Document 6481178

SPONSORED SYMPOSIUM HIGHLIGHTS
At a Menarini-sponsored symposium during the 19th World Congress on Gynecology and Infertility held at the Venetian Macau Hotel
last February 22, 2014, experts discussed the latest information about Asian scar management, with particular emphasis on the recently
published Asian scar treatment guidelines.
Updates on Asian Scar Management and Treatment Guidelines
Marie Socouer Medina-Oblepias, MD
Consultant Dermatologist
Research Institute for Tropical Medicine
Philippines
The Asian Scar Treatment Guidelines
A combination of prolonged inflammation, increased tension and
genetic predisposition may lead to excessive scarring.1 Ethnicity
may also be an important factor. Specifically, Asians have been
described to have unique skin characteristics that predispose
them to scarring. They exhibit a thicker dermis with greater
collagen density and propensity to fibroblast proliferation. Asians
also have larger melanosomes that make them more prone to
hyperpigmentation after a cutaneous injury. Thus, to manage scars
in Asians, expectations must be set realistically, because their scars
may take a longer time to heal, and may require close monitoring.2,3
Moreover, because of the unique features of the Asian skin, specific
guidelines are needed to optimize scar treatment outcomes.
The recent publication of the paper, “Update on Scar Management:
Guidelines for Treating Asian Patients,” makes specific
recommendations for treating Asian scars, and emphasizes the
importance of initiating scar prevention in all Asian patients (Table).2
The guidelines also recognize the significant efficacy of a siliconebased gel therapy in Asian patients, highlighting its ease of use
and improved patient compliance when compared with silicone
gel sheeting.2-5 Silicone gels were also assessed to be as effective
as silicone gel sheeting in preventing hypertrophic scars, and that
in select patients, silicone gel therapy is recommended as first-line
treatment.2,4 Aside from decreasing scar height and erythema and
improving pliability, silicone gels have also been shown to improve
the subjective symptoms of pain, itching and tension associated
with scars.5 The guidelines will hopefully help practitioners make
optimal and evidence-based treatment decisions for their patients
to prevent excessive scarring and improve treatment outcomes.
Table. Recommendations for scar management in Asian patients2
Scar type
Recommendations
All scars
• In select patients, silicone gel therapy is recommended
as first-line treatment for the management of both
hypertrophic and keloid scars
Hypertrophic
scars
• Silicone-based gel is as effective as silicone gel sheeting
• Multiple sessions of lower fluences of pulsed-dye lasers
are recommended for prevention of hyperpigmentation
in Asian patients with hypertrophic scars
Keloids
• Steroid monotherapy is effective for symptom
management
• Combined excision plus steroid injections or other
adjuvant therapies is effective and safe
• Keloid sites with a high risk of recurrence should be
treated with escalated doses of radiation and posttreatment self-management
EE Cherk Cheong, MD
Consultant, Plastic, Reconstructive
and Aesthetic Surgery
Tan Tock Seng Hospital
Singapore
Scar prevention post-surgery
Prevention is always better than treatment, and in terms of scars,
good and early wound management yields better scar outcomes.
Planning the incision, with the consideration of several factors,
also determines the resulting scar. Factors to note are as follows:
anatomic site of injury, symptoms involved, degree of psychological
distress and functional impairment.
Treatment is best commenced when the scar is immature but with
the overlying epithelium already intact. This can be achieved via a
multimodal approach to scar therapy. For new scars, silicone gels or
sheeting may be used, together with sun avoidance. An enhanced
silicone gel formulation – Dermatix® Ultra – has vitamin C that not
only stimulates collagen repair for healing, but also blocks melanin
formation that helps lighten scars. Meanwhile, steroid injections,
surgery and radiotherapy should be reserved for more problematic
scars.
Dominic Fuk-Him Li, MD
Honorary Clinical Assistant Professor
Department of Obstetrics and Gynecology
University of Hong Kong
Hong Kong
Scar management and prevention in
Obstetrics-Gynecology
Hypertrophic scars are common problems encountered in postcesarean section patients.6 The risk for scarring is influenced by
certain factors including age, skin color, family history, location and
size of the scar and duration of inflammation. It affects patients
both physically and psychosocially, and should not be trivialized.
As with any surgery, a proactive preventive approach on scar
management should always be employed in obstetric and
gynecologic procedures. Silicone-based therapy is considered as
a gold standard in treatment. Based on experience, the use of the
non-invasive silicone gel Dermatix® Ultra has been superior in its
ease of use and patient acceptability in obstetric and gynecologic
procedures.
References
1. Bayat A, et al. BMJ 2003;326:88-92. 2. Kim S, et al. Plast Reconstr Surg 2013;132:1-10. 3. Mustoe TA, et al. Plast Reconstr
Surg 2002;110:560-71. 4. Mustoe TA. Equivalent efficacy of silicone gel (Dermatix® Ultra) & silicone gel sheeting in scar
management: Clinical results & MOA. Presented at the 21st World Congress of Dermatology 2007;Buenos Aires, Argentina.
5. Chernoff WG, et al. Aesth Plast Surg 2007;31:495-500. 6. Atkinson JM. Plast Reconstr Surg 2005;116:1648-56.
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Advanced Scar Formula