Management of keloids and hypertrophic scars: Current and emerging options

Clinical, Cosmetic and Investigational Dermatology

Volumn 6, Issue , 2013, Pages 103-114

  Gauglitz, Gerd G ^a  

^a UNIVERSITY OF MUNICH   (Germany)

Author keywords

Intralesional cryotherapy; Lasers; TGF ; Triamcinolone acetonide

Indexed keywords

ALPHA2B INTERFERON; AVOTERMIN; BLEOMYCIN; BOTULINUM TOXIN A; CORTICOSTEROID; FLUOROURACIL; IMIQUIMOD; ONION EXTRACT; PLACEBO; SILICONE; TRIAMCINOLONE ACETONIDE;

ANEMIA; BONE MARROW DEPRESSION; CARBON DIOXIDE LASER; CONTROLLED CLINICAL TRIAL (TOPIC); CRYOSURGERY DEVICE; CRYOSURGERY NEEDLE; CRYOTHERAPY; DEPIGMENTATION; DRUG CONTRAINDICATION; ERBIUM YAG LASER; ERYTHEMA; ESTHETICS; FLU LIKE SYNDROME; HUMAN; HYPERPIGMENTATION; HYPERTROPHIC SCAR; INFECTION; INJECTION SITE PAIN; KELOID; LASER SURGERY; LEUKOPENIA; LOW DRUG DOSE; MEDICAL DECISION MAKING; METHODOLOGY; NEODYMIUM YAG LASER; PHASE 3 CLINICAL TRIAL (TOPIC); PHOTODYNAMIC THERAPY; PREGNANCY; PULSED DYE LASER; PURPURA; REVIEW; RISK REDUCTION; SKIN ATROPHY; SKIN IRRITATION; SKIN SURGERY; SKIN TINGLING; SKIN ULCER; SUTURING METHOD; THROMBOCYTOPENIA; W PLASTY; WOUND CLOSURE; WOUND HEALING; Z PLASTY;

EID: 84876551840     PISSN: 11787015     EISSN: None     Source Type: Journal    
DOI: 10.2147/CCID.S35252     Document Type: Review

References (118)

1. Gauglitz GG, Korting HC, Pavicic T, Ruzicka T, Jeschke MG. Hypertrophic scarring and keloids: pathomechanisms and current and emerging treatment strategies. Mol Med. 2011;17(1-2):113-125.
2. Tredget EE, Nedelec B, Scott PG, Ghahary A. Hypertrophic scars, keloids, and contractures. The cellular and molecular basis for therapy. Surg Clin North Am. 1997;77(3):701-730.
3. Niessen FB, Spauwen PH, Schalkwijk J, Kon M. On the nature of hypertrophic scars and keloids: a review. Plast Reconstr Surg. 1999; 104(5):1435-1458.
4. Slemp AE, Kirschner RE. Keloids and scars: a review of keloids and scars, their pathogenesis, risk factors, and management. Curr Opin Pediatr. 2006;18(4):396-402.
5. Gauglitz GG, Pavicic T. [Emerging strategies for the prevention and therapy of excessive scars.] MMW Fortschr Med. 2012;154(15):55-58. German.
6. Bond JS, Duncan JA, Mason T, etal. Scar redness in humans: how long does it persist after incisional and excisional wounding? Plast Reconstr Surg. 2008;121(2):487-496.
7. Brown JJ, Bayat A. Genetic susceptibility to raised dermal scarring. Br J Dermatol. 2009;161(1):8-18.
8. Wynn TA. Fibrotic disease and the T(H)1/T(H)2 paradigm. Nat Rev Immunol. 2004;4(8):583-594.
9. Doucet C, Brouty-Boye D, Pottin-Clemenceau C, Canonica GW, Jasmin C, Azzarone B. Interleukin (IL) 4 and IL-13 act on human lung fibroblasts. Implication in asthma. J Clin Invest. 1998;101(10):2129-2139.
10. Mustoe TA, Cooter RD, Gold MH, etal. International clinical recommendations on scar management. Plast Reconstr Surg. 2002;110(2): 560-571.
11. Mutalik S. Treatment of keloids and hypertrophic scars. Indian J Dermatol Venereol Leprol. 2005;71(1):3-8.
12. Ogawa R, Akaishi S, Huang C, etal. Clinical applications of basic research that shows reducing skin tension could prevent and treat abnormal scarring: the importance of fascial/subcutaneous tensile reduction sutures and flap surgery for keloid and hypertrophic scar reconstruction. J Nippon Med Sch. 2011;78(2):68-76.
13. Reish RG, Eriksson E. Scar treatments: preclinical and clinical studies. J Am Coll Surg. 2008;206(4):719-730.
14. Leventhal D, Furr M, Reiter D. Treatment of keloids and hypertrophic scars: a meta-analysis and review of the literature. Arch Facial Plast Surg. 2006;8(6):362-368.
15. Muir IF. On the nature of keloid and hypertrophic scars. Br J Plast Surg. 1990;43(1):61-69.
16. Nast A, Eming S, Fluhr J, etal. German S2k guidelines for the therapy of pathological scars (hypertrophic scars and keloids). J Dtsch Dermatol Ges. 2012;10(10):747-762.
17. Poochareon VN, Berman B. New therapies for the management of keloids. J Craniofac Surg. 2003;14(5):654-657.
18. Robles DT, Berg D. Abnormal wound healing: keloids. Clin Dermatol. 2007;25(1):26-32.
19. Zuber TJ, DeWitt DE. Earlobe keloids. Am Fam Physician. 1994; 49(8):1835-1841.
20. Jalali M, Bayat A. Current use of steroids in management of abnormal raised skin scars. Surgeon. 2007;5(3):175-180.
21. Cruz NI, Korchin L. Inhibition of human keloid fibroblast growth by isotretinoin and triamcinolone acetonide in vitro. Ann Plast Surg. 1994;33(4):401-405.
22. Boyadjiev C, Popchristova E, Mazgalova J. Histomorphologic changes in keloids treated with Kenacort. J Trauma. 1995;38(2): 299-302.
23. Murray JC. Keloids and hypertrophic scars. Clin Dermatol. 1994;12(1): 27-37.
24. Lawrence WT. In search of the optimal treatment of keloids: report of a series and a review of the literature. Ann Plast Surg. 1991;27(2): 164-178.
25. Boutli-Kasapidou F, Tsakiri A, Anagnostou E, Mourellou O. Hypertrophic and keloidal scars: an approach to polytherapy. Int J Dermatol. 2005;44(4):324-327.
26. Jaros E, Priborsky J, Klein L. [Treatment of keloids and hypertrophic scars with cryotherapy.] Acta Medica (Hradec Kralove) Suppl. 1999; 42(2):61-63. Czech.
27. Yosipovitch G, Widijanti Sugeng M, Goon A, Chan YH, Goh CL. A comparison of the combined effect of cryotherapy and corticosteroid injections versus corticosteroids and cryotherapy alone on keloids: a controlled study. J Dermatolog Treat. 2001;12(2):87-90.
28. Sharpe D. Of apples and oranges, file drawers and garbage: why validity issues in meta-analysis will not go away. Clin Psychol Rev. 1997;17(8): 881-901.
29. Atiyeh BS. Nonsurgical management of hypertrophic scars: evidence-based therapies, standard practices, and emerging methods. Aesthetic Plast Surg. 2007;31(5):468-494.
30. Zouboulis CC, Blume U, Buttner P, Orfanos CE. Outcomes of cryosurgery in keloids and hypertrophic scars. A prospective consecutive trial of case series. Arch Dermatol. 1993;129(9):1146-1151.
31. Barara M, Mendiratta V, Chander R. Cryotherapy in treatment of keloids: evaluation of factors affecting treatment outcome. J Cutan Aesthet Surg. 2012;5(3):185-189.
32. Baur PS, Larson DL, Stacey TR, Barratt GF, Dobrkovsky M. Ultrastructural analysis of pressure-treated human hypertrophic scars. J Trauma. 1976;16(12):958-967.
33. Macintyre L, Baird M. Pressure garments for use in the treatment of hypertrophic scars-a review of the problems associated with their use. Burns. 2006;32(1):10-15.
34. Kelly AP. Medical and surgical therapies for keloids. Dermatol Ther. 2004;17(2):212-218.
35. Reno F, Sabbatini M, Lombardi F, etal. In vitro mechanical compression induces apoptosis and regulates cytokines release in hypertrophic scars. Wound Repair Regen. 2003;11(5):331-336.
36. Van den Kerckhove E, Stappaerts K, Fieuws S, etal. The assessment of erythema and thickness on burn related scars during pressure garment therapy as a preventive measure for hypertrophic scarring. Burns. 2005;31(6):696-702.
37. Candy LH, Cecilia LT, Ping ZY. Effect of different pressure magnitudes on hypertrophic scar in a Chinese population. Burns. 2010;36(8): 1234-1241.
38. Anzarut A, Olson J, Singh P, Rowe BH, Tredget EE. The effectiveness of pressure garment therapy for the prevention of abnormal scarring after burn injury: a meta-analysis. J Plast Reconstr Aesthet Surg. 2009;62(1):77-84.
39. Bran GM, Brom J, Hormann K, Stuck BA. Auricular keloids: combined therapy with a new pressure device. Arch Facial Plast Surg. 2012;14(1): 20-26.
40. Kadouch DJ, van der Veer WM, Mahdavian Delavary B, Kerkdijk D, Niessen FB. Therapeutic hotline: An alternative adjuvant treatment after ear keloid excision using a custom-made methyl methacrylate stent. Dermatol Ther. 2010;23(6):686-692.
41. Ragoowansi R, Cornes PG, Moss AL, Glees JP. Treatment of keloids by surgical excision and immediate postoperative single-fraction radiotherapy. Plast Reconstr Surg. 2003;111(6):1853-1859.
42. Guix B, Henriquez I, Andres A, Finestres F, Tello JI, Martinez A. Treatment of keloids by high-dose-rate brachytherapy: a seven-year study. Int J Radiat Oncol Biol Phys. 2001;50(1):167-172.
43. Escarmant P, Zimmermann S, Amar A, etal. The treatment of 783 keloid scars by iridium 192interstitial irradiation after surgical excision. Int J Radiat Oncol Biol Phys. 1993;26(2):245-251.
44. Sallstrom KO, Larson O, Heden P, Eriksson G, Glas JE, Ringborg U. Treatment of keloids with surgical excision and postoperative X-ray radiation. Scand J Plast Reconstr Surg Hand Surg. 1989;23(3):211-215.
45. van de Kar AL, Kreulen M, van Zuijlen PP, Oldenburger F. The results of surgical excision and adjuvant irradiation for therapy-resistant keloids: a prospective clinical outcome study. Plast Reconstr Surg. 2007;119(7):2248-2254.
46. Ogawa R, Mitsuhashi K, Hyakusoku H, Miyashita T. Postoperative electron-beam irradiation therapy for keloids and hypertrophic scars: retrospective study of 147 cases followed for more than 18 months. Plast Reconstr Surg. 2003;111(2):547-555.
47. Apfelberg DB, Maser MR, Lash H, White D, Weston J. Preliminary results of argon and carbon dioxide laser treatment of keloid scars. Lasers Surg Med. 1984;4(3):283-290.
48. Alster T. Laser scar revision: comparison study of 585-nm pulsed dye laser with and without intralesional corticosteroids. Dermatol Surg. 2003;29(1):25-29.
49. Alster TS, Williams CM. Treatment of keloid sternotomy scars with 585 nm flashlamp-pumped pulsed-dye laser. Lancet. 1995;345(8959): 1198-1200.
50. Dierickx C, Goldman MP, Fitzpatrick RE. Laser treatment of erythematous/hypertrophic and pigmented scars in 26 patients. Plast Reconstr Surg. 1995;95(1):84-92.
51. Akaishi S, Koike S, Dohi T, Kobe K, Hyakusoku H, Ogawa R. Nd:YAG Laser treatment of keloids and hypertrophic scars. Eplasty. 2012;12:e1.
52. Tanzi EL, Alster TS. Laser treatment of scars. Skin Therapy Lett. 2004;9(1):4-7.
53. Alster TS, Handrick C. Laser treatment of hypertrophic scars, keloids, and striae. Semin Cutan Med Surg. 2000;19(4):287-292.
54. Paquet P, Hermanns JF, Pierard GE. Effect of the 585nm flashlamp-pumped pulsed dye laser for the treatment of keloids. Dermatol Surg. 2001;27(2):171-174.
55. Allison KP, Kiernan MN, Waters RA, Clement RM. Pulsed dye laser treatment of burn scars. Alleviation or irritation? Burns. 2003;29(3): 207-213.
56. Wittenberg GP, Fabian BG, Bogomilsky JL, etal. Prospective, single-blind, randomized, controlled study to assess the efficacy of the 585-nm flashlamp-pumped pulsed-dye laser and silicone gel sheeting in hypertrophic scar treatment. Arch Dermatol. 1999;135(9):1049-1055.
57. Durani P, Bayat A. Levels of evidence for the treatment of keloid disease. J Plast Reconstr Aesthet Surg. 2008;61(1):4-17.
58. Shih PY, Chen HH, Chen CH, Hong HS, Yang CH. Rapid recurrence of keloid after pulse dye laser treatment. Dermatol Surg. 2008;34(8): 1124-1127.
59. Cho SB, Lee JH, Lee SH, Lee SJ, Bang D, Oh SH. Efficacy and safety of 1064-nm Q-switched Nd:YAG laser with low fluence for keloids and hypertrophic scars. J Eur Acad Dermatol Venereol. 2010;24(9): 1070-1074.
60. Garg GA, Sao PP, Khopkar US. Effect of carbon dioxide laser ablation followed by intralesional steroids on keloids. J Cutan Aesthet Surg. 2011;4(1):2-6.
61. Sawada Y, Sone K. Hydration and occlusion treatment for hypertrophic scars and keloids. Br J Plast Surg. 1992;45(8):599-603.
62. Fulton JE Jr. Silicone gel sheeting for the prevention and management of evolving hypertrophic and keloid scars. Dermatol Surg. 1995;21(11): 947-951.
63. Ahn ST, Monafo WW, Mustoe TA. Topical silicone gel: a new treatment for hypertrophic scars. Surgery. 1989;106(4):781-786; discussion 786-787.
64. Carney SA, Cason CG, Gowar JP, etal. Cica-Care gel sheeting in the management of hypertrophic scarring. Burns. 1994;20(2):163-167.
65. Lee SM, Ngim CK, Chan YY, Ho MJ. A comparison of Sil-K and Epiderm in scar management. Burns. 1996;22(6):483-487.
66. Mustoe TA. Evolution of silicone therapy and mechanism of action in scar management. Aesthetic Plast Surg. 2008;32(1):82-92.
67. O'Brien L, Pandit A. Silicon gel sheeting for preventing and treating hypertrophic and keloid scars. Cochrane Database Syst Rev. 2006;1: CD003826.
68. Bianchi FA, Roccia F, Fiorini P, Berrone S. Use of Patient and Observer Scar Assessment Scale for evaluation of facial scars treated with self-drying silicone gel. J Craniofac Surg. 2010;21(3):719-723.
69. van der Wal MB, van Zuijlen PP, van de Ven P, Middelkoop E. Topical silicone gel versus placebo in promoting the maturation of burn scars: a randomized controlled trial. Plast Reconstr Surg. 2010;126(2): 524-531.
70. Steinstraesser L, Flak E, Witte B, etal. Pressure garment therapy alone and in combination with silicone for the prevention of hypertrophic scarring: randomized controlled trial with intraindividual comparison. Plast Reconstr Surg. 2011;128(4):306e-313e.
71. Chernoff WG, Cramer H, Su-Huang S. The efficacy of topical silicone gel elastomers in the treatment of hypertrophic scars, keloid scars, and post-laser exfoliation erythema. Aesthetic Plast Surg. 2007;31(5):495-500.
72. Stoffels I, Wolter TP, Sailer AM, Pallua N. [The impact of silicone spray on scar formation. A single-center placebo-controlled double-blind trial.] Hautarzt. 2010;61(4):332-338. German.
73. Fitzpatrick RE. Treatment of inflamed hypertrophic scars using intralesional 5-FU. Dermatol Surg. 1999;25(3):224-232.
74. Nanda S, Reddy BS. Intralesional 5-fluorouracil as a treatment modality of keloids. Dermatol Surg. 2004;30(1):54-57.
75. Liu W, Wu X, Gao Z, Song N. Remodelling of keloid tissue into normal-looking skin. J Plast Reconstr Aesthet Surg. 2008;61(12): 1553-1554.
76. Wu XL, Liu W, Cao YL. Clinical study on keloid treatment with intralesional injection of low concentration 5-fluorouracil. Zhonghua Zheng Xing Wai Ke Za Zhi. 2006;22(1):44-46. Chinese.
77. Wu XL, Gao Z, Song N, Liu W. [Clinical study of auricular keloid treatment wtih both surgical excision and intralesional injection of low-dose 5-fluorouracil and corticosteroids.] Zhonghua Yi Xue Za Zhi. 2009;28(89):1102-1105. Chinese.
78. Asilian A, Darougheh A, Shariati F. New combination of triamcinolone, 5-fluorouracil, and pulsed-dye laser for treatment of keloid and hypertrophic scars. Dermatol Surg. 2006;32(7):907-915.
79. Darougheh A, Asilian A, Shariati F. Intralesional triamcinolone alone or in combination with 5-fluorouracil for the treatment of keloid and hypertrophic scars. Clin Exp Dermatol. 2009;34(2):219-223.
80. Davison SP, Dayan JH, Clemens MW, Sonni S, Wang A, Crane A. Efficacy of intralesional 5-fluorouracil and triamcinolone in the treatment of keloids. Aesthet Surg J. 2009;29(1):40-46.
81. Phan TT, Lim IJ, Sun L, etal. Quercetin inhibits fibronectin production by keloid-derived fibroblasts. Implication for the treatment of excessive scars. J Dermatol Sci. 2003;33(3):192-194.
82. Phan TT, Lim IJ, Chan SY, Tan EK, Lee ST, Longaker MT. Suppression of transforming growth factor beta/smad signaling in keloid-derived fibroblasts by quercetin: implications for the treatment of excessive scars. J Trauma. 2004;57(5):1032-1037.
83. Maragakis M, Willital GH, Michel G, Gortelmeyer R. Possibilities of scar treatment after thoracic surgery. Drugs Exp Clin Res. 1995;21(5): 199-206.
84. Chanprapaph K, Tanrattanakorn S, Wattanakrai P, Wongkitisophon P, Vachiramon V. Effectiveness of onion extract gel on surgical scars in Asians. Dermatol Res Pract. 2012;2012:212945.
85. Jackson BA, Shelton AJ. Pilot study evaluating topical onion extract as treatment for postsurgical scars. Dermatol Surg. 1999;25(4):267-269.
86. Chung VQ, Kelley L, Marra D, Jiang SB. Onion extract gel versus petrolatum emollient on new surgical scars: prospective double-blinded study. Dermatol Surg. 2006;32(2):193-197.
87. Beuth J, Hunzelmann N, Van Leendert R, Basten R, Noehle M, Schneider B. Safety and efficacy of local administration of contractubex to hypertrophic scars in comparison to corticosteroid treatment. Results of a multicenter, comparative epidemiological cohort study in Germany. In Vivo. 2006;20(2):277-283.
88. Ho WS, Ying SY, Chan PC, Chan HH. Use of onion extract, heparin, allantoin gel in prevention of scarring in chinese patients having laser removal of tattoos: a prospective randomized controlled trial. Dermatol Surg. 2006;32(7):891-896.
89. Koc E, Arca E, Surucu B, Kurumlu Z. An open, randomized, controlled, comparative study of the combined effect of intralesional triamcinolone acetonide and onion extract gel and intralesional triamcinolone acetonide alone in the treatment of hypertrophic scars and keloids. Dermatol Surg. 2008;34(11):1507-1514.
90. Har-Shai Y, Sabo E, Rohde E, Hyams M, Assaf C, Zouboulis CC. Intralesional cryosurgery enhances the involution of recalcitrant auricular keloids: a new clinical approach supported by experimental studies. Wound Repair Regen. 2006;14(1):18-27.
91. Har-Shai Y, Amar M, Sabo E. Intralesional cryotherapy for enhancing the involution of hypertrophic scars and keloids. Plast Reconstr Surg. 2003;111(6):1841-1852.
92. Har-Shai Y, Brown W, Labbe D, etal. Intralesional cryosurgery for the treatment of hypertrophic scars and keloids following aesthetic surgery: the results of a prospective observational study. Int J Low Extrem Wounds. 2008;7(3):169-175.
93. Tziotzios C, Profyris C, Sterling J. Cutaneous scarring: pathophysiology, molecular mechanisms, and scar reduction therapeutics Part II. Strategies to reduce scar formation after dermatologic procedures. J Am Acad Dermatol. 2012;66(1):13-24; quiz 25-26.
94. Zurada JM, Kriegel D, Davis IC. Topical treatments for hypertrophic scars. J Am Acad Dermatol. 2006;55(6):1024-1031.
95. Berman B, Kaufman J. Pilot study of the effect of postoperative imiquimod 5% cream on the recurrence rate of excised keloids. J Am Acad Dermatol. 2002;47(Suppl 4):S209-S211.
96. Chuangsuwanich A, Gunjittisomram S. The efficacy of 5% imiquimod cream in the prevention of recurrence of excised keloids. J Med Assoc Thai. 2007;90(7):1363-1367.
97. Martin-Garcia RF. Imiquimod: an effective alternative for the treatment of invasive cutaneous squamous cell carcinoma. Dermatol Surg. 2005;31(3):371-374.
98. Stashower ME. Successful treatment of earlobe keloids with imiquimod after tangential shave excision. Dermatol Surg. 2006;32(3):380-386.
99. Berman B, Harrison-Balestra C, Perez OA, etal. Treatment of keloid scars post-shave excision with imiquimod 5% cream: a prospective, double-blind, placebo-controlled pilot study. J Drugs Dermatol. 2009;8(5):455-458.
100. Cacao FM, Tanaka V, Messina MC. Failure of imiquimod 5% cream to prevent recurrence of surgically excised trunk keloids. Dermatol Surg. 2009;35(4):629-633.
101. Espana A, Solano T, Quintanilla E. Bleomycin in the treatment of keloids and hypertrophic scars by multiple needle punctures. Dermatol Surg. 2001;27(1):23-27.
102. Naeini FF, Najafian J, Ahmadpour K. Bleomycin tattooing as a promising therapeutic modality in large keloids and hypertrophic scars. Dermatol Surg. 2006;32(8):1023-1030.
103. Saray Y, Gulec AT. Treatment of keloids and hypertrophic scars with dermojet injections of bleomycin: a preliminary study. Int J Dermatol. 2005;44(9):777-784.
104. Jimenez SA, Freundlich B, Rosenbloom J. Selective inhibition of human diploid fibroblast collagen synthesis by interferons. J Clin Invest. 1984;74(3):1112-1116.
105. Berman B, Duncan MR. Short-term keloid treatment in vivo with human interferon alfa-2b results in a selective and persistent normalization of keloidal fibroblast collagen, glycosaminoglycan, and collagenase production in vitro. J Am Acad Dermatol. 1989;21(4 Pt 1):694-702.
106. Tredget EE, Shankowsky HA, Pannu R, etal. Transforming growth factor-beta in thermally injured patients with hypertrophic scars: effects of interferon alpha-2b. Plast Reconstr Surg. 1998;102(5):1317-1328; discussion 1329-1330.
107. Viera MH, Amini S, Valins W, Berman B. Innovative therapies in the treatment of keloids and hypertrophic scars. J Clin Aesthet Dermatol. 2010;3(5):20-26.
108. Lee BJ, Jeong JH, Wang SG, Lee JC, Goh EK, Kim HW. Effect of botulinum toxin type a on a rat surgical wound model. Clin Exp Otorhinolaryngol. 2009;2(1):20-27.
109. Gassner HG, Brissett AE, Otley CC, etal. Botulinum toxin to improve facial wound healing: a prospective, blinded, placebo-controlled study. Mayo Clin Proc. 2006;81(8):1023-1028.
110. Zhibo X, Miaobo Z. Intralesional botulinum toxin type A injection as a new treatment measure for keloids. Plast Reconstr Surg. 2009;124(5): 275e-277e.
111. Xiao Z, Zhang F, Lin W, Zhang M, Liu Y. Effect of botulinum toxin type A on transforming growth factor beta1in fibroblasts derived from hypertrophic scar: a preliminary report. Aesthetic Plast Surg. 2010;34(4):424-427.
112. Gauglitz GG, Bureik D, Dombrowski Y, Pavicic T, Ruzicka T, Schauber J. Botulinum toxin A for the treatment of keloids. Skin Pharmacol Physiol. 2012;25(6):313-318.
113. Karrrer S, Bosserhoff AK, Weiderer P, etal. Influence of 5-aminolevulinic acid and red light on collagen metabolism of human dermal fibroblasts. J Invest Dermatol. 2003;120:325-331.
114. Heckenkamp J, Aleksic M, Gawenda M, etal. Modulation of human adventitial fibroblast function by photodynamic therapy of collagen matrix. Eur J Vasc Endovasc Surg. 2004;28:651-659.
115. Ud-Din S, Thomas G, Morris J, etal. Photodynamic therapy: an innovative approach to the treatment of keloid disease evaluated using subjective and objective non-invasive tools. Arch Dermatol Res. Epub November 2, 2012.
116. Ferguson MW, Duncan J, Bond J, etal. Prophylactic administration of avotermin for improvement of skin scarring: three double-blind, placebo-controlled, phase I/II studies. Lancet. 11, 2009;373(9671): 1264-1274.
117. Thepharmaletter. com [homepage on the Internet]. Available from: http://www.thepharmaletter.com. Accessed March 24, 2013.
118. Har-Shai Y. Intralesional cryosurgery for enhancing the involution of hypertrophic scars and keloids. A new effective technology based on experimental and clinical data. Journal of Wound Technology. 2012;15:8-9.