Saulis Alexandrina S, Mogford Jon H, Mustoe Thomas A
Division of Plastic and Reconstructive Surgery, Northwestern University Medical School, Galter Pavilion, 675 N Saint Claire, Chicago, IL 60611, USA.
Plast Reconstr Surg. 2002 Jul;110(1):177-83; discussion 184-6. doi: 10.1097/00006534-200207000-00029.
Currently accepted conservative treatments of hypertrophic scars are limited to steroid injections, radiation therapy, and silicone occlusive therapy. However, the use of Mederma for these problematic lesions has become quite prevalent in the clinical setting. Little scientific evidence exists to support the efficacy of this product in reducing hypertrophic scars. The aim of this study was to study the effects of Mederma on hypertrophic scars in the rabbit hypertrophic scar model, allowing the histologic quantification of scar elevation, dermal collagen organization, vascularity, and inflammation and the gross examination of scar erythema. Full-thickness wounds down to cartilage, four per ear, were created in four New Zealand White rabbits, for a total of 32 scars. Twenty-eight days after the initial wounding, the hypertrophic scars were photographed, and treatment of half of the scars on each ear was begun with Mederma three times per day for a total of 4 weeks. The untreated scars served as control scars and were left exposed to air. After 4 weeks of treatment, the scars were once again photographed. The rabbits were then killed, and the scars were analyzed histologically. The pretreatment and posttreatment photographs were compared by using computer quantification of magenta, yellow, and cyan expression within the scars. Histologic analysis demonstrated no significant reduction in scar hypertrophy or scar elevation index. However, a significant improvement in dermal collagen organization was noted on comparing Mederma-treated scars with untreated control scars (p < 0.05). No significant difference in dermal vascularity or inflammation was noted. Computer analysis of the scar photographs demonstrated no significant reduction in scar erythema with Mederma treatment. The active product in Mederma, allium cepa, has as its derivative quercetin, a bioflavonoid noted for its antiproliferative effects on both normal and malignant cells, and its antihistamine release effects. These properties could theoretically prove beneficial in reversing the inflammatory and proliferative responses noted in hypertrophic scars. Despite the authors' inability to demonstrate a reduction in scar hypertrophy, the improvement in collagen organization noted in the Mederma-treated scars suggests it may have an effect on the pathophysiology of hypertrophic scar formation.
目前公认的肥厚性瘢痕保守治疗方法仅限于类固醇注射、放射治疗和硅胶封闭疗法。然而，在临床环境中，使用美德玛治疗这些有问题的损伤已变得相当普遍。几乎没有科学证据支持该产品在减少肥厚性瘢痕方面的疗效。本研究的目的是在兔肥厚性瘢痕模型中研究美德玛对肥厚性瘢痕的影响，从而对瘢痕隆起、真皮胶原组织、血管形成和炎症进行组织学定量分析，并对瘢痕红斑进行大体检查。在4只新西兰白兔的每只耳朵上制造4个深至软骨的全层伤口，共形成32个瘢痕。初始伤口形成28天后，对肥厚性瘢痕进行拍照，每只耳朵上一半的瘢痕开始用美德玛治疗，每天3次，共4周。未治疗的瘢痕作为对照瘢痕，暴露于空气中。治疗4周后，再次对瘢痕进行拍照。然后处死兔子，对瘢痕进行组织学分析。通过计算机定量分析瘢痕内品红色、黄色和青色的表达，比较治疗前和治疗后的照片。组织学分析表明，瘢痕肥厚或瘢痕隆起指数没有显著降低。然而，与未治疗的对照瘢痕相比，美德玛治疗的瘢痕在真皮胶原组织方面有显著改善（p<0.05）。真皮血管形成或炎症方面没有显著差异。对瘢痕照片的计算机分析表明，美德玛治疗后瘢痕红斑没有显著减少。美德玛中的活性成分洋葱含有其衍生物槲皮素，槲皮素是一种生物类黄酮，以其对正常细胞和恶性细胞的抗增殖作用以及抗组胺释放作用而闻名。从理论上讲，这些特性可能有助于逆转肥厚性瘢痕中出现的炎症和增殖反应。尽管作者未能证明瘢痕肥厚有所减轻，但美德玛治疗的瘢痕中胶原组织的改善表明它可能对肥厚性瘢痕形成的病理生理学有影响。
