SPONSORED SYMPOSIUM HIGHLIGHTS At a Menarini-sponsored symposium during the 19th World Congress on Gynecology and Infertility held at the Venetian Macau Hotel last February 22, 2014, experts discussed the latest information about Asian scar management, with particular emphasis on the recently published Asian scar treatment guidelines. Updates on Asian Scar Management and Treatment Guidelines Marie Socouer Medina-Oblepias, MD Consultant Dermatologist Research Institute for Tropical Medicine Philippines The Asian Scar Treatment Guidelines A combination of prolonged inflammation, increased tension and genetic predisposition may lead to excessive scarring.1 Ethnicity may also be an important factor. Specifically, Asians have been described to have unique skin characteristics that predispose them to scarring. They exhibit a thicker dermis with greater collagen density and propensity to fibroblast proliferation. Asians also have larger melanosomes that make them more prone to hyperpigmentation after a cutaneous injury. Thus, to manage scars in Asians, expectations must be set realistically, because their scars may take a longer time to heal, and may require close monitoring.2,3 Moreover, because of the unique features of the Asian skin, specific guidelines are needed to optimize scar treatment outcomes. The recent publication of the paper, “Update on Scar Management: Guidelines for Treating Asian Patients,” makes specific recommendations for treating Asian scars, and emphasizes the importance of initiating scar prevention in all Asian patients (Table).2 The guidelines also recognize the significant efficacy of a siliconebased gel therapy in Asian patients, highlighting its ease of use and improved patient compliance when compared with silicone gel sheeting.2-5 Silicone gels were also assessed to be as effective as silicone gel sheeting in preventing hypertrophic scars, and that in select patients, silicone gel therapy is recommended as first-line treatment.2,4 Aside from decreasing scar height and erythema and improving pliability, silicone gels have also been shown to improve the subjective symptoms of pain, itching and tension associated with scars.5 The guidelines will hopefully help practitioners make optimal and evidence-based treatment decisions for their patients to prevent excessive scarring and improve treatment outcomes. Table. Recommendations for scar management in Asian patients2 Scar type Recommendations All scars • In select patients, silicone gel therapy is recommended as first-line treatment for the management of both hypertrophic and keloid scars Hypertrophic scars • Silicone-based gel is as effective as silicone gel sheeting • Multiple sessions of lower fluences of pulsed-dye lasers are recommended for prevention of hyperpigmentation in Asian patients with hypertrophic scars Keloids • Steroid monotherapy is effective for symptom management • Combined excision plus steroid injections or other adjuvant therapies is effective and safe • Keloid sites with a high risk of recurrence should be treated with escalated doses of radiation and posttreatment self-management EE Cherk Cheong, MD Consultant, Plastic, Reconstructive and Aesthetic Surgery Tan Tock Seng Hospital Singapore Scar prevention post-surgery Prevention is always better than treatment, and in terms of scars, good and early wound management yields better scar outcomes. Planning the incision, with the consideration of several factors, also determines the resulting scar. Factors to note are as follows: anatomic site of injury, symptoms involved, degree of psychological distress and functional impairment. Treatment is best commenced when the scar is immature but with the overlying epithelium already intact. This can be achieved via a multimodal approach to scar therapy. For new scars, silicone gels or sheeting may be used, together with sun avoidance. An enhanced silicone gel formulation – Dermatix® Ultra – has vitamin C that not only stimulates collagen repair for healing, but also blocks melanin formation that helps lighten scars. Meanwhile, steroid injections, surgery and radiotherapy should be reserved for more problematic scars. Dominic Fuk-Him Li, MD Honorary Clinical Assistant Professor Department of Obstetrics and Gynecology University of Hong Kong Hong Kong Scar management and prevention in Obstetrics-Gynecology Hypertrophic scars are common problems encountered in postcesarean section patients.6 The risk for scarring is influenced by certain factors including age, skin color, family history, location and size of the scar and duration of inflammation. It affects patients both physically and psychosocially, and should not be trivialized. As with any surgery, a proactive preventive approach on scar management should always be employed in obstetric and gynecologic procedures. Silicone-based therapy is considered as a gold standard in treatment. Based on experience, the use of the non-invasive silicone gel Dermatix® Ultra has been superior in its ease of use and patient acceptability in obstetric and gynecologic procedures. References 1. Bayat A, et al. BMJ 2003;326:88-92. 2. Kim S, et al. Plast Reconstr Surg 2013;132:1-10. 3. Mustoe TA, et al. Plast Reconstr Surg 2002;110:560-71. 4. Mustoe TA. Equivalent efficacy of silicone gel (Dermatix® Ultra) & silicone gel sheeting in scar management: Clinical results & MOA. Presented at the 21st World Congress of Dermatology 2007;Buenos Aires, Argentina. 5. Chernoff WG, et al. Aesth Plast Surg 2007;31:495-500. 6. Atkinson JM. Plast Reconstr Surg 2005;116:1648-56. Sponsored as a service to the medical profession by A. Menarini Editorial development by MIMS. The opinions expressed in this publication are not necessarily those of the editor, publisher or sponsor. Any liability or obligation for loss or damage howsoever arising is hereby disclaimed.© 2014 MIMS. All rights reserved. No part of this publication may be reproduced by any process in any language without the written permission of the publisher. 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