Controlling Inflammation Pre-Emptively or at the Time of Cutaneous Injury Optimises Outcome of Skin Scarring

Abstract

Inflammation plays an active role during the wound healing process. There is a direct association between the extent of injury as well as inflammation and the amount of subsequent cutaneous scarring. Evidence to date demonstrates that high levels of inflammation are associated with excessive dermal scarring and formation of abnormal pathological scars such as keloids and hypertrophic scars. In view of the multiple important cell types being involved in the inflammatory process and their influence on the extent of scar formation, many scar therapies should aim to target these cells in order to control inflammation and by association help improve scar outcome. However, most current treatment strategies for the management of a newly formed skin scar often adopt a watch-and-wait approach prior to commencing targeted anti-inflammatory therapy. Moreover, most of these therapies have been evaluated in the remodelling phase of wound healing and the evaluation of anti-inflammatory treatments at earlier stages of healing have not been fully explored and remain limited. Taken together, in order to minimise the risk of developing a poor scar outcome, it is clear that adopting an early intervention prior to skin injury would be optimal, however, the concept of pre-emptively priming the skin prior to injury has not yet been thoroughly evaluated. Therefore, the aim of this review was to evaluate the available literature regarding scar therapies that aim to target inflammation which are commenced prior to when a scar is formed or immediately after injury, with a particular focus on the role of pre-emptive priming of skin prior to injury in order to control inflammation for the prevention of poor scarring outcome.

A comprehensive exploration of hydrogel applications in multi-stage skin wound healing

“…They aid in the interchange of fluids between unhealthy and healthy tissues, which encourages the healing of wounds. 148 Therefore, achieving quick wound healing without leaving scars is the main objective at this stage.…”

Insights into the role of adipose-derived stem cells and secretome: potential biology and clinical applications in hypertrophic scarring

“…ADSC can further reduce proliferative scarring by inhibiting the number and activity of mast cells [ 94 ]. Prostaglandin E2 (PGE2) is produced with the help of the cyclooxygenase (COX)-1 or COX-2 and is the most abundant form of prostaglandin in the body [ 109 ]. It is well-known that PGE2 produced by ADSCs has an anti-inflammatory effect in the context of wound healing and pathologic scar formation, as it inhibits the proliferation and function of immune cells and induces macrophages to upregulate IL-10 expression.…”