12 hours ago

Scar Team

A further addition to the debate about radiation for keloids has been provided by a dermatology team from Florida, USA. They have undertaken a case series on patients with large keloids that have been intransigent to other treatments. After first removing the keloid surgically, they undertook three treatments with radiation on consecutive days. Each radiation treatment was quite superficial and low dose compared to previous radiation treatments for keloids. The aim was to reduce high radiation exposure which can damage the surrounding skin. The long term benefit was to reduce the risk of malignant change in the keloid and surrounding tissue. The group found that there was a recurrence rate of less than 10% at one year. ...

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4 days ago

Scar Team

Radiation therapy is a long-standing treatment for keloid scars that have not responded to any other treatment. The literature is not decisive about the overall benefit, but some scars which have not responded to all other approaches seem to improve. Also, it is not something that we consider lightly as there is a small risk of malignant change when tissues are irradiated, usually many decades later. Our expert on the team at this specialist approach is Dr Amar Challapalli, a consultant clinical oncologist. At The Scar II Conference, Dr Mahmood Zidan described an unusual approach to using radiation for both hypertrophic and keloid scars. His team used external beam radiotherapy both the day before and the day after an operation to remove a problematic scar. They reported very good results. This is a topic we will be exploring over the coming months. We are hearing stories of excellent results with low dose radiotherapy used very soon after surgery for a significant scar. The doses of radiotherapy are such that it may reduce the long-term risk of malignant change. ...

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5 days ago

Scar Team

There has been a range of studies in recent years that have investigated how grafts of fat beneath the skin may improve the appearance of scars within the skin. This was a chance finding at first from the world of breast surgery. Patients who had their breast reconstructed with standard plastic surgical techniques often had the contours improved around the edges of the reconstruction by filling with fat removed by liposuction from a distant site. Completely unexpectedly, it was noted that some of the scars upon the reconstructed breast improved after this procedure. Geoffrey Gurtner at The Scar II Conference explained that we have still much to learn. The improvements in skin quality are unpredictable. We are still trying to optimise the procedure and there are key components of preparation that are still being investigated such as whether to wash the fat and how much to inject. A key area of interest is whether we should be aiming to graft the most potent cells within the fat - types of 'stem cells' - or whether we need all the components of the fat for an effect. ...

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6 days ago

Scar Team

At Scar II, Prof Yaron Har-Shai talked about intralesional cryotherapy (Cryoshape). A probe is inserted deep within to hypertrophic scars and keloids and there is gradual freezing with liquid nitrogen. His team have evaluated hundreds of patients after this treatment and noted a significant improvement in colour, hardness, pain and volume of scars. For example, for volume, they noted a 67% decrease for the ear, 60% for the shoulders and 50% for the chest. 3% of scars did not respond. They reported that not a single patients was made worse by the day case procedure. Here at The Scar Team in Bristol, we have been offering this treatment for three years and have one of the largest experiences of this technique in Europe. There has been an improvement with keloids of all sizes with a single treatment, but we have noted that about 5-10% of patients need two treatments to produce address more problematic lesions. ...

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1 week ago

Scar Team

Dr Ardeshir Bayat proposed an interesting new approach to keloid scars at The Scar II Conference. Photodynamic therapy (PDT) is already used for some forms of skin cancer and other skin lesions. In this standard technique, the patient is injected with a drug that sensitises the skin to light energy. After a period of time, that area is then illuminated with light of a particular wavelength. This activates the drug that was injected only at the site and as a result, kills only the local cells. Dr Bayat has proposed using the same technique for keloid scars. In several papers published in recent years, he has shown this approach to be beneficial in cells in the laboratory and has now advanced to treating patients. However, this work is still experimental in nature and importantly, he has shown that the benefit is dependent upon a range of factors including the type of photosensitiser drug injected, the amount of light energy hitting the skin and the part of the keloid in which the target cells reside. ...

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1 week ago

Scar Team

The dermatologist Michael Gold has an interest in lasers for early, aggressive scarring. Recent work with colleagues in China has focused on the utility of combining two laser types in the treatment of hypertrophic scars. Published in The Journal of Cosmetic Dermatology, their team made a rigorous attempt to undertake a controlled trial by assigning 56 patients to either a pulsed dye laser (PDL) or PDL followed by a fractional CO2 laser. Both PDL and fractional CO2 lasers are thought to work in different, but complementary ways on scarred skin. Using a Vancouver Scar Scale (VSS) and other parameters to assess outcome, they found that the combination of PDL and CO2 lasers was statistically better. There were some potential methodological issues with the work, not least the utility of the VSS to pick up change, duration of follow up and the issues of non-identical scars for both limbs. However, this piece of work was a useful addition to our understanding of the utility of lasers and we must now work on optimisation of the timing post-injury and settings of each laser to find the optimal means of treatment. ...

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1 week ago

Scar Team

Ardeshir Bayat of the University of Manchester gave a fascinating talk about the role of energy-based therapies in wound healing and scarring. It has been known for many years that a small electrical field exists across the skin and that on injury, a 'shock current' is passed between cells. Dr Bayat explained that within the epidermis of the skin the stratum corneum at the very top has a negative potential to the layers below. This field of charge is disrupted upon injury and a new 'endogenous electric field' is created which may have a role in repair. His group have modelled the application of external electric fields to the skin and shown that a particular current, voltage and waveform of electricity seem to stimulate wound healing in cell cultures. Moreover, the application of the same current to 60 healthy volunteers who had punch biopsies of their arms showed that certain beneficial chemicals (shown by a genomic mRNA screen) were stimulated by the electricity. These chemicals seem to be associated with reducing inflammation, increasing new blood vessel growth (angiogenesis), stimulating nerve growth (neurogenesis) and remodelling mature scar. ...

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2 weeks ago

Scar Team

What is new in the realm of silicone preparations? Silicone is thought to reduce inflammation within the epidermis of the skin and this, in turn, reduces inflammation in the layers of the skin below. The dermatologist Michael Gold has suggested that we should be moving beyond the traditional paradigm of placing silicone onto closed wounds and instead, looking at formulations which modulate the same effects on open wounds. Open wounds might include those that occur after chemical peels or laser treatment. Further, he has suggested using silicone formulations at an earlier stage in wound healing to pre-empt hypertrophic or keloid scar formation. Lastly, he has advocated using silicone formulations with added hypochlorous acid; this agent is thought to dampen down over-exuberant wound healing. Our thoughts are that silicone on open wounds needs to be examined in the context of a randomised controlled trial (RCT) to produce first rate evidence of its benefit. However, there is some evidence that for open wounds, an occlusive environment with increased moisturisation enhances epithelialisation (the regrowth of the top layer of the skin). If the trajectory of wound healing is improved, the late remodelling phase is likely to be less exuberant. In relation to hypochlorous acid, more evidence is required and it is useful that Dr Gold has recently published a treatment regimen with the new agent that could be one limb of an RCT (Journal of Cosmetic Dermatology, June 2017). ...

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2 weeks ago

Scar Team

At The Scar II Conference, Christine Dierickx presented a useful case series on how laser-assisted delivery can make a real-world benefit to problematic scars. 12 patients with 32 keloid or hypertrophic scars all improved rapidly with a fractionated laser and the application of traditional topical agents such as triamcinalone and 5-fluorouracil. The study only really qualified as 'proof of concept' given the small numbers recruited and the outcome measures involved. However, the presented work certainly raises the hypothesis that laser-assisted delivery can deliver potent drugs to the heart of a dense scar quickly and effectively. ...

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2 weeks ago

Scar Team

If we are going to deliver drugs to the bottom layer of the skin (the dermis), there may be a few problems inherent in the technique of using lasers to create multiple small, temporary tunnels in the skin. As surgeon scientist, Dr Josef Haik, reported at The Scar II Conference, it is all very well getting a laser to create a route for drugs to get to scars, but the laser may stimulate surrounding swelling and a physical block from burning, both of which prevent drug movement. His research team are getting around this problem by investigating how a unique device can create a physical pressure wave to drive drugs into the small holes that the laser makes and as such, improve the likelihood of therapeutic success. ...

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2 weeks ago

Scar Team

At The Scar II Conference, there was much talk about how we can get drugs deep into the skin to improve scarring. Normally the top layer of the skin provides a waterproof barrier to prevent loss of salty fluids and protein from the skin. This is a beneficial and vital role. However, the waterproofing of the epidermis can also prevent drug entry unless the chemical is adapted to make it favour the more fat-like epidermis (a 'lipophilic' drug). One way of allowing drugs to penetrate more deeply is to give them an artificial route into the bottom layer of the skin. Uwe Pasch from the University of Leipzig gave a fascinating talk on how lasers can help. The fractionated, ablative lasers create thousands of microscopic tunnels within the skin down to the dermis where scars are formed. If a drug is applied immediately after the tunnels are created, it enters and exerts its action after binding to the walls of each tunnel. This may be a future simple route for drug delivery which could be tailored to the nature of each scar. Thicker scars would necessitate a stronger laser energy and more tunnels on the surface to allow more drug to penetrate deeply. ...

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2 weeks ago

Scar Team

Michael Gold, a dermatologist from the United States, has carried out a number of studies to demonstrate the utility of silicone in the setting of hypertrophic scars. In 1993, he undertook a split-site study, where only one half of the scar was treated with topical silicone gel sheeting and the other was not. Only the treated side flattened and became less red. Since then, his group have undertaken experiments seemingly indicating that early topical silicone, immediately after a wound has been closed, has a similar benefit in so much as there was a lesser recurrence of hypertrophic scarring. We have long used topical silicone at the scar team and over the coming months, we will be exploring how it should be used and the potential mechanisms by which it is thought to work. ...

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2 weeks ago

Scar Team

How long does it take for a scar to a mature? In work at the University of Maastricht, the answer was found to be, 'surprisingly long'. In a review of 361 patients over five years, there was a clear difference with age and with treatment modality. Young subjects (<30 years) took longer for their hypertrophic scars to mature (average 35.6 months) compared to older patients (>55 years, average 22.5 months to mature). Treatment techniques seemed to expedite healing including: pressure garments (23.2 months average); silicone (35.5 months) and combination therapy (30.6 months). Although not entirely rigorous as an observational study of a cohort of patients, it still raises important questions about the trajectory of a scar and when to intervene. ...

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3 weeks ago

Scar Team

Pressure therapy has been used for decades to treat hypertrophic or keloid scars. Examples of its usage include pressure garments and clip earrings. However, to get exactly the right pressure (15-25 mmHg) takes a great deal of expertise. A recent paper in the journal Burns from an Australian group has shown that the pressure beneath a garment diminishes with time and can also be influenced by site. This reinforces the need for pressure garments to be fitted by an expert scar therapist and also to be regularly checked to ensure that they are exerting adequate force. Alison Guy on our team has vast experience in this field. She can measure, order and re-assess garments which are bespoke in nature. ...

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3 weeks ago

Scar Team

When should you use a laser to treat a maturing scar? According to Merete Haedersdal of the University of Copenhagen at the Scar II Conference, there is no clear consensus. Her team undertook a rigorous review of the literature - a systematic review - and found that there were few scientific studies which addressed how long after injury it is most advantageous to use laser treatment. Only 17 studies satisfied the very stringent criteria for analysis with comparison to an untreated scar. The types of lasers used included PDL, KTP, Er:YAG and fractional CO2. Treatments were given in different phases of wound healing: inflammation, proliferation and remodelling. Although there was no type of laser or time after injury that was most effective, a broad conclusion was that there was an overall benefit from laser application in terms of the severity of the final scar. ...

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3 weeks ago

Scar Team

A fascinating paper from the East Grinstead team in the journal BMJ Case Reports made an interesting finding about self-harm scars. A patients with such scars was assessed by a psychologist during their journey through surgical management. Although the surgery made the scar more conspicuous, there was a 'profound psychological benefit'. There is certainly a theory that a significant procedure can alter the perception of a stigmatising scar. We would advocate a multi-modal approach with every scar being taken on its merits. We are seeing a greater number of self-harm patients in clinic and there are a number of approaches to this difficult problem. ...

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3 weeks ago

Scar Team

How might lasers work to improve scarring? One theory was put forward by Uwe Paasch of the University of Leipzig at The Scar II Conference this year. It is thought that the heating effect of certain lasers induces molecules called heat shock proteins (HSPs) within skin cells. HSPs are important for protecting proteins from permanent damage. In effect, HSPs bind to essential proteins within cells and sustain their function. Moreover, HSPs also enhance the suppress activity of certain immune cells called T regulatory cells. T regulatory cells may calm the immune response to injury within the skin. Therefore, there are at least two suggested ways by which the targeted heating effect of a laser is effective at changing the response to injury. ...

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3 weeks ago

Scar Team

The Imperial College team has found that by grafting hairs into atrophic or thinned scars, there is a remarkable transformation in the skin. Collagen thickness is increased, the collagen fibres are more aligned and the dermis is more dense. In essence, the bottom layer of the skin remodels to a structure that is more in keeping with normal skin. Looking at one form of messenger molecule in such skin using a global screening approach, it was found that over 200 genes were modified by the presence of transplanted hairs. This work reinforces one approach that The Scar Team take for visible scars in hair-bearing areas: hair transplantation to mask the scar and improve its structure. ...

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4 weeks ago

Scar Team

An interesting approach to remodelling an angry scar was described at both Scar II and ScarCon by Magdalena Plotczyk of Imperial College, London. She is using hair follicles to remodel stretched scars. Stretched, or atrophic, scars can be very difficult to treat as the bottom layer of the skin - the dermis - is thinned and disorganised. Often they occur after slow wound healing or at particular body sites. Ideally, we would remodel the dermis to produce a structure similar to uninjured skin. During hair follicle growth, the surroundings - termed 'extracellular matrix' undergo constant remodelling. Her hypothesis is that this natural phenomenon can be harnessed to stimulate thickening and re-organisation of the bottom layer of the skin. ...

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4 weeks ago

Scar Team

Prof Gurtner at Scar II indicated that his team had developed a dressing to shield a healing wound from stresses - mechanical forces across the wound. Clinical trials had shown reduced scarring. Modulation of the tension across a wound is an approach we have used for a long time at The Scar Team. Prof Gurtner emphasised that it seems to have benefit for both acute and, surprisingly, chronic wounds. ...

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4 weeks ago

Scar Team

Professor Geoffrey Gurtner addressed whether we can ever aspire to truly scarless wound healing at the Scar II Conference. His work has focused on whether the stresses across a wound can make the resulting scar at the site become more hypertrophic - abnormally red, raised and itchy. His team's initial work identified that an anchor molecule on the surface of cells, focal adhesion kinase (FAK), transforms any tension on the outside into an internal trigger that drives the production of lots of inflammatory chemicals. Ultimately, this leads to inflammation and fibrosis. This work is fundamental to lots of proposed treatment for hypertrophic and keloid scarring - does offloading tension on a scar in clinic reduce how angry it gets? It has relevance to a range of techniques, from massage to pressure garments. The field is termed mechanotransduction and it is one of the most exciting areas of current scar research. ...

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4 weeks ago

Scar Team

Prof Bayat reported at the Scar II conference that he has optimised a keloid model where cells are suspended in a collagen gel. This model does not use animals and can be tested for the response to interventions that we use clinically. Using this technique, the molecule PAI-1 has been identified as a potential target for anti-scarring drugs. ...

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4 weeks ago

Scar Team

Ardeshir Bayat noted at Scar II that artificial 3D models of keloids do not really match real scars. This has led researchers to look at models in which keloid tissue is transplanted onto mice. However, again this is not perfect as the transplant is attacked by the host’s immune system. It may also be altered by the hormones of the host. Not only may the results not reflect what happens to scars in humans, but there are also ethical issues of animal models. ...

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1 month ago

Scar Team

Ardeshir Bayat from The University of Manchester gave a comprehensive talk about the models and causes of keloid scarring during the Scar II Conference. He noted that most existing models of keloid scars rely upon single cell culture. This is very artificial. In real life, the fibroblast cells which drive collagen production are influenced by both the overlying top layer of the skin (epidermis) and the surrounding connective-tissue. In order to address this problem, groups around the world are starting to create artificial mixtures of cells in three dimensions. This is thought to better replicate the reality of keloid biology. ...

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1 month ago

Scar Team

At Scar II, Gerg Gauglitz, professor of dermatology in Munich, gave a comprehensive talk on the structure of scars. Hypertrophic scars are thought to have an excess of a certain type of collagen called ‘type III’. This collagen seems to line up parallel to the top layer of the skin. Hypertrophic scars seem to have large numbers of cells called myofibroblasts which lay down connective-tissue. In contrast, keloid tissue is mainly composed of type I and type III collagen which is organised in a more haphazard manner. There are also less myofibroblasts in a mature keloid. A key message from Prof Gauglitz’s talk was that abnormal scarring seems to be associated with a failure to resolve early wound healing. ...

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1 month ago

Scar Team

The Scar II Conference was held in Tel Aviv, Israel. There were a wide range of world famous researchers and scar clinicians who were giving updates on recent advances. Dr Ofir Artzi, The conference chairman, reported that there are an estimated 15 million people a year who sustained significant scarring from accidents, surgery or disease in the first world setting. ...

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1 month ago

Scar Team

Over the next few weeks we will be giving updates about the advances in scar management from the two leading international conferences, Scar II and ScarCon. ...

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4 years ago

Scar Team

The effect of a significant scar are devastating to the individual. Pain, itch and limitation of range of motion may make simple tasks impossible. Sleep may be disrupted. Moreover, the effects on appearance and perceived body image may make the sufferer withdrawn, cause flashbacks and even trigger clinical depression. Each problem cannot be dealt with in isolation - that is why we are here. ...

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4 years ago

Scar Team

Welcome to The Scar Team Facebook page. We are a multi-disciplinary team based in Bristol who focus on the treatment of scarring of the skin. ...

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4 years ago

Scar Team

The Scar Team were delighted to see a new consensus statement on scar management that was reached by a renowned international group. The review, published in the journal JPRAS, indicated the key strategies to reduce scar formation of limiting tension, avoiding excessive ultraviolet light exposure and keeping the early scar hydrated. Further, we offer the majority of the recommended treatments for developing scars, from topical silicone to pressure garments. We will be discussing the findings of this group, led by respected scar investigators such as Luc Teot and Esther Middelkoop, over the coming weeks. ...

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