Apoyando el uso del laser co2 fraccionado en la remodelación de cicatrices.

Apoyando el uso del laser co2 fraccionado en la remodelación de cicatrices., inclusive en la población pediátrica y adolescente.

Published in Dermatology

Journal Scan / Review · February 22, 2016

Scar Management in Pediatric and Adolescent Populations

Pediatrics

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• This review article addresses new scar treatment strategies for scar management in the pediatric and adolescent populations. Intralesional corticosteroids and intralesional 5-fluorouracil have both proven effective in the treatment of keloids and hypertrophic scars, but 5-fluorouracil is "off-label" in pediatrics. Autologous fat transfer (AFT) is used for scars associated with volume loss and for the treatment of facial malformations. Additionally, AFT combined with composite grafting offers benefits beyond volume replacement alone. Surgical excision and revision may be necessary when conservative management fails or when scars are associated with debilitating contractures. Pulsed dye laser targets hemoglobin and can reduce scar erythema, pain, itch, and prominence. Fractional ablative laser treatments have established a new gold standard in acne, surgical, and traumatic scar treatment due to their high efficacy and safety. They work by inducing scar remodeling with the resulting architecture closer to that of normal skin.

• Data on laser-assisted delivery of topical corticosteroids are limited, but this technique shows promise. Theoretical treatments on the horizon include reactivation of fetal pathways, stem cells, autologous fibroblasts injections, interleukin-10, basic fibroblast growth factor, and MMPs. Several safe and efficacious treatment modalities are available for scar treatment in pediatrics and adolescents. Novel treatments that target specific molecular and cellular pathways are on the horizon.

– Anna Wile, MD

Abstract

This abstract is available on the publisher's site.

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For most children and adolescents who have developed symptomatic scars, cosmetic concerns are only a portion of the motivation that drives them and their caregivers to obtain treatment. In addition to the potential for cosmetic disfigurement, scars may be associated with a number of physical comorbidities including hypertrichosis, dyshidrosis, tenderness/pain, pruritus, dysesthesias, and functional impairments such as contractures, all of which may be compounded by psychosocial factors. Although a plethora of options for treating scars exists, specific management guidelines for the pediatric and adolescent populations do not, and evidence must be extrapolated from adult studies. New modalities such as the scar team approach, autologous fat transfer, and ablative fractional laser resurfacing suggest a promising future for children who suffer symptomatically from their scars. In this state-of-the-art review, we summarize cutting-edge scar treatment strategies as they relate to the pediatric and adolescent populations.