Mechanisms for keloid formation include drastic changes in growth factor actions, collagen turnover, mechanical forces applied over the skin, and genetic and immunologic contributions. The use of corticosteroids to manage keloids increases basic fibroblast growth factor production while decreasing transforming growth factor-beta1 production by human dermal fibroblasts, endogenous vascular endothelial growth factor, and insulin-like growth factor-1. The use of corticosteroid injections is, to date, the core treatment available for the management of excessive tissue production in scars. Currently, the most effective and safe regimen for keloid management appears to be the use of corticotherapy-injection of intradermal steroids after a surgical excision.

Scars evolve through a maturation stage during which it is necessary to adapt different treatments. To adapt treatments, it is necessary to assess various parameters linked to inflammation. To this end, clinical scar assessments are subjective though reliable, and validation is operator dependent. The Vancouver Scar Scale, Visual Analogic Scale, Patient and Observer Scar Assessment Scale, and the Manchester Scale assess different scar characteristics. These scales are interesting, depending on the type of scars, and are easy to use but subject to errors. To use clinical a scale, the raters must be trained. Parameters can also be precisely assessed by technical means, whereby they rate only one parameter, but are more accurate. Some scales are easy to use, have low cost, and can be used for clinical assessment. Others scales are more complex and expensive, and can be used in research or treatment evaluation.

Current methods of measuring changes in the thickness of scarred tissue are prone to error, making it hard to assess the effectiveness of treatment. PRIMOS is a digital system that makes accurate measurements of three-dimensional images.

No abstract

No abstract