is important, as is uniform distribution of the suture tensile strength along the carefully approximated and evenly sutured skin counterparts.11Moy R.L. Waldman B. Hein D.W. A review of sutures and suturing techniques.J Dermatol Surg Oncol. 1992; 18: 785-795Crossref PubMed Scopus (130) Google Scholar Both vertical and horizontal mattress sutures afford excellent results—as do buried intradermal sutures12Hohenleutner U. Egner N. Hohenleutner S. Landthaler M. Intradermal buried vertical mattress suture as sole skin closure: evaluation of 149 cases.Acta Derm Venereol. 2000; 80: 344-347Crossref PubMed Scopus (25) Google Scholar—and their early removal can minimize their classic “railway road” cutaneous scars.13Zuber T.J. The mattress sutures: vertical, horizontal, and corner stitch.Am Fam Physician. 2002; 66: 2231-2236PubMed Google Scholar Interestingly, randomized controlled trials comparing absorbable with nonabsorbable suture materials have not found any significant differences in the long-term cosmetic outcomes.14Luck R.P. Flood R. Eyal D. Saludades J. Hayes C. Gaughan J. Cosmetic outcomes of absorbable versus nonabsorbable sutures in pediatric facial lacerations.Pediatr Emerg Care. 2008; 24: 137-142Crossref PubMed Scopus (35) Google Scholar, 15Karounis H. Gouin S. Eisman H. Chalut D. Pelletier H. Williams B. A randomized, controlled trial comparing long-term cosmetic outcomes of traumatic pediatric lacerations repaired with absorbable plain gut versus nonabsorbable nylon sutures.Acad Emerg Med. 2004; 11: 730-735Crossref PubMed Scopus (56) Google Scholar, 16Parell G.J. Becker G.D. Comparison of absorbable with nonabsorbable sutures in closure of facial skin wounds.Arch Facial Plast Surg. 2003; 5: 488-490Crossref PubMed Scopus (86) Google Scholar Nonabsorbable sutures have been reported to perform better in regions of high skin tension, such as the anterior chest wall.17Durkaya S. Kaptanoglu M. Nadir A. Yilmaz S. Cinar Z. Dogan K. Do absorbable sutures exacerbate presternal scarring?.Tex Heart Inst J. 2005; 32: 544-548PubMed Google Scholar A 2007 meta-analysis highlights the lack of large and methodologically sound randomized controlled trials comparing absorbable with nonabsorbable sutures.18Al-Abdullah T. Plint A.C. Fergusson D. Absorbable versus nonabsorbable sutures in the management of traumatic lacerations and surgical wounds: a meta-analysis.Pediatr Emerg Care. 2007; 23: 339-344Crossref PubMed Scopus (28) Google Scholar In terms of suture material, monofilament sutures are preferred over braided sutures, because they have been reported to cause less inflammation19Niessen F.B. Spauwen P.H. Kon M. The role of suture material in hypertrophic scar formation: monocryl vs. vicryl-rapide.Ann Plast Surg. 1997; 39: 254-260Crossref PubMed Scopus (77) Google Scholar—but again, the conducted studies are neither large and sound nor adequate.Nonsurgical scar reduction strategiesKey points•There are numerous antiscarring agents available over the counter, including silicone dressings, onion extract, and vitamin E–based remedies, none of which are supported by a sufficient evidence base•There is some evidence base underpinning the use of intralesional corticosteroids, 5-fluorouracil, and bleomycinThere is a multitude of commonly used over the counter scar treatment products that have little evidence-based efficacy.20Shih R. Waltzman J. Evans G.R. Review of over-the-counter topical scar treatment products.Plast Reconstr Surg. 2007; 119: 1091-1095Crossref PubMed Scopus (34) Google Scholar, 21O’Brien L. Pandit A. Silicon gel sheeting for preventing and treating hypertrophic and keloid scars.Cochrane Database Syst Rev. 2006; 1: CD003826PubMed Google Scholar Among these, silicone dressings, onion extract, and vitamin E–based remedies rank as the top selling products, despite lacking an evidence base.20Shih R. Waltzman J. Evans G.R. Review of over-the-counter topical scar treatment products.Plast Reconstr Surg. 2007; 119: 1091-1095Crossref PubMed Scopus (34) Google Scholar, 21O’Brien L. Pandit A. Silicon gel sheeting for preventing and treating hypertrophic and keloid scars.Cochrane Database Syst Rev. 2006; 1: CD003826PubMed Google Scholar, 22Morganroth P. Wilmot A.C. Miller C. Over-the-counter scar products for postsurgical patients: disparities between online advertised benefits and evidence regarding efficacy.J Am Acad Dermatol. 2009; 61: e31-e47Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar Often, the advertised beneficial claims lure patients into seeking or purchasing such products, and clinicians should be aware of the disparity between advertised benefits and evidence in support of their efficacy.22Morganroth P. Wilmot A.C. Miller C. Over-the-counter scar products for postsurgical patients: disparities between online advertised benefits and evidence regarding efficacy.J Am Acad Dermatol. 2009; 61: e31-e47Abstract Full Text Full Text PDF PubMed Scopus (17) Google ScholarSilicone dressingsSilicone-based products are widely available and have long been used for hypertrophic scar prophylaxis and treatment. They have been advocate" @default.
• W2593414596 created "2017-03-16" @default.
• W2593414596 creator A5037095218 @default.
• W2593414596 creator A5059299937 @default.
• W2593414596 creator A5060317641 @default.
• W2593414596 date "2012-01-01" @default.
• W2593414596 modified "2023-10-10" @default.
• W2593414596 title "Cutaneous scarring: Pathophysiology, molecular mechanisms, and scar reduction therapeutics" @default.
• W2593414596 cites W1503446950 @default.
• W2593414596 cites W1965463861 @default.
• W2593414596 cites W1965887982 @default.
• W2593414596 cites W1971159275 @default.
• W2593414596 cites W1972880236 @default.
• W2593414596 cites W1972917598 @default.
• W2593414596 cites W1975546118 @default.
• W2593414596 cites W1976960570 @default.
• W2593414596 cites W1977429002 @default.
• W2593414596 cites W1977674210 @default.
• W2593414596 cites W1979037468 @default.
• W2593414596 cites W1983453888 @default.
• W2593414596 cites W1988890977 @default.
• W2593414596 cites W1994048029 @default.
• W2593414596 cites W1996201445 @default.
• W2593414596 cites W1996824903 @default.
• W2593414596 cites W1997159217 @default.
• W2593414596 cites W1998763878 @default.
• W2593414596 cites W1999902333 @default.
• W2593414596 cites W2000401375 @default.
• W2593414596 cites W2001710040 @default.
• W2593414596 cites W2002022705 @default.
• W2593414596 cites W2002527763 @default.
• W2593414596 cites W2002536959 @default.
• W2593414596 cites W2005530413 @default.
• W2593414596 cites W2005699555 @default.
• W2593414596 cites W2006900795 @default.
• W2593414596 cites W2008928798 @default.
• W2593414596 cites W2010156500 @default.
• W2593414596 cites W2016933767 @default.
• W2593414596 cites W2019044832 @default.
• W2593414596 cites W2020278534 @default.
• W2593414596 cites W2024688143 @default.
• W2593414596 cites W2024931794 @default.
• W2593414596 cites W2026040436 @default.
• W2593414596 cites W2026383001 @default.
• W2593414596 cites W2027066293 @default.
• W2593414596 cites W2029246131 @default.
• W2593414596 cites W2029734142 @default.
• W2593414596 cites W2032013289 @default.
• W2593414596 cites W2037246823 @default.
• W2593414596 cites W2038539027 @default.
• W2593414596 cites W2040738150 @default.
• W2593414596 cites W2040774841 @default.
• W2593414596 cites W2043778734 @default.
• W2593414596 cites W2045807490 @default.
• W2593414596 cites W2046113347 @default.
• W2593414596 cites W2047151166 @default.
• W2593414596 cites W2051001832 @default.
• W2593414596 cites W2052842827 @default.
• W2593414596 cites W2053094885 @default.
• W2593414596 cites W2057480133 @default.
• W2593414596 cites W2059208277 @default.
• W2593414596 cites W2059684261 @default.
• W2593414596 cites W2070359389 @default.
• W2593414596 cites W2071635675 @default.
• W2593414596 cites W2072439818 @default.
• W2593414596 cites W2074393853 @default.
• W2593414596 cites W2075842813 @default.
• W2593414596 cites W2081197657 @default.
• W2593414596 cites W2084419824 @default.
• W2593414596 cites W2086006172 @default.
• W2593414596 cites W2088853187 @default.
• W2593414596 cites W2102927685 @default.
• W2593414596 cites W2106451761 @default.
• W2593414596 cites W2112365941 @default.
• W2593414596 cites W2116827387 @default.
• W2593414596 cites W2116996384 @default.
• W2593414596 cites W2122265366 @default.
• W2593414596 cites W2123101763 @default.
• W2593414596 cites W2124702253 @default.
• W2593414596 cites W2126293684 @default.
• W2593414596 cites W2131171461 @default.
• W2593414596 cites W2134111155 @default.
• W2593414596 cites W2137561034 @default.
• W2593414596 cites W2142481650 @default.
• W2593414596 cites W2145568812 @default.
• W2593414596 cites W2147641426 @default.
• W2593414596 cites W2149196939 @default.
• W2593414596 cites W2156135044 @default.
• W2593414596 cites W2158763719 @default.
• W2593414596 cites W2160187795 @default.
• W2593414596 cites W2162264955 @default.
• W2593414596 cites W2162389808 @default.
• W2593414596 cites W2163790254 @default.
• W2593414596 cites W2335054972 @default.
• W2593414596 cites W4240757417 @default.
• W2593414596 cites W4253954903 @default.
• W2593414596 cites W4380869259 @default.
• W2593414596 doi "https://doi.org/10.1016/j.jaad.2011.08.035" @default.

• next