Huang Chenyu, Ogawa Rei
Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School, Tokyo, Japan; Department of Plastic Surgery, Meitan General Hospital, Beijing, China.
Wound Repair Regen. 2014 Jul-Aug;22(4):462-6. doi: 10.1111/wrr.12197.
Pathological scars, namely, keloids and hypertrophic scars (HSs), are caused by excessive cutaneous wound healing that is characterized by histological extracellular matrix (ECM) accumulation, clinically relevant irritating symptoms, and frequent recurrence after surgical excision. To date, there are few effective and specific treatments. This partly reflects the poor understanding of the etiology of these scars and the lack of a suitable animal model. Systemic hypertension has been suggested to participate in pathological scarring. The evidence that supports this hypothesis is reviewed here. Thus, hypertension associates with changes that resemble the aberrant cutaneous wound-healing phases that characterize pathological scar development. It also associates with profibrotic functional changes in the cells that constitute keloids and HSs (endothelial cells, pericytes/myofibroblasts, dermal fibroblasts, and mast cells) and profibrotic ECM remodeling. These hypertension-associated changes are mediated to some extent by inflammation, hypoxia, and the angiotensin/renin-angiotensin-aldosterone system. Thus, hypertension may be an aggravating/risk factor for keloids and HSs. This will help to identify patients who are prone to heavy scars after surgery or postsurgical recurrence. Moreover, pharmacological agents for the prophylaxis and treatment of hypertension-induced fibrosis in other organs may also be useful for keloids/HSs.
病理性瘢痕，即瘢痕疙瘩和增生性瘢痕（HSs），是由皮肤伤口过度愈合引起的，其特征在于组织学上细胞外基质（ECM）积累、临床上相关的刺激性症状以及手术切除后频繁复发。迄今为止，几乎没有有效的特异性治疗方法。这在一定程度上反映了对这些瘢痕病因的了解不足以及缺乏合适的动物模型。有研究表明系统性高血压参与了病理性瘢痕形成。本文综述了支持这一假说的证据。因此，高血压与类似于病理性瘢痕发展特征的异常皮肤伤口愈合阶段的变化相关。它还与构成瘢痕疙瘩和增生性瘢痕的细胞（内皮细胞、周细胞/肌成纤维细胞、真皮成纤维细胞和肥大细胞）中的促纤维化功能变化以及促纤维化ECM重塑相关。这些与高血压相关的变化在一定程度上是由炎症、缺氧以及血管紧张素/肾素 - 血管紧张素 - 醛固酮系统介导的。因此，高血压可能是瘢痕疙瘩和增生性瘢痕的加重/风险因素。这将有助于识别术后易形成严重瘢痕或术后复发的患者。此外，用于预防和治疗其他器官中高血压诱导的纤维化的药物制剂也可能对瘢痕疙瘩/增生性瘢痕有用。
