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Papers of The 2nd Japan Scar Workshop |
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16. The classification and treatment of hypertrophic scars and
keloids
Yasuyoshi Tosa, Yoshiaki Hosaka, Kiyoaki Tsutsumi, Kaneshige Satoh,
Toshiya Yokoyama, *Atsuomi Saiga
Department of Plastic and Reconstructive Surgery, Showa University
School of Medicine, Tokyo, Japan
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Hypertrophic scars are classified into two categories, high grade and
middle or low grade, or by the term keloids in Japan (Ohura
classification). Clinical diagnosis is difficult since the appearance
varies depending on the stage (early, active, mature, etc.) and the
mixing of hypertrophic scars and keloids. Overseas, the International
Clinical Recommendations on Scar Management recognizes four grades of
hypertrophic scars and classifies keloids as minor and major. Treatments
include conservative therapy (oral administration of tranilast, local
injection of adrenal cortical hormone, external use of ointments
containing adrenal cortical hormone, occlusive therapy with silicone gel
sheets, and application of silicone cushions), physical therapy
(pressure treatment), surgical therapy, radiation therapy (electron beam
irradiation), and cryotherapy (liquid nitrogen therapy). The objectives
of treatment include flattening the elevated lesion,
alleviation/elimination of itching and pain, reduction of redness, and
release of scar contracture. These therapies, either alone or in
combination, produce different therapeutic effects depending on the
site, age, and clinical conditions. The method of evaluation was based
on the report of Hirshowitz et al., with objective findings and
subjective symptoms scored and improvement assessed. The occurrence of
adverse events was also assessed. |
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