Clinical and Histological Correlation in Post-Burn Hypertrophic Scar for Pain and Itching Sensation

Abstract

BackgroundHypertrophic scar following a burn is caused by the excessive deposit of collagen resulting in an exaggerated wound healing response. The burn patient complains of pain and itching over the scar, which can give rise to cosmetic and functional problems.ObjectiveThe aim of this study was to investigate the clinical and histological correlation of a hypertrophic burn scar for itching and pain sensations.MethodsThirty-eight patients underwent a scar release and skin graft. the modified Vancouver scar scale and the verbal numerical rating scale were recorded. All biopsies were taken from scar tissue (scar) and normal tissue (normal). Histologically, tissues were observed in the epidermis, the monocytes around the vessels, the collagen fiber, elastic fiber, and the mast cells.ResultsThe mean total score of MVSS was 8.4±2.7 (pliability 2.0±0.9; thickness 1.8±0.9; vascularity 2.0± 0.9; and pigmentation 2.1±0.9). Pain and itching were 2.4±2.0 and 2.9±3.0. Epidermis were 7.9±2.8 layers (scar) and 4.0±0.8 layers (normal). The collagen fibers were thin and dense (scar) and thicker and loose (normal). The elastic fibers were thin and nonexistent (scar) and thin and loose (normal). Mast cells were 11.2±5.8/high power field (scar) and 7.4±4.1 (normal).ConclusionAs the scar tissue thickens, the itching becomes more severe. The stiffness of the scar with the pain appeared to be associated with the condition of the tissue. The correlation between clinical and histological post-burn hypertrophic scars will help further studies on the scar. This helped with the development of the base material for therapeutic strategies.

Increased epidermal thickness and abnormal epidermal differentiation in keloid scars

“…However, to date we have not found a publication comparing and measuring the epidermal thickness of sufficiently matured scars (≥ 1 year old) of the entire scar spectrum in a standardized, quantifiable manner. Hypertrophic scars also showed a trend towards increased epidermal thickness compared with normal skin and normotrophic scars, in line with Andriessen et al . However, in our study only keloid scars were found to have significantly increased epidermal thickness compared with normotrophic scars in addition to normal skin.…”

Biotechnological Management of Skin Burn Injuries: Challenges and Perspectives in Wound Healing and Sensory Recovery

“…This corroborates outcomes showing that this neuropeptide is especially elevated in case of hypertrophic scars, a complication tightly correlated with thermal injury and highly associated with itching (158)(159)(160). All of these data support many neurophysiological studies demonstrating that itching results from neuropathic mechanisms (161).…”

Functional Outcomes of Burn Patients with or without Rehabilitation in Mainland China

“…This may be because pain level would decrease but itchiness would increase during the period from wound healing to 6 months after injury. Itching usually begins at the time of wound healing and peaks at approximately 3e12 months or later (Choi, Kim, Kim, Jang, & Kwak, 2013). Rehabilitation can help to ease the uncomfortable symptoms of itching, as confirmed in previous studies (Cho et al, 2014;Li-Tsang, Zheng, & Lau, 2010;Wiechman, 2011).…”