Scar Prevention


Prescription placebos used in research and pra...

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Renovo, a UK company, announced on February 11 that Phase III trials of its lead scar reduction treatment, Juvista (human TGF-beta3) had failed on its primary endpoint (assessment of the scars by independent experts) and on its secondary endpoint (assessment by the patients themselves). The news was even worse as the company is now trying figure out why in some patients, the half of the scar treated with placebo seemed to heal better than the Juvista-treated half.

The REVISE Trial was a double blind, within patient, placebo controlled trial to assess the efficacy of two dose levels of Juvista (200ng and 500ng/100ul/linear cm of wound margin) given twice, following wound closure and 24 hours later, on the appearance of scars following scar revision surgery. Over 350 patients were recruited from 56 centres in UK France, Hungary, Germany, Italy, Poland, Spain, Denmark, Latvia and USA. The EMA agreed primary endpoint for efficacy was a photographic based assessment at 12 months following surgery by an independent panel of experts using the Global Scar Comparison Scale. Secondary endpoints included an assessment of the scars using the Global Scar Comparison Scale by the patients themselves and by the clinical trial investigator. None of the primary or secondary endpoints were met for either dose.

For some additional analysis visit IN VIVO blog.

Surgeon doing a surgical breast biopsy.

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PharmEcosse, a Scottish company, is starting clinical trials to explore the use of insulin (PE001) for the reduction or prevention of surgical scars in patients undergoing non-cancer bilateral breast surgery. The trial will commence in January 2011 and is expected to report in the first quarter of 2013.

Insulin was found to control the activity of the key cells involved in wound closure and subsequent scar formation which apparently slows down or stops the build up of scar tissue.

For more information about taking part in clinical trials, please go to pharmecosse.com

We occasionally receive questions by email or in the comments section. Let us know if you have any questions related to scars, scar treatment or scar prevention and we will try to answer them. You can ask the questions anonymously via the comments section below. And remember, the only stupid question is the one you don’t ask.

 

In a recent interview with Life & Style, the former star of “The Hills” described a variety of post-surgery scars ranging from a two-inch long blemish under her chin to lumpy legs, uneven breasts and bald spots left from a brow lift.

“People have fewer scars from car accidents than I have on my body,” Montag told the magazine.

All plastic surgery but especially major surgeries like tummy tucks and breast reductions, can involve scarring. Ask your doctor to show you a picture of what the scar looks like beforehand. Another important question is what sort of treatments they offer to minimize scarring, for example silicone gel (e.g. Strataderm), silicone sheeting or laser procedures. It’s not always easy to know in advance whether or not you’re likely to scar. Some people are more prone to scarring than others. People heal differently, and patients with a poor history of wound healing or keloid scars are at high risk of scarring.

When your wound starts to heal the body produces more collagen which gathers around the damaged tissue and seals it. However, in keloid scars the collagen production doesn’t stop and the scar extends beyond the borders of the original wound in the form of dense fibrous tissue.

Keloid scars are raised and range in consistency from soft and doughy to hard and rubbery. They can appear anywhere on the body although they usually form in the area of shoulders, cheeks, earlobes and neck area. Burn scars or infected lesions, including acne, are more likely to form keloids. Keloid scars sometimes itch and may be painful. Keloid scars are 15 times more likely to occur in darker-skinned individuals, may be familial, and tend to develop more readily during and after puberty.

While keloid scars are difficult to treat, combination treatments seem to be the most effective. International Clinical Recommendations on Scar Management highlight a primary role for silicone and intralesional corticosteroids in the management of a wide variety of abnormal scars including keloids. Silicone is also recommended as first-line prophylaxis for keloid scars. Other options include surgery (high risk of recurrence), radiotherapy, cryotherapy, and laser.

If your skin is keloid prone, you should avoid piercings, tattoo and any unnecessary incisions, such as plastic surgery. You should treat acne thoroughly to reduce lesions and potential for scarring or, if surgery is necessary, silicone may be combined with intralesional steroids or other treatments (above) to reduce the likelihood or size of keloid scarring.

In a cesarean birth (C-section), the baby is delivered through an incision in the mother’s abdomen and uterus (womb). C-Section births exceed 30% in USA, Brazil, Italy, Mexico, Turkey, Korea, Portugal, Australia, Thailand, and other countries. China is the only country where C-section births exceed 40%. The number of cesarean sections in the U.S. has risen nearly 46% since 1996.

Every C-Section is a major abdominal surgery that leaves a scar. The size of your C-section scar will depend on several factors: the size and position of the baby, whether the C-section was planned or not, etc. Generally, the C-section scar is around 4-6 inches (10-15 cm) long and 1/8 inch (0.3 cm) wide.

Usually the “bikini cut” incision is used but sometimes the “classical” incision will be made vertically from just below the belly button (naval) to just above the pubic bone. To close the wound, some surgeons prefer to use staples whereas others still use suture; there is little statistical evidence to show that one way or another will increase or decrease the size or the appearance of the scar.

Treatment. Initially, the C-section scar will be red, raised and could itch. After the wound is closed you should start using a silicone based product like Strataderm to make the scar softer, flatter and smoother and to relieve itching. The majority of women will develop “mature” C-section scars by the sixth month after delivery. If you have darker skin and/or are prone to keloids you should consult a physician before the C-Section.

Acne is the most common skin disorder, affecting around 15% of the adult population and up to 80% of adolescents. Facial scarring because of acne occurs to some degree in most cases. The majority of acne scars are flat and depressed below the surrounding skin (atrophic), generally small and often round with an indented or inverted centre. To prevent acne scars, do not pop, squeeze, or pick at acne; do not pull scabs of acne; seek treatment early for acne that does not respond to OTC medications.

Types of Acne Scars:

–          red and/or hyperpigmented marks: a post-inflammatory change that usually disappears in 6-12 months

–          acne scars – icepick: depressed scars, deep, narrow and sharp; usually too deep for dermabrasion or laser skin resurfacing

–          acne scars – boxcar: depressed scars, round with sharp edges

–          rolling acne scars: depressed scars, wavy texture in the skin

–          keloids and hypertrophic scars are raised acne scars that may become larger and more noticeable, sometimes painful and itchy.  

Silicone gel like Strataderm is effective for treatment of acne scars and prevention of keloids and hypertrophic scars. Other effective treatments for depressed acne scars include laser skin resurfacing, dermabrasion, scar surgery (punch excision, punch elevation, punch graft, subcutaneous incision), fillers, chemical peel, microdermabrasion and similar procedures that you should discuss with your dermatologist. For raised acne scars, like keloid and hypertrophic scars, your doctor might consider options like intralesional injections, cryotherapy, surgery, laser and light therapy. Your dermatologist will be able to create a treatment plan based on the type of your acne acne scars, results you can expect, and your medical history.

Acne Scars:

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