November 8, 2006 Wound Healing and Scar Formation When the skin is cut or broken, the body mobilizes a wound repair process. The blood vessels constrict and clots form to minimize blood loss. A scab, or hardened crust, forms over the top of the wound. The scab acts like a natural covering to protect the area while the body continues the repair process. Tiny fibers of collagen fill in the hole and eventually reconnect the ends. By the time the scab naturally falls off, much of the initial repair has been finished. However, the area is far from healed. Depending upon the size, depth and location of the injury, it can take months to years for the skin to return to normal strength. Scar formation is a natural part of the healing process. A scar forms from excess amounts of collagen in the wound as the body attempts a repair. Many scars eventually fade. But they tend not to go away completely. Generally, the larger the wound, the longer it takes to heal and the greater the chance of a visible scar. Sometimes the body goes overboard in the healing process, leading to the development of thick and/or raised scars. There are several types of these "problematic" scars. Hypertropic scars are raised, pinkish-red areas located inside the borders of the original injury. They are often described as "itchy". In some cases, hypertropic scars shrink and fade on their own. Keloids are raised, deep-red areas that tend to cover much more area than that of the original injury. Even when surgically removed, keloids tend to recur. Atrophic scars are skin depressions, like those that sometimes form from severe acne. They are caused by inflammation that destroys the collagen during the rebuilding process, leaving an area of indentation. BOTOX® for Scars Scars can cause serious cosmetic and emotional concerns for some people. Since scar formation is a natural part of the wound healing process, they cant be entirely prevented. However, researchers have found a way to lessen their severity by injecting the drug, BOTOX® near the site of the wound. Anthony Brissett, M.D., a Plastic Surgeon with Baylor College of Medicine, says when a person experiences another kind of injury, like a broken bone, doctors place the area in a sling to immobilize the limb and allow the body to heal. BOTOX works in a similar fashion. When injected into muscles near the wound, the drug prevents the muscles from pulling on the wound site, allowing the area to heal without excessive disruption. Studies have shown BOTOX is effective in reducing scar formation from facial wounds. Researchers still need to determine if the drug may be effective for other places on the body. Brissett says the sooner after an injury the patient receives BOTOX, the better the results. He injects BOTOX into incision sites to minimize scarring from surgery. The treatment wont help scars that have already healed (i.e., are more than a year old). There are many other treatments that can be used to minimize the appearance of older scars. Brissett also cautions the FDA has not approved BOTOX as a treatment to minimize facial scars. Doctors are using the drug "off-label" for this purpose. AUDIENCE INQUIRY For general information on wounds, scars, and scar treatments: American Academy of Dermatology, http://www.aad.org American Society for Dermatologic Surgery, http://www.asds-net.org American Society of Plastic Surgeons, http://www.plasticsurgery.org Wound Care Information Network, http://www.medicaledu.com BIBLIOGRAPHY Batra, R., M.D., "Surgical Techniques for Scar Revision," Skin Therapy Letter, May 2005, Vol. 10, No 4, pp. 4-8. Bayat, A., and D. McGrouther, "Clinical Management of Skin Scarring," Skinmed, May-June 2005, Vol. 4, No. 3, pp. 165-173. 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