Prevention and Management of Hypertrophic Scars and Keloids After Burns in Children

Abstract

Hypertrophic scars and keloids are challenging to manage, particularly as sequelae of burns in children in whom the psychologic burden and skin characteristics differ substantially from adults. Prevention of hypertrophic scars and keloids after burns is currently the best strategy in their management to avoid permanent functional and aesthetical alterations. Several actions can be taken to prevent their occurrence, including parental and children education regarding handling sources of fire and flammable materials, among others. Combination of therapies is the mainstay of current burn scar management, including surgical reconstruction, pressure therapy, silicon gels and sheets, and temporary garments. Other adjuvant therapies such as topical imiquimod, tacrolimus, and retinoids, as well as intralesional corticosteroids, 5-fluorouracil, interferons, and bleomycin, have been used with relative success. Cryosurgery and lasers have also been reported as alternatives. Newer treatments aimed at molecular targets such as cytokines, growth factors, and gene therapy, currently in developing stages, are considered the future of the treatment of postburn hypertrophic scars and keloids in children.

Efficacy of the combination of herbal extracts and a silicone derivative in the treatment of hypertrophic scar formation after burn injury

“…Many studies have addressed these problems and many treatment methods have been used (Bock et al, 2006;Gauglitz et al, 2011). Patients prone to scar formation during wound healing should receive early preventive treatment (Berman et al, 2008).…”

Long-term expression pattern of melanocyte markers in light- and dark-pigmented dermo-epidermal cultured human skin substitutes

“…The application of split-thickness skin grafts still is the standard method to cover full-thickness skin defects resulting from excisions of large burn injuries, scar revisions, and giant congenital nevi [1,2]. Obviously, the use of split-thickness skin is limited by the amount of donor sites available.…”

Evaluation of the Efficacy of Ablative vs. Fractional Er:YAG Laser Modes as a Treatment of Post-Burn Scars

“…The hand piece can be set to provide 7, 10 and 12 mm treatment spot sizes and Pixel Size 20-300 μm, Number of Pixel 4 -256 Pixels according to the selected level. In larger scar areas the technique we did, the first pass on all the area and the second pass only on the elevated bands the average number of passes (3)(4)(5), Energy (1000-1200 mJ) Mode SP, Spot size (7 mm) and frequency (3-5 Hz). The laser settings were developed from clinical experience with prior scar and resurfacing treatments.…”

“…Burn scars have, in addition, some functional morbidity such as contractures, hypertrophic changes and keloid formation. Furthermore, burn scars could produce persistent hyperemia, chronic folliculitis, intense and unrelenting pruritis and neuropathic pain [4,5].…”