Pathogenetically justified treatment of hypertrophic scars: a review of modern methods

Formation of pathological scars, including hypertrophic ones, is caused by a disruption of physiological regeneration mechanisms under the influence of various systemic and local factors. Hypertrophic scars are a consequence of excessive formation of structural proteins of the extracellular matrix due to enhanced expression of pro-inflammatory cytokines, increased production of various growth factors and activation of angiogenesis. Hypertrophic scars do not affect a human’s health, but their presence can be accompanied by a significant decrease in the patient’s quality of life due to aesthetic or functional discomfort. In this connection, the importance of timely treatment is determined not only by medical aspects but also by the significant impact of the considered defects on the psycho-emotional state of patients, their self-esteem and social adaptation. Targeted selection of the most effective methods for the prevention and treatment of hypertrophic scars should be based on an understanding of the mechanisms of scar formation and morphological characteristics of the scar tissue. Modern methods of treating hypertrophic scars include the use of topical and injectable agents (glucocorticosteroids, cytostatic and enzymatic preparations, botulinum toxin type A, silicone scar sheets, silicone gel occlusive dressings), hardware procedures that promote the destruction of excessive collagen and vessels of the scar formation (laser therapy, cryodestruction, microneedling) as well as ensure the effective delivery of anti-fibrotic enzymes to the scar tissue (phono- and ultraphonophoresis). It seems advisable to use combined scar correction protocols as well as to develop new treatment methods aimed at the main pathogenetic mechanisms of hypertrophic scar formation.