Synergistic Effects of Quercetin-modified Silicone Gel Sheet in Scar Treatment

Both silicone gel and quercetin are effective in scar treatment but have different action mechanisms. Quercetin is mainly applied in the gel form and can lead to poor adhesion of silicone gel sheet; therefore, they cannot be combined in clinical use. In this study, a silicone gel sheet that releases quercetin in a sustained manner for 48 hours was successfully developed. Four round scars (Ø: 1 cm) were made in the ears of New-Zealand albino rabbits (n=10). After scar healing, the rabbits were divided into four groups: blank control group with no treatment, silicone gel sheet group with dressing change every 2 days, quercetin group with dressing change 3 times daily, and combination treatment group with dressing change every 2 days. Scar assessment was performed 3 months later. Transepidermal water loss showed no difference between the combination treatment group and the silicone gel sheet group, but was lower than that in the quercetin group and the blank control group. Immunohistochemistry of CD 31 and proliferating cell nuclear antigen showed the following results: combination treatment group < silicone gel sheet group = quercetin group < blank control group. Polymerase chain reaction results showed that the expression of type-I and type-III collagen in the combination treatment group and the quercetin group was significantly lower than that in the other two groups. Thus, quercetin-modified silicone gel sheet combines the advantages of the two treatments and is more effective at inhibiting cell proliferation in scar tissue than either of the two treatments alone.

117 Feasibility and Scar Outcome with a Single-use Adhesive Silicone in Pediatric Burn Survivors

Introduction Silicone sheets are commonly used for prevention and treatment of burn scars and silicone-based products have recently been recommended as the gold standard non-invasive treatment choice. One problem with silicone gel sheets application is that the sheets lose their adhesive qualities making them difficult to affix to the patient and costly to replace when lost. A new ultra-thin, clear and adhesive silicone gel sheet layered on a semi-permeable polyester backing was trialed at our burn center. The silicone is designed to be a one-time application, worn during all activities until it naturally falls off, thus eliminating the need for daily removal and cleaning. The purpose of this study was to evaluate the feasibility and effectiveness of the single-use adhesive silicone sheets with pediatric burn survivors. Methods Medical records of pediatric burn survivors who used the adherent silicone sheets between September 2019 and July 2020 were retrospectively reviewed. Information regarding details of silicone use and scar outcome scores were extracted from the records. Data were analyzed using paired Student t-tests and Wilcoxon Signed Rank to compare scars before and after using the silicone. Results The silicone was applied to 22 body areas of 9 patients. The average age of the patients was 7.4 (±8.5) years and TBSA 53 ±17%. The time from injury or grafting to when the silicone was applied was 200.5 (±13.4) days. The silicone was worn without interruption for an average of 12.8 days. Total Patient Observer Scar Assessment Scale (POSAS) scores for both the patient and observer evaluations significantly improved after use with the single-use adherent silicone (↓13.83 patient p=.005, ↓5.4 observer p=.01). Evaluating individual scar parameters showed 4/7 patient reported and observed areas of the POSAS evaluation improved significantly with adherent silicone use (Figure 1). Only one patient reported a complication of itch at day 5 and the silicone was removed. Conclusions The single-use adhesive silicone investigated in this study appears to adequately adhere to patients over multiple days, thus overcoming common barriers to silicone use of the products falling off, getting lost and needing to be replaced. Use of such a product could improve ease and continuity with scar management. In addition, for this small cohort of patients, scar improvement was noted with silicone use. The results of this study indicate that larger prospective studies evaluating the silicone efficacy may be beneficial.

Keloid Formation after Circumcision: A Case Report and Current Literature Review

Although penile keloid formation can be seen after major penile surgeries, it is rarely reported after circumcision and there is no standard method for the treatment of this complication. We present a patient who was admitted with a penile keloid mass that occurred after circumcision surgery and discuss the treatment we administered in light of the current literature review. A 7-year-old white boy was admitted to our clinic with a swollen stiff mass on the foreskin six months after circumcision. The parents indicated that no complication occurred in the early postoperative period. Physical examination revealed a white-colored stiff mass measuring approximately 2×1.5 cm in size along the penile ventral surface. Intralesional injection of 0.5 ml triamcinolone acetonide was administered for 12 weeks. At 9 months after circumcision, the keloid tissue was resected. Beginning from the first postoperative week, a silicone gel sheet and topical steroid application were administered for 8 weeks. At a 1-year follow-up, the penis had a satisfactory appearance.

Management of Scars in Skin of Color

Keloids and hypertrophic scars are abnormal scars, produced by an odd wound-healing response to trauma with a higher incidence in pigmented skin patients. They could be painful or itchy, producing functional and/or cosmetic disability. This chapter focuses on defining scars especially in pigmented skin and the different methods for treating keloids that have been investigated in the literature. Up to the present time, the ideal treatment method has not been defined, although numerous modalities have been designated. We will represent the variances among different scar types and their management methods, concentrating on their indications, modes of action, uses, safety, and efficiency of the following therapies: intralesional steroid, injections of silicone gel/sheet, radiotherapy, photodynamic therapy, electrical stimulation, surgical excision and adjuvant therapy, and cryosurgery. Combination therapies have also shown some value. Still, there is a shortage of randomized clinical trials (RCTs) evaluating such treatment modalities. Management of scar in pigmented (colored) skin is clinically challenging. Therefore, strategic assessment and targeted therapy with focus on deterring recurrence are most needed. The quality of evidence is crucial to select efficient treatments for patients with colored skin, presenting with keloid.

ALTERATION IN GENE EXPRESSION OF TRANSFORMING GROWTH FACTOR- Β FOLLOWING TREATMENT OF HYPERTROPHIC BURN SCARS WITH THREE DIFFERENT THERAPEUTIC MODALITIES

Background: Hypertrophic scar (HTS) is a dermal form of fibro-proliferative disorder often caused by thermal injury to the deep dermis. Transforming growth factor β1 & 2 are well known pro-fibrotic cytokines promoting ECM production and tissue fibrosis. The present study was designed to evaluate the different therapeutic modalities for management of hypertrophic scar and correlate it with altered expression of TGF beta gene at the molecular level. Materials and Methods: One hundred and twenty patients with hypertrophic post burn scar were randomly distributed into three different treatment groups of Pressure Garments, Silicone Gel Sheet and Triamcinolone Injection. Total RNA was isolated from the scar tissue in cases before and 6 months after the therapy and from normal skin in controls to evaluate the expression of TGF beta (1, 2 & 3) by real time PCR. Results: Following treatment, the expression of TGF β-1 & 2 was down regulated while that of β-3 up regulated. The overall positive response (combining all the groups) was 94% out of which, 16.6% were cured, 47.5% showed major improvement and minor changes were observed in 30.8% of patients. Discussion: All the three modalities of treatment were effective in bringing down the level of TGF β-1&2 and in up-regulating antifibrotic β3 and this correlated well with the clinical improvement in the scar thickness, pliability etc. Conclusion: Out of all, intralesional Triamcinolone Injection achieved the best result. Keywords: Hypertrophic Scar, Transforming Growth Factor β, Pressure Garments, Silicone Gel Sheet, Triamcinolone Injection