Vascular and Collagen Target: A Rational Approach to Hypertrophic Scar Management

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Vascular and Collagen Target: A Rational Approach to Hypertrophic Scar Management
Title:
Vascular and Collagen Target: A Rational Approach to Hypertrophic Scar Management
Journal Title:
Advances in Wound Care
Publication Date:
10 August 2021
Citation:
Yuan, B., Upton, Z., Leavesley, D., Fan, C., & Wang, X.-Q. (2021). Vascular and Collagen Target: A Rational Approach to Hypertrophic Scar Management. Advances in Wound Care. doi:10.1089/wound.2020.1348
Abstract:
Significance: Hypertrophic scarring is a challenging issue for patients and clinicians. The prevalence of hypertrophic scarring can be up to 70% after burns, and patients suffer from pain, itching, and loss of joint mobility. To date, the exact mechanisms underlying hypertrophic scar formation are unclear, and clinical options remain limited. Recent Advances: Several studies have demonstrated that pathological scars are a type of hyperactive vascular response to wounding. Scar regression has been found to be accompanied by microvessel occlusion, which causes severe hypoxia, malnutrition, and endothelial dysfunction, suggesting the essential roles of microvessels in scar regression. Therefore, interventions that target the vasculature, such as intense pulsed light, pulsed dye lasers, vascular endothelial growth factor antibodies, and Endostar, represent potential treatments. In addition, the mass of scar-associated collagen is usually not considered by current treatments. However, collagen-targeted therapies such as fractional CO2 laser and collagenase have shown promising outcomes in scar treatment. Critical Issues: Traditional modalities used in current clinical practice only partially target scar-associated microvessels or collagen. As a result, the effectiveness of current treatments is limited and is too often accompanied by undesirable side effects. The formation of scars in the early stage is mainly affected by microvessels, whereas the scars in later stages are mostly composed of residual collagen. Traditional therapies do not utilize specific targets for scars at different stages. Therefore, more precise treatment strategies are needed. Future Directions: Scars should be classified as either “vascular-dominant” or “collagen-dominant” before selecting a treatment. In this way, strategies that are vascular-targeted, collagen-targeted, or a combination thereof could be recommended to treat scars at different stages.
License type:
Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)
Funding Info:
This research / project is supported by the Agency for Science, Technology and Research (A*STAR) - Industry Alignment Fund—Prepositioning Programme
Grant Reference no. : H17/01/a0/0B9; H17/01/a0/0C9

National Natural Science Foundation of China (No. 81671914 and No. 81101433; B.Y., X.-Q.W.)
Description:
This Open Access article is distributed under the terms of the Creative Commons Attribution Noncommercial License [CC-BY-NC] ( http://creativecommons.org/licenses/by-nc/4.0/) which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and the source are cited.
ISSN:
2162-1918
2162-1934