Correction to: Treatment of Immature Scars: Manual Massages

Owing to an oversight on the part of the production, this chapter was initially published with incorrect authorship. The chapter was published with first author name alone, co-authors were inadvertently missed.

Effectiveness of Corticosteroid Tapes and Plasters for Keloids and Hypertrophic Scars

In Japan, corticosteroid tapes and plasters have long served as a first-line therapy for keloids and hypertrophic scars. Pediatric patients are particularly responsive to this type of treatment. This may reflect the fact children have thinner skin than adults and the steroids are therefore more easily absorbed. The postoperative application of corticosteroid tapes/plasters also significantly prevents the development of keloids and hypertrophic scars after surgery. Steroid tape is available in the following three countries in different preparations. In the UK, the commercially available formulation comprises a fludroxycortide-impregnated tape (4 μg/cm2). Fludroxycortide tape is a Group III preparation. The USA has a steroid tape preparation that contains 4 μg/cm2 flurandrenolide, which is also a Group III preparation. In Japan, two steroid tape formulations are available, namely, the Group III preparation found in the UK (4 μg/cm2 fludroxycortide tape) and a 20 μg/cm2 deprodone propionate tape. Deprodone propionate tape is considered to be a Group I or II preparation. In our experience, deprodone propionate tape (Eclar® plaster) is the most effective tape for the treatment and prevention of keloids.

Scar Symptoms: Pruritus and Pain

Scars can present with a wide variety of symptoms relating to appearance, function, as well as sensory disturbances. Pain and pruritus (itch) are by far the most common symptoms in clinical practice; they are often severe and have the propensity to persist over a prolonged period of time following wound healing. Earlier notions supported itch as a sub-modality of pain; however, with recent advances in the pathophysiology field and the delineation of discrete neurological pathways, they are recognized to comprise separate sensory modalities albeit sharing common key features. There is a significant amount of evidence that sensory symptoms can decrease patients’ quality of life in the acute and rehabilitative phase of wound healing and scar formation. This chapter aims to outline the basic pathophysiological processes underlying pain and pruritus in scars and present a variety of options available for management of these symptoms. The section will primarily draws upon scientific and clinical studies relating to burn hypertrophic and keloid scars given that most literature reports have studied sensory disturbances in these subtypes.

Emerging Technologies in Scar Management: Remodeling of Post-surgical Linear Scar Using Microplasma Radiofrequency

Linear scar is a common problem in all fields of surgery as it leads to unpleasant appearance that is not socially acceptable. In particular, linear scars in the exposed areas such as face, neck, and upper extremities cause significant psychological disturbance to patients who need proper medical assistance to release their suffering. The author proposed tissue remodeling strategy on an existed linear scar using FMRT (fractional microplasma radiofrequency technology) to render gross view of a linear scar less visible or non-visible by changing the scar tissue architecture. Similar concept is also applied to the intervention of an early-stage wound to significantly alter the natural process of wound healing via FMRT-mediated change of the histological architecture of a wound, and thus to prevent the formation of a grossly visible linear scar. This chapter introduces the general background information, FMRT concept, and its application on linear scar treatment and prevention with the presentation of several typical cases.

New Drugs for Scar Treatment

Cutaneous scar formation following injury is an exuberant fibro-proliferative event and causes aesthetic distress associated with functional problems for those afflicted. Traditionally, surgical revision of excessive hypertrophic scars is commonly performed. However, scar recurrence rate is high and surgical treatments are often combined with radiation therapy, corticosteroid injections, or with other noninvasive therapies. Pharmacological intervention of scar-promoting cellular activities has recently gained traction based on the emerging scientific evidence proving efficacy and safety of new therapeutics in preclinical studies. Ideal new drug therapies would be noninvasive, inexpensive, safe-to-use, and effective in prevention of scar formation. Recently, cytokine-based therapies and modulators of mechanotransduction are being evaluated for their anti-fibrotic properties in the reduction and prevention of scarring. Therapeutic potential of evidence-based new scar therapeutics holds promise toward improving the current wound and scar management practice.

Management of Scarring Following Aesthetic Surgery

Patients undergo cosmetic surgery to improve their appearance and so, even though surgical scars cannot be avoided, they must be minimized as part of the aesthetic care process. The challenge is to make scars as inconspicuous as possible, and there are many techniques to be considered, including proper patient selection, preoperative preparation, the choice of surgical techniques, and postoperative care. The proactive management of tissue healing with prophylaxis of pathological scarring is particularly important. As the scarring process passes through multiple phases over a 6-week to 6-month period, cosmetic surgeons should not only plan to prepare patients well in advance of surgery but also be prepared to provide support to patients well after.

Makeup Therapy for Scars

Because we live in a society that is very much concerned with physical appearance, looking as good as possible has become everyone’s main goal. Consequently, unsightly skin imperfections can have a dramatic and highly negative impact on a patient’s personal, social, or working life.Medical makeup thus represents an alternative solution, helping patients to regain their self-confidence, particularly in the case of visible dermatoses, scars, and burns, whether permanent or temporary.

Minimally Invasive Technologies for Treatment of HTS and Keloids: Fractional Laser

This chapter presents a state-of-the-art insight into the use of fractional laser for the management of this complex problem. In particular, we focus on the management of complex scars such as those occurring post-burn injury and split-thickness skin grafting.

Structural Assessment of Scars Using Optical Techniques

The evaluation of scar treatment benefits from exact structural measurements. Accurate assessment of thickness, surface area, and relief is crucial in routine clinical follow-up. From an experimental perspective, precise visualization of the microstructural organization is necessary for a better understanding of the mechanisms underlying pathological scarring. Structural proteins in scars differ from healthy skin in terms of amount, type, and importantly, organization. The precise quantification of this extracellular matrix (ECM) organization was, until recently, limited to two-dimensional images from fixated and stained tissue. Advances in optical techniques now allow high-resolution imaging of these structures, in some cases in vivo. The enormous potential of these techniques as objective assessment tools is illustrated by a substantial increase in available devices. This chapter describes currently used devices and techniques used in the clinical follow-up of scar progression from a volumetric standpoint. Furthermore, some of the most powerful techniques for microstructural research are described including optical coherence tomography, nonlinear optical techniques such as second harmonic generation microscopy, and confocal microscopy.

Invasive Techniques in Scar Management: Skin Substitutes

In the last decades, skin substitutes have emerged as an important innovation in improving scar quality. They can be applied during the initial wound management but also during scar reconstruction procedures. This chapter provides an overview on the development, current state, and future of cell-seeded and tissue-engineered skin substitutes. We will discuss some of the most important varieties of skin substitutes in the context of scar formation and wound healing.