**1. Introduction**

Animals developed a generally well-functioning pathway in the healing of damaged tissues. While some species have the ability to regenerate damaged or missing tissues, it is rare for people. Only the epidermis has full regeneration capacity, after the second trimester of fetal development, so any damage involving the dermis always heals with a scar. In humans, wounds usually heal with a normal scar, and hypertrophic scar process is not common. In some cases, the scar overcomes the original injury and results in the lesion known as keloid. Both hypertrophic scars and keloids cause a significant discomfort and malformation.

Although we believe that the word of "keloid" was first used by Aliberti in the nineteenth century, there were hypertrophic scar and keloid definitions among ancient Egypt hieroglyphs [1].

#### **1.1. Epidemiology**

Keloid and hypertrophic scars can occur all over the world and in all skin types. The risk of keloid formation increases as the skin color becomes darker, and the incidence of keloid in

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the Black population was found as high as 16%. Keloid develops equally in both men and women. Although reported in all ages, it is rare in young children and elderly people. It is thought that there is a familial predisposition for hypertrophic scarring and keloid development. Although previous reports have implied an autosomal recessive inheritance pattern, an autosomal dominant transition with incomplete clinical penetrance and variable expression was considered in a recent review. Two rare syndromes involving spontaneous keloid development are Rubinstein-Taybi and Goeminne syndromes [2, 3].

small vessel walls, and nodules with fine collagen fibrils. Over time, these nodules become thinner and the collagen bands become parallel to the skin surface. Keloids are histologically characterized by large, thick collagen fibers composed of numerous, firmly attached fibrils. An ultrastructurally amorphous extracellular material surrounds the fibroblastic cells in the

The Therapeutic Effects of Conservative Treatments on Burn Scars

http://dx.doi.org/10.5772/intechopen.70833

63

Hypertrophic scarring/keloid is often seen when the injury affects the reticular dermis and, in

Severe burns caused high mortality rates in the past. The development of specialized burn centers and advances in treatment options have led to more survivors of the burn victim. Due to long hospitalization periods and deprivation of daily physical activity, burn patients suffer from problems such as reduction in muscle strength, limitation of joint movements, and decrease in fitness level. Moreover, hypertrophic scarring, which can be seen even after minor burn injuries, is a common complication and generally develops within 6–8 weeks following reepithelialization. Although children are particularly susceptible to hypertrophic scarring due to the rapid nature of their cell formation, burn scars are common both in children and

There are many different options used in the treatment of burn scar. The purpose of this chapter is to provide the reader a brief information on the conservative treatment methods used

Formation of hypertrophic scar (HS) is a common undesirable consequence of trauma directing to the skin [6]. A classical scar is in red-pink or purple color, rigid, and raised and usually

keloid [5].

**1.5. Hypertrophic scar-keloid and burn injury**

particular, after a deep dermal or full thickness burn.

adults and can result in extensive skin damage [6–8].

in burn scar treatment.

• Pressure therapy

• Hydration

• Ultrasound

• Onion extract

• Massage therapy • Combined therapy

**2.1. Pressure therapy**

• Silicone gel therapy

• Electroacupuncture

**2. Conservative treatments**

#### **1.2. Pathogenesis**

The pathogenesis of hypertrophic scarring and keloid formation is unknown. In patients with hypertrophic scars and keloids, wound healing process shifts in a different direction than normal, and spontaneous involution does not generally occur. Its cause is unknown, but events such as infections, extreme wound tightness, and foreign bodies that are known to trigger for inflammation have been emphasized in the keloid development.

Melanocytes may play a role in the development of hypertrophic scar, because keloids have not been reported in patients with oculocutaneous albinism and keloids are more common in dark-skinned individuals. Mast cells are found intensely in hypertrophic scars and keloids. Mast cell mediators regulate collagen synthesis and are known to contribute to excessive accumulation.

Transforming growth factor-B (TGF-B) appears to be another molecule that causes scarring and keloid formation, because both transforming growth factor-B (TGF-B)-1 and TGF-B-2 are produced more from fibroblasts in keloid tissue than in normal fibroblasts [1–5].

#### **1.3. Clinical features**

Hypertrophic scars and keloids have many common features. Both are rough, often painful, itchy, pink-purple lesions. The epidermis is typically flat and the dermal part of the lesion is felt hard with palpation. Hypertrophic scars and keloids are malformed and may prevent normal movement of the surrounding tissues. Hypertrophic scars and keloids may appear anywhere of body, but especially ear lobe, upper part of body, and deltoid region are more risky areas. On the other hand, keloids are rare in the middle of the face, eyelids, and genital area.

Although hypertrophic scars and keloids usually appear after a trauma, they can also develop spontaneously. Before the onset of hypertrophic scars and keloids, various skin injuries such as acne, infection, burns, and piercing can be found. Clinical findings of lesions distinguish hypertrophic scars from keloids. Although hypertrophic scars remain in the area of original damage and tend to regress progressively over time, keloids tend to slowly heal in the middle parts, but tend to invade the surrounding tissues [1, 2].

#### **1.4. Pathology**

Both hypertrophic scars and keloids have increased cellularity, vascularity, and connective tissue compared to normal skin and normal scar. Hypertrophic scars include myofibroblasts, small vessel walls, and nodules with fine collagen fibrils. Over time, these nodules become thinner and the collagen bands become parallel to the skin surface. Keloids are histologically characterized by large, thick collagen fibers composed of numerous, firmly attached fibrils. An ultrastructurally amorphous extracellular material surrounds the fibroblastic cells in the keloid [5].

#### **1.5. Hypertrophic scar-keloid and burn injury**

Hypertrophic scarring/keloid is often seen when the injury affects the reticular dermis and, in particular, after a deep dermal or full thickness burn.

Severe burns caused high mortality rates in the past. The development of specialized burn centers and advances in treatment options have led to more survivors of the burn victim. Due to long hospitalization periods and deprivation of daily physical activity, burn patients suffer from problems such as reduction in muscle strength, limitation of joint movements, and decrease in fitness level. Moreover, hypertrophic scarring, which can be seen even after minor burn injuries, is a common complication and generally develops within 6–8 weeks following reepithelialization. Although children are particularly susceptible to hypertrophic scarring due to the rapid nature of their cell formation, burn scars are common both in children and adults and can result in extensive skin damage [6–8].

There are many different options used in the treatment of burn scar. The purpose of this chapter is to provide the reader a brief information on the conservative treatment methods used in burn scar treatment.
