A Medical Device Daily

Thanks to new advances, dermatologists are finding better ways to keep surgical scars from leaving their mark, according to remarks made during the 64th annual meeting of the American Academy of Dermatology (AAD; Schaumburg, Illinois) in San Francisco, which began Friday and continues through tomorrow.

There are many reasons for a surgical procedure, including the diagnosis or removal of skin cancer. Regardless of the reason or type, whenever a patient undergoes surgery, there will be a resulting scar. Though a natural part of the body's healing process, scars can be reminders that make people feel self-conscious, particularly if the scar is located on exposed skin.

As discussed at the AAD meeting, two new treatment methods that are beneficial in minimizing the appearance of surgical scars are the use of a pulsed-dye laser and topical application of the immune response modifier (IRM) imiquimod. The pulsed-dye laser uses a yellow, high-energy light to remove scar redness and flatten hypertrophic scars and keloids. This also can improve the itching and burning sensations that accompany some scars.

James Spencer, MD, clinical professor of dermatology at Mount Sinai School of Medicine (New York), discus-sed types of scars, treatments and common scar treatment myths.

“Both an individual's age and the location of the scar on the body or face affect the way a scar forms,“ he said. “Younger skin makes strong repairs, but can overheal causing a thicker scar, and scars on tighter skin will seem more visible. Whatever the type, thanks to new research, we're finding improved ways to minimize the appearance of surgical scars.“

There are several different types of scars: atrophic scars, hypertrophic scars and keloids. Atrophic scars are skin depressions or indentations. They can be a result of surgery, but more often result from medical conditions such as acne. Hypertrophic scars and keloids are elevated above the skin.

Hypertrophic scars have a tendency to become thick and appear swollen. The wounds usually take longer to heal and the scars remain within the bounds of the original wound. Treatment is important during the healing phase to improve the cosmetic appearance of this type of scar.

“Patients with darker skin types have a higher incidence of developing hypertrophic scars and keloids,“ said Spencer. “Studies have shown an incidence rate of 4.5% to 16% in the African-American and Hispanic-American populations.“

Keloids are similar to hypertrophic scars, but keloids are much more aggressive. Keloids form because both skin cells and connective tissue cells, or fibroblasts, begin multiplying excessively to repair the damage to the skin. The fibroblasts continue to multiply even after the wound is healed, causing the scar to swell and widen beyond the original mark.

“With the pulsed-dye laser, patients can return to work or regular activity within one week, though the treated skin may remain pink for several weeks,“ he said. “While this treatment can be used with any type of scar, hypertrophic scars or keloids typically need two or more treatments every one or two months.“

IRMs enhance the skin's ability to identify and control or destroy certain viral infections in the skin by stimulating cytokine production in the skin. Cytokines are naturally occurring proteins used by immune system cells to communicate with each other. When IRMs stimulate the cytokines, cell immunity is enhanced and the body is able to more efficiently control or eliminate virus-infected cells.

“Imiquimod stimulates one of the skin's naturally occurring inflammatory agents, interferon, which can affect the skin's wound-healing function,“ Spencer said. “Using this topical agent on scar sites after surgery may help produce a smaller scar.“

Over the years, there have been many different treatments for scars, some of which have grown into “myths“ on how to treat them. Among those myths are two topical treatments: topical vitamin E and onion extract.

Though many people have used vitamin E to attempt to improve the appearance of scars, studies have shown that there is no benefit and in some cases, its use may actually worsen the scar's appearance. Additionally, many people can develop contact dermatitis from using vitamin E.

Many people believe that the onion extract acts as an anti-inflammatory and will inhibit the overproduction of collagen in a scar. In fact, a recent study on a topical treatment with onion extract showed that it was no more effective than other over-the-counter treatments.

“Scars can be disfiguring and emotionally disturbing,“ said Spencer. “With so many treatment options available, it is important that patients work closely with a dermatologist to identify the treatment that will be most beneficial for their scars.“

Also at AAD, Inamed (Santa Barbara, California) said that Phase III clinical data for the three formulations of Juvederm – a next-generation, non-animal, cross-linked hy-aluronic acid-based dermal filler, were presented Friday.

The three formlations include Juvederm 24HV, Juve-derm 30HV and Juvederm 30.

The Phase III data, which shows superior efficacy and duration of effect vs. Zyplast, a cross-linked bovine collagen, were presented by Gary Monheit, MD, associate clinical professor of dermatology and ophthalmology at the University of Alabama at Birmingham and president of the American Society for Dermatologic Surgery .

Based on the independent investigators' assessments, the percentage of patients improved with Juvederm at six months was in the range of 81% to 90% vs. 36% to 45% for Zyplast. At six months, patient preference for Juvederm over Zyplast was in the 78% to 88% range.

No meaningful differences were reported in adverse events between Juvederm and Zyplast. Most adverse events reported were mild or moderate in nature and temporary, lasting less than seven days.

“The data underscore the benefit of adding a new generation of dermal filler to the current aesthetic treatments offered by physicians to patients,“ said Monheit. “The superior duration of effect and high patient satisfaction of the family of Juvederm products is an important advancement in the treatment of facial wrinkles.“

The data also were displayed at a Friday poster exhibit at the Moscone Convention Center.

Hani Zeini, executive vice president of Inamed Aesthetics , said the Juvederm family of products “is an important strategic advance in our facial aesthetics portfolio.“

Inamed, which submitted its premarket approval application to the FDA during 4Q05, has an exclusive licensing agreement with the Corneal Group for the Juvederm family of products and future product line extensions in the U.S., Canada, and Australia. It also has a non-exclusive agreement in certain European markets under the name HydraFill.