Ricketts C H, Martin L, Faria D T, Saed G M, Fivenson D P
Department of Dermatology, Henry Ford Hospital, Detroit, MI 48202, USA.
Dermatol Surg. 1996 Nov;22(11):955-9. doi: 10.1111/j.1524-4725.1996.tb00640.x.
Treatment of hypertrophic scars can be difficult for both patients and physicians. Silicone-containing gel dressings have been reported to be an effective alternative treatment for hypertrophic scars, yet the mechanism of action of these dressings is unknown.
To determine whether silicone is an essential factor in the treatment of hypertrophic scars and investigate the effects of occlusive dressing therapy on the expression of key wound healing mediators.
A pilot paired comparison, nonrandomized study was conducted comparing a silicone gel sheeting (Silastic [SGS]) with a hydrogel dressing (ClearSite). The effects of the dressings were compared side by side in the treatment of 15 hypertrophic scars at both the clinical and molecular levels through the use of reverse transcriptase/polymerase chain reaction to evaluate effects on the expression of interleukin 8 (IL-8), basic fibroblast growth factor (bFGF), granulocyte-macrophage colony-stimulating factor (GMCSF), epidermal growth factor (EGF), transforming growth factor beta (TGF-beta), and fibronectin.
Comparable clinical improvement of the hypertrophic scars was obtained with both dressings. Treatment of hypertrophic scars resulted in increased mean levels of IL-8, bFGF, and GMCSF mRNA; while mean TGF beta and fibronectin mRNAs decreased after treatment with both dressings. Comparison between the two dressings revealed significant changes in IL-8 and fibronectin mRNA levels after treatment with ClearSite, while only fibronectin changes were significant after treatment with SGS with respect to normal skin. Only ClearSite induced significant changes in IL-8 and bFGF levels when untreated scars were compared with posttreatment lesions, suggesting that the hydrogel augments collagenolysis via promotion of inflammation.
This study demonstrates that silicone is not a necessary component of occlusive dressings in the treatment of hypertrophic scars. The pathogenesis of hypertrophic scars is further elucidated by demonstrating that there is molecular evidence for extensive connective tissue remodeling occurring during occlusive dressing therapy.
肥厚性瘢痕的治疗对患者和医生来说都可能具有挑战性。据报道，含硅凝胶敷料是治疗肥厚性瘢痕的一种有效替代疗法，但其作用机制尚不清楚。
确定硅酮是否为治疗肥厚性瘢痕的关键因素，并研究封闭敷料疗法对关键伤口愈合介质表达的影响。
开展一项初步配对比较、非随机研究，将硅凝胶片（Silastic [SGS]）与水凝胶敷料（ClearSite）进行比较。通过逆转录酶/聚合酶链反应评估对白细胞介素8（IL-8）、碱性成纤维细胞生长因子（bFGF）、粒细胞-巨噬细胞集落刺激因子（GMCSF）、表皮生长因子（EGF）、转化生长因子β（TGF-β）和纤连蛋白表达的影响，在临床和分子水平对两种敷料在治疗15例肥厚性瘢痕时的效果进行并排比较。
两种敷料均使肥厚性瘢痕在临床上得到了类似改善。治疗肥厚性瘢痕导致IL-8、bFGF和GMCSF mRNA的平均水平升高；而两种敷料治疗后TGF-β和纤连蛋白mRNA的平均水平均下降。两种敷料之间的比较显示，使用ClearSite治疗后IL-8和纤连蛋白mRNA水平有显著变化，而使用SGS治疗后相对于正常皮肤只有纤连蛋白的变化显著。当将未治疗的瘢痕与治疗后的病变进行比较时，只有ClearSite诱导了IL-8和bFGF水平的显著变化，这表明水凝胶通过促进炎症增强了胶原溶解。
本研究表明，硅酮不是治疗肥厚性瘢痕的封闭敷料的必要成分。通过证明在封闭敷料治疗期间发生广泛结缔组织重塑的分子证据，进一步阐明了肥厚性瘢痕的发病机制。
