ABSTRACT
Several early reports suggested that performance of dermatosurgical procedures in patients on oral isotretinoin is associated with abnormal skin healing, keloid or hypertrophic scar formation. However, this association has been recently questioned in some studies. This review examines this issue, analyzes the studies published and concludes that the recommendation made earlier about the need to avoid dermatosurgical procedures in patients on isotretinoin is based on inadequate and insufficient evidence and hence needs revision. The review also suggests that recent studies on the subject establish that performing such procedures is safe.
Subject(s)
Dermatologic Agents/administration & dosage , Dermatologic Surgical Procedures/methods , Isotretinoin/administration & dosage , Acne Vulgaris/diagnosis , Acne Vulgaris/therapy , Cicatrix, Hypertrophic/diagnosis , Cicatrix, Hypertrophic/therapy , Dermatologic Agents/adverse effects , Dermatologic Surgical Procedures/standards , Hair Removal/methods , Hair Removal/standards , Humans , Isotretinoin/adverse effectsABSTRACT
BACKGROUND: Hypertrophic scars are dermal fibroproliferative disorders that typically develop after a skin injury heals. They can cause physical, psychological, and cosmetic problems. The management of such scars remains a matter of debate due to lack of effective treatment methods and the inability to prevent recurrences. Recent reports have demonstrated that botulinum toxin type A improves wound healing so it may play a role in treating hypertrophic scars. AIMS: We assessed the effectiveness of intralesional botulinum toxin type A injection for treating hypertrophic scars. METHODS: This prospective clinical study included twenty patients with hypertrophic scars. Intralesional injection of botulinum toxin type A was given once a month for three months with a follow-up period of six months. Each lesion was injected until slight blanching occurred. Therapeutic satisfaction of the patient and physician were recorded. Lesions were assessed for erythema, itching and pliability. Each item was assessed on a 5-point scale. RESULTS: Therapeutic satisfaction was recorded as 'good' in 14 patients and 'excellent' in the remaining six. The mean erythema score decreased from 3.2 to 1.0, the mean pliability score from 3.3 to 0.8 and the mean itching score from 2.7 to 0.7. All of these were statistically significant. LIMITATIONS: A larger sample size and longer follow-up period would have given a better evaluation but was not feasible due to the high expenses involved. CONCLUSION: Botulinum toxin type A is a novel and promising therapy for hypertrophic scars with few side effects.
Subject(s)
Botulinum Toxins, Type A/administration & dosage , Cicatrix, Hypertrophic/diagnosis , Cicatrix, Hypertrophic/drug therapy , Injections, Intralesional , Adult , Female , Follow-Up Studies , Humans , Injections, Intralesional/methods , Male , Prospective Studies , Young AdultABSTRACT
Keloids and hypertrophic scars (HTS) are the result of overgrowth of fibrous tissue, following healing of a cutaneous injury, and cause morbidity. There are several treatment modalities which are useful for the management of keloids, though no single modality is completely effective. The most commonly used modalities are pressure, silicone gel sheet, intralesional steroids, 5-fluorouracil (5 FU), cryotherapy, surgical excision, and lasers. They may be used either singly or, as is done more commonly, in combinations. Any qualified dermatologist who has attained postgraduate qualification in dermatology can treat keloids and HTS. Some procedures, such as cryosurgery and surgical excision, may require additional training in dermatologic surgery. Most modalities for keloids, including intralesional injections and mechanical therapies such as pressure and silicone gel based products, can be given/prescribed on OPD basis. Surgical excision requires a minor operation theater with the facility to handle emergencies. It is important to counsel the patient about the nature of the problem. One should realize that keloid will only improve and not disappear completely. Patients should be informed about the high recurrence rates. Different modalities carry risk of adverse effects and complications and the treating physician needs to be aware of these and patients should be informed about them.
Subject(s)
Cicatrix, Hypertrophic/therapy , Keloid/therapy , Practice Guidelines as Topic , Adrenal Cortex Hormones/therapeutic use , Cicatrix, Hypertrophic/diagnosis , Cryosurgery/methods , Esthetics , Fluorouracil/therapeutic use , Follow-Up Studies , Humans , Injections, Intralesional , Keloid/diagnosis , Laser Therapy/methods , Risk Assessment , Severity of Illness Index , Treatment OutcomeABSTRACT
Clinicians always find it difficult to treat hypertrophic scars and keloids. Various treatment modalities are available. Intralesional corticosteroids, topical applications, cryotherapy, surgery, laser therapy, and silicone sheeting are the widely used options. Radiation therapy can also help in cases of recalcitrant keloids. Most recently, pulsed-dye laser has been successfully used to treat keloids and hypertrophic scars. There are no set guidelines for the treatment of keloids. Treatment has to be individualized depending upon the distribution, size, thickness, and consistency of the lesions and association of inflammation. A combination approach to therapy seems to be the best option.