My daughter had three well-circumscribed, <2-mm warts in a triangular pattern on her left elbow. Cryotherapy has left a dime-sized, raised-pink-papule hypertrophied scar, which causes her pain with the slightest pressure. She has undergone four unsuccessful laser treatments and steroid injections in an effort to remove the scar. Other than surgical excision, what options are there?
—Debbie Mascovich, PA-C, FNP, Grand Junction, Colo.
Skin wounds may subsequently develop hypertrophic scars or keloids. Although some of the same treatment modalities can be used for both conditions, hypertrophic scars and keloids have distinguishing clinical features and biochemical alterations. Your initial approach may involve (1) manipulation of the mechanical properties of wound repair, (2) correction of the abnormal balance of collagen synthesis and degradation, and (3) alteration of the immune/inflammatory response.
Treatment options for hypertrophic scars include surgical excision, laser surgery, pressure, silicone-gel sheeting, intralesional corticosteroid injection, and intralesional 5-fluorouracil injection. Other agents or modalities that have been studied include topical retinoic acid, topical putrescine (Fibrostat), adhesive zinc tape, static-electric field induction, and iontophoretic transdermal delivery of transilast (J Am Acad Dermatol. 2002;46:S63-S97 and Semin Cutan Med Surg. 2002;21:46-75).
—Philip R. Cohen, MD (104-6)