Skin Hardness Measurement in Hypertrophic Scars
Skin Hardness Measurement in Hypertrophic Scars
Objective evaluation of hypertrophic scarring through noninvasive techniques is an essential way to monitor biomechanical cutaneous parameters and to control the efficacy of related treatments. Several techniques, such as transcutaneous gas diffusion measurement, high-frequency ultrasound, tonometry, and laser Doppler evaluation, have been advocated for a correct assessment of burn scars. Recent reports have documented the reliability of a durometer in assessing skin induration in scleroderma and lipodermatosclerosis. The purpose of this study was to test the usefulness of the durometer in assessing skin hardness of immature hypertrophic burn scars and to compare the numeric data with a clinical scoring. The study was carried out over a six-month period, and patients were instructed to wear compression garments as the only treatment for hypertrophic scars. A direct linear relation (r = 0.769) was found between skin severity score and durometer readings (p < 0.01). Increased clinical skin scores were associated with higher durometer readings. After six months, the use of compression garments was found to be significantly effective (p < 0.05) in 76 percent of sites examined by means of durometer readings compared to baseline values. The durometer appeared to be a useful tool for the assessment of skin hardness in burn scars and may be used to test the efficacy of various treatments over time.
Hypertrophic scars and keloids represent the abnormal result of cutaneous tissue repair after an acute injury and are characterized by an excessive synthesis of collagen due to the increased activity of different types of fibroblasts. Hypertrophic scars develop within the boundary of the original wound and may spontaneously regress over time, while keloids extend beyond the wound boundary and tend to remain elevated. Other differences between keloids and hypertrophic scars include histologic morphology, cellular response to growth factors, and scar appearance. These cutaneous fibrotic conditions can be caused by minor insults to the skin, such as ear piercing, abrasions, or tattooing, or by major trauma, such as severe burns. Despite the defect, symptoms, and psychological impact of these abnormal wound responses, the literature offers little consensus about appropriate therapy. It has been difficult to assess the efficacy of the existing treatment modalities, because they have been limited to numbers of controlled, comparative studies on the effectiveness of various treatment methods in improving the appearance or symptoms of such scars. The main objectives in managing keloids and hypertrophic scars include restoration of the functional utility of the affected anatomic site, relief of symptoms, and prevention of recurrence. In terms of keloids and hypertrophic formation, the most important point is prevention. The best therapeutic choices appear to be surgery plus adjuvants, such as intralesional steroids, silicone gel sheeting, pressure, radiotherapy, collagen, and mucopolysaccharides creams. In the present study, the authors considered that objective quantification of skin hardness through noninvasive techniques is an essential way to control hypertrophic scarring and the efficacy of related treatments. Several methods, including transcutaneous oxygen tension measurement, ultrasonography, tonometry, and laser Doppler evaluation, have been used for appropriate assessment of physical parameters in burn scars. In this preliminary study, the authors used a durometer, a new hand-held engineering instrument that is the international standard for measuring the hardness of plastic, rubber, and other nonmetallic material, to assess skin hardness of hypertrophic scars derived from burn wounds, to compare the numeric data with a clinical scoring, and to monitor scar maturation during treatment over time.
Objective evaluation of hypertrophic scarring through noninvasive techniques is an essential way to monitor biomechanical cutaneous parameters and to control the efficacy of related treatments. Several techniques, such as transcutaneous gas diffusion measurement, high-frequency ultrasound, tonometry, and laser Doppler evaluation, have been advocated for a correct assessment of burn scars. Recent reports have documented the reliability of a durometer in assessing skin induration in scleroderma and lipodermatosclerosis. The purpose of this study was to test the usefulness of the durometer in assessing skin hardness of immature hypertrophic burn scars and to compare the numeric data with a clinical scoring. The study was carried out over a six-month period, and patients were instructed to wear compression garments as the only treatment for hypertrophic scars. A direct linear relation (r = 0.769) was found between skin severity score and durometer readings (p < 0.01). Increased clinical skin scores were associated with higher durometer readings. After six months, the use of compression garments was found to be significantly effective (p < 0.05) in 76 percent of sites examined by means of durometer readings compared to baseline values. The durometer appeared to be a useful tool for the assessment of skin hardness in burn scars and may be used to test the efficacy of various treatments over time.
Hypertrophic scars and keloids represent the abnormal result of cutaneous tissue repair after an acute injury and are characterized by an excessive synthesis of collagen due to the increased activity of different types of fibroblasts. Hypertrophic scars develop within the boundary of the original wound and may spontaneously regress over time, while keloids extend beyond the wound boundary and tend to remain elevated. Other differences between keloids and hypertrophic scars include histologic morphology, cellular response to growth factors, and scar appearance. These cutaneous fibrotic conditions can be caused by minor insults to the skin, such as ear piercing, abrasions, or tattooing, or by major trauma, such as severe burns. Despite the defect, symptoms, and psychological impact of these abnormal wound responses, the literature offers little consensus about appropriate therapy. It has been difficult to assess the efficacy of the existing treatment modalities, because they have been limited to numbers of controlled, comparative studies on the effectiveness of various treatment methods in improving the appearance or symptoms of such scars. The main objectives in managing keloids and hypertrophic scars include restoration of the functional utility of the affected anatomic site, relief of symptoms, and prevention of recurrence. In terms of keloids and hypertrophic formation, the most important point is prevention. The best therapeutic choices appear to be surgery plus adjuvants, such as intralesional steroids, silicone gel sheeting, pressure, radiotherapy, collagen, and mucopolysaccharides creams. In the present study, the authors considered that objective quantification of skin hardness through noninvasive techniques is an essential way to control hypertrophic scarring and the efficacy of related treatments. Several methods, including transcutaneous oxygen tension measurement, ultrasonography, tonometry, and laser Doppler evaluation, have been used for appropriate assessment of physical parameters in burn scars. In this preliminary study, the authors used a durometer, a new hand-held engineering instrument that is the international standard for measuring the hardness of plastic, rubber, and other nonmetallic material, to assess skin hardness of hypertrophic scars derived from burn wounds, to compare the numeric data with a clinical scoring, and to monitor scar maturation during treatment over time.
