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A comprehensive evidence-based review on the role of topicals and dressings in the management of skin scarring.

Sidgwick GP, McGeorge D, Bayat A - Arch. Dermatol. Res. (2015)

Bottom Line: Scars appear as a different colour to the surrounding skin and can be flat, stretched, depressed or raised, manifesting a range of symptoms including inflammation, erythema, dryness and pruritus, which can result in significant psychosocial impact on patients and their quality of life.In total, 39 articles were included, involving 1703 patients.There was limited clinical evidence to support their efficacy; the majority of articles (n = 23) were ranked as category 4 LOE, being of limited quality with individual flaws, including low patient numbers, poor randomisation, blinding, and short follow-up periods.

View Article: PubMed Central - PubMed

Affiliation: Plastic and Reconstructive Surgery Research, Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, Manchester Institute of Biotechnology, University of Manchester, 131 Princess Street, Manchester, M1 7DN, UK.

ABSTRACT
Wound healing after dermal injury is an imperfect process, inevitably leading to scar formation as the skin re-establishes its integrity. The resulting scars have different characteristics to normal skin, ranging from fine-line asymptomatic scars to problematic scarring including hypertrophic and keloid scars. Scars appear as a different colour to the surrounding skin and can be flat, stretched, depressed or raised, manifesting a range of symptoms including inflammation, erythema, dryness and pruritus, which can result in significant psychosocial impact on patients and their quality of life. In this paper, a comprehensive literature review coupled with an analysis of levels of evidence (LOE) for each published treatment type was conducted. Topical treatments identified include imiquimod, mitomycin C and plant extracts such as onion extract, green tea, Aloe vera, vitamin E and D, applied to healing wounds, mature scar tissue or fibrotic scars following revision surgery, or in combination with other more established treatments such as steroid injections and silicone. In total, 39 articles were included, involving 1703 patients. There was limited clinical evidence to support their efficacy; the majority of articles (n = 23) were ranked as category 4 LOE, being of limited quality with individual flaws, including low patient numbers, poor randomisation, blinding, and short follow-up periods. As trials were performed in different settings, they were difficult to compare. In conclusion, there is an unmet clinical need for effective solutions to skin scarring, more robust long-term randomised trials and a consensus on a standardised treatment regime to address all aspects of scarring.

No MeSH data available.


Related in: MedlinePlus

A proposed flowchart indicating the different stages of the scar management timeline, as recommended by the corresponding senior author. A structured clinical assessment is required, taking into consideration patient medical and family history, including current signs and symptoms and utilising a range of quantitative and qualitative measurements in order to enable a targeted treatment, which may evolve over time as signs and symptoms change
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Fig2: A proposed flowchart indicating the different stages of the scar management timeline, as recommended by the corresponding senior author. A structured clinical assessment is required, taking into consideration patient medical and family history, including current signs and symptoms and utilising a range of quantitative and qualitative measurements in order to enable a targeted treatment, which may evolve over time as signs and symptoms change

Mentions: What is clear from this review is that a standardised and systematic approach and strategy for evaluating scars prior to deciding on the appropriate treatment regime is required (Fig. 2). Symptoms and signs, as well as physical and psychosocial complaints, need to be considered early, through use of objective scar assessment scales and possibly tools, to elucidate the most significant factors. The PRISM scale [18] potentially has additional benefit in this context, as it includes a patient’s perspective. Treatment, if appropriate, needs to address these specific issues individually (Table 3; Fig. 3). It is important to regularly monitor and re-evaluate response to therapy, particularly to assess signs and symptoms as they change in response to treatment and scar maturation. Thus, as symptoms and signs of the scars change over time, a clinician’s approach with targeted therapy would need to be altered. A greater utilisation of a range of subjective and objective non-invasive tools throughout this process, such as standardised photography, laser Doppler imaging, 3D cameras, and SIAscopy, would likely aid interpretation and evaluation of the skin scars, both in a research and clinical setting, and lead to a more targeted treatment based on managing problematic scar-related signs and symptoms.Fig. 2


A comprehensive evidence-based review on the role of topicals and dressings in the management of skin scarring.

Sidgwick GP, McGeorge D, Bayat A - Arch. Dermatol. Res. (2015)

A proposed flowchart indicating the different stages of the scar management timeline, as recommended by the corresponding senior author. A structured clinical assessment is required, taking into consideration patient medical and family history, including current signs and symptoms and utilising a range of quantitative and qualitative measurements in order to enable a targeted treatment, which may evolve over time as signs and symptoms change
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4506744&req=5

Fig2: A proposed flowchart indicating the different stages of the scar management timeline, as recommended by the corresponding senior author. A structured clinical assessment is required, taking into consideration patient medical and family history, including current signs and symptoms and utilising a range of quantitative and qualitative measurements in order to enable a targeted treatment, which may evolve over time as signs and symptoms change
Mentions: What is clear from this review is that a standardised and systematic approach and strategy for evaluating scars prior to deciding on the appropriate treatment regime is required (Fig. 2). Symptoms and signs, as well as physical and psychosocial complaints, need to be considered early, through use of objective scar assessment scales and possibly tools, to elucidate the most significant factors. The PRISM scale [18] potentially has additional benefit in this context, as it includes a patient’s perspective. Treatment, if appropriate, needs to address these specific issues individually (Table 3; Fig. 3). It is important to regularly monitor and re-evaluate response to therapy, particularly to assess signs and symptoms as they change in response to treatment and scar maturation. Thus, as symptoms and signs of the scars change over time, a clinician’s approach with targeted therapy would need to be altered. A greater utilisation of a range of subjective and objective non-invasive tools throughout this process, such as standardised photography, laser Doppler imaging, 3D cameras, and SIAscopy, would likely aid interpretation and evaluation of the skin scars, both in a research and clinical setting, and lead to a more targeted treatment based on managing problematic scar-related signs and symptoms.Fig. 2

Bottom Line: Scars appear as a different colour to the surrounding skin and can be flat, stretched, depressed or raised, manifesting a range of symptoms including inflammation, erythema, dryness and pruritus, which can result in significant psychosocial impact on patients and their quality of life.In total, 39 articles were included, involving 1703 patients.There was limited clinical evidence to support their efficacy; the majority of articles (n = 23) were ranked as category 4 LOE, being of limited quality with individual flaws, including low patient numbers, poor randomisation, blinding, and short follow-up periods.

View Article: PubMed Central - PubMed

Affiliation: Plastic and Reconstructive Surgery Research, Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, Manchester Institute of Biotechnology, University of Manchester, 131 Princess Street, Manchester, M1 7DN, UK.

ABSTRACT
Wound healing after dermal injury is an imperfect process, inevitably leading to scar formation as the skin re-establishes its integrity. The resulting scars have different characteristics to normal skin, ranging from fine-line asymptomatic scars to problematic scarring including hypertrophic and keloid scars. Scars appear as a different colour to the surrounding skin and can be flat, stretched, depressed or raised, manifesting a range of symptoms including inflammation, erythema, dryness and pruritus, which can result in significant psychosocial impact on patients and their quality of life. In this paper, a comprehensive literature review coupled with an analysis of levels of evidence (LOE) for each published treatment type was conducted. Topical treatments identified include imiquimod, mitomycin C and plant extracts such as onion extract, green tea, Aloe vera, vitamin E and D, applied to healing wounds, mature scar tissue or fibrotic scars following revision surgery, or in combination with other more established treatments such as steroid injections and silicone. In total, 39 articles were included, involving 1703 patients. There was limited clinical evidence to support their efficacy; the majority of articles (n = 23) were ranked as category 4 LOE, being of limited quality with individual flaws, including low patient numbers, poor randomisation, blinding, and short follow-up periods. As trials were performed in different settings, they were difficult to compare. In conclusion, there is an unmet clinical need for effective solutions to skin scarring, more robust long-term randomised trials and a consensus on a standardised treatment regime to address all aspects of scarring.

No MeSH data available.


Related in: MedlinePlus