Nderlands tijdschrift voor dermatologie en venereologie vol:24 issue:09 pages:607-613
SNNDV location:Brussels, Belgium date:6-7 november 2014
Normal and pathological scars are daily practice for the dermatologist and preventive as well as therapeutic management often lies within their hands. Dermal fibrosis is an inevitable event in adult scarring. A hypertrophic scar and keloid both result from an imbalance between the synthesis and breakdown of the extracellular matrix, favoring excessive fibrosis. To date no plausible hypothesis explaining the origin and differential behavior of a hypertrophic scar or keloid exists, but deregulated TGF-β transduced signals are considered to play a key role. A wide variety of different and combined scar management techniques have been advocated both for prevention and treatment of unaesthetic mature scars, hypertrophic scars and keloid. Preventive measures include a meticulous surgical technique and application of silicone gels or sheets. Surgical excision, dermabrasion and laser are established treatment modalities to improve non-pathological scars. Intralesional therapies with corticosteroids or antineoplastic agents are indicated to treat the excessive parts of hypertrophic scars and keloids. Cryosurgery and combination of excision with radiotherapy are considered to be more invasive methods and are therefore reserved for scars resistant to other therapies. Further research into the molecular mechanism and the genetic footprint of pathologic scars will optimize a tailored approach for every different scar type.