Scars and keloids

BMJ 2004; 328 doi: https://doi.org/10.1136/bmj.328.7452.1329 (Published 03 June 2004) Cite this as: BMJ 2004;328:1329
  1. Thomas A Mustoe (tmustoe@nmh.org), professor
  1. Division of Plastic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Chicago Ill 60611, USA

    Several treatments are used, but the evidence base is lacking

    The reparative response of a fetus to injury is regeneration of tissue without scar. However, in children and adults the inevitable response to injury is scar formation, which in skin causes disfigurement and may result in restriction of motion. In other organs excessive scarring is responsible for pulmonary fibrosis, cirrhosis, end stage glomerulonephritis, and systemic scleroderma. The molecular signals that cause an active wound healing process to turn off in the process of scar maturation are unknown. The clinical treatment of scars has therefore been largely empirical. Multiple treatments have been proposed, often backed by anecdotal evidence only. Some treatments, such as topical vitamin E, have been widely promulgated as effective in the popular press in the United States,1 whereas others have been marketed directly to the consumer despite a lack of evidence.2 So how should we treat excessive scarring given the poverty of evidence?

    The first step in minimising scarring should be attention to the early care of wounds, and the following recommendations are based on general principles of wound healing. The goal with minor wounds such as abrasions is to achieve rapid epithelisation by moist healing …

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