Russian Journal of Physiotherapy, Balneology and RehabilitationRussian Journal of Physiotherapy, Balneology and RehabilitationФизиотерапия, бальнеология и реабилитация1681-34562413-2969Eco-Vector11503310.17816/rjpbr115033Original studiesОригинальные исследованияResearch ArticleCurrent trends in the treatment of hypertrophic scarsСовременные тенденции в лечении гипертрофических рубцовhttps://orcid.org/0000-0001-8182-72932354-8420NogerovAlim R.НогеровАлим Русланович
Russian Federation
drnogerov@yandex.ruhttps://orcid.org/0000-0002-8824-12411107-4372KruglovaLarisa S.КругловаЛариса Сергеевна
Russian Federation

MD, Dr. Sci. (Med.), Professor

д.м.н., профессор

kruglovals@mail.ruhttps://orcid.org/0000-0003-3437-52331309-4668GryazevaNatalia V.ГрязеваНаталья Владимировна
Russian Federation

MD, Cand. Sci. (Med.), Associated Professor

к.м.н., доцент

tynrik@yandex.ruCentral State Medical Academy of the Presidential Administration of the Russian FederationЦентральная государственная медицинская академия Управления делами Президента Российской Федерации041220222131631700212202203122022Copyright ©; 2022, Nogerov A.R., Kruglova L.S., Gryazeva N.V.Copyright ©; 2022, Ногеров А.Р., Круглова Л.С., Грязева Н.В.2022Nogerov A.R., Kruglova L.S., Gryazeva N.V.Ногеров А.Р., Круглова Л.С., Грязева Н.В.https://creativecommons.org/licenses/by-nc-nd/4.0/https://rjpbr.com/1681-3456/article/view/115033

BACKGROUND: The therapeutic arsenal for the treatment of hypertrophic scars and keloids has expanded significantly in recent years. Traditional methods of treatment, such as intraocular injection of corticosteroids, pressure therapy and cryotherapy, are increasingly supplemented with new methods. The level of evidence for treatment approaches has increased due to the development of systematic reviews and national and international recommendations.

AIM: To study the effectiveness of pneumokinetic micro-jet "needle-free" delivery of corticosteroid drug and fluorouracil in hypertrophic scars.

MATERIAL AND METHODS: We observed 23 patients (with hypertrophic scars. The average age was 31.3±4.3 years. The duration of the existence of hypertrophic scars in the average group was 7.8±2.3 months. Previously, patients did not receive therapy for the correction of scars. All patients were treated with intra-cicatricial administration of durant corticosteroid and fluorouracil. The technology of pneumokinetic micro-jet "needle-free" was used.

RESULTS: A high effect was achieved in all patients. Thus, the total Dermatological symptom scale index decreased with localization of the process on the face by 79.1% (p <0.01), with localization on the neck by 81.2% (p <0.01), with localization on the abdomen by 73.4% (p <0.01).

CONCLUSION: The technology of pneumokinetic micro-jet "needle-free" delivery of corticosteroid drug and fluorouracil subdermally can be considered as the method of choice in this category of patients.

Обоснование. Терапевтический арсенал для лечения гипертрофических рубцов и келоидов в последние годы значительно расширился. Традиционные способы лечения, такие как внутриочаговая инъекция кортикостероидов, терапия под давлением и криотерапия, всё больше дополняются новыми методами. Уровень доказательности подходов к лечению увеличился благодаря разработке систематических обзоров и национальных и международных рекомендаций.

Цель исследования ― изучение эффективности пневмокинетической микроструйной needle-free доставки кортикостероидного препарата и фторурацила при гипертрофических рубцах.

Материал и методы. Под нашим наблюдением находились 23 пациента с гипертрофическими рубцами. Средний возраст участников исследования составил 31,3±4,3 года. Длительность существования гипертрофических рубцов в среднем по группе ― 7,8±2,3 мес. Ранее пациенты не получали терапии для коррекции рубцов. Всем пациентам проводили внутрирубцовое введение дюрантного кортикостероида и фторурацила. Использована технология пневмокинетической микроструйной needle-free.

Результаты. Высокий эффект был достигнут у всех пациентов: так, суммарный дерматологический индекс шкалы симптомов редуцировал при локализации процесса на лице на 79,1% (р <0,01), при локализации на шее ― на 81,2% (р <0,01), при локализации на животе ― на 73,4% (р <0,01).

Заключение. Технологию пневмокинетической микроструйной needle-free доставки кортикостероидного препарата и фторурацила субдермально можно рассматривать в качестве метода выбора у данной категории пациентов.

hypertrophic scarslaser therapyglucocorticosteroidsfluorouracilгипертрофические рубцылазерная терапияглюкокортикостероидыфторурацилGold MH, Berman B, Clementoni MT, et al. Updated international clinical recommendations on scar management: part 1: evaluating the evidence. Dermatol Surg. 2014;40(8):817–824. doi: 10.1111/dsu.0000000000000049Gold M.H., Berman B., Clementoni M.T., et al. Updated international clinical recommendations on scar management. Part 1: evaluating the evidence // Dermatol Surg. 2014. Vol. 40, N 8. P. 817–824. doi: 10.1111/dsu.0000000000000049Eberle FC, Krug M, Breuninger H, Häfner HM. Primary wound closure with tension--tips and tricks. J Dtsch Dermatol Ges. 2013;11(6):558–560. doi: 10.1111/ddg.12088Eberle F.C., Krug M., Breuninger H., Häfner H.M. Primary wound closure with tension — tips and tricks // J Dtsch Dermatol Ges. 2013. Vol. 11, N 6. P. 558–560. doi: 10.1111/ddg.12088Gold MH, McGuire M, Mustoe TA, et al. International advisory panel on scar management. Updated international clinical recommendations on scar management. Part 2: algorithms for scar prevention and treatment. Dermatol Surg. 2014;40(8):825–831. doi: 10.1111/dsu.0000000000000050Gold M.H., McGuire M., Mustoe T.A., et al.; International advisory panel on scar management. Updated international clinical recommendations on scar management. Part 2: algorithms for scar prevention and treatment // Dermatol Surg. 2014. Vol. 40, N 8. P. 825–831. doi: 10.1111/dsu.0000000000000050Gauglitz GG, Kunte C. [Recommendations for the prevention and therapy of hypertrophic scars and keloids]. Hautarzt. 2011;62(5):337–346. (In German). doi: 10.1007/s00105-010-2087-4Gauglitz G.G., Kunte C. [Recommendations for the prevention and therapy of hypertrophic scars and keloids] // Hautarzt. 2011. Vol. 62, N 5. P. 337–346. German. doi: 10.1007/s00105-010-2087-4Van Leeuwen MC, van der Wal MB, Bulstra AE, et al. Intralesional cryotherapy for treatment of keloid scars: A prospective study. Plast Reconstr Surg. 2015;135(2):580–589. doi: 10.1097/PRS.0000000000000911Van Leeuwen M.C., van der Wal M.B., Bulstra A.E., et al. Intralesional cryotherapy for treatment of keloid scars: A prospective study // Plast Reconstr Surg. 2015. Vol. 135, N 2. P. 580–589. doi: 10.1097/PRS.0000000000000911Mustoe TA. Evolution of silicone therapy and mechanism of action in scar management. Aesthetic Plast Surg. 2008;32(1):82–92. doi: 10.1007/s00266-007-9030-9Mustoe T.A. Evolution of silicone therapy and mechanism of action in scar management // Aesthetic Plast Surg. 2008. Vol. 32, N 1. P. 82–92. doi: 10.1007/s00266-007-9030-9Shaarawy E, Hegazy RA, Abdel Hay RM. Intralesional botulinum toxin type A equally effective and better tolerated than intralesional steroid in the treatment of keloids: A randomized controlled trial. J Cosmet Dermatol. 2015;14(2):161–166. doi: 10.1111/jocd.12134Shaarawy E., Hegazy R.A., Hay R.M. Intralesional botulinum toxin type A equally effective and better tolerated than intralesional steroid in the treatment of keloids: A randomized controlled trial // J Cosmet Dermatol. 2015. Vol. 14, N 2. P. 161–166. doi: 10.1111/jocd.12134Lee DH, Choi YS, Min SU, et al. Comparison of a 585-nm pulsed dye laser and a 1064-nm Nd:YAG laser for the treatment of acne scars: A randomized split-face clinical study. J Am Acad Dermatol. 2009;60(5):801–807. doi: 10.1016/j.jaad.2008.11.883Lee D.H., Choi Y.S., Min S.U., et al. Comparison of a 585-nm pulsed dye laser and a 1064-nm Nd:YAG laser for the treatment of acne scars: A randomized split-face clinical study // J Am Acad Dermatol. 2009. Vol. 60, N 5. P. 801–807. doi: 10.1016/j.jaad.2008.11.883Koike S, Akaishi S, Nagashima Y, et al. Nd:YAG laser treatment for keloids and hypertrophic scars: An analysis of 102 cases. Plast Reconstr Surg Glob Open. 2014;2(12):e272. doi: 10.1097/GOX.0000000000000231Koike S., Akaishi S., Nagashima Y., et al. Nd:YAG laser treatment for keloids and hypertrophic scars: An analysis of 102 cases // Plast Reconstr Surg Glob Open. 2014. Vol. 2, N 12. P. e272. doi: 10.1097/GOX.0000000000000231Huang L, Cai YJ, Lung I, et al. A study of the combination of triamcinolone and 5-fluorouracil in modulating keloid fibroblasts in vitro. J Plast Reconstr Aesthet Surg. 2013;66(9):e251–e259. doi: 10.1016/j.bjps.2013.06.004Huang L., Cai Y.J., Lung I., et al. A study of the combination of triamcinolone and 5-fluorouracil in modulating keloid fibroblasts in vitro // J Plast Reconstr Aesthet Surg. 2013. Vol. 66, N 9. P. e251–e259. doi: 10.1016/j.bjps.2013.06.004Choi JE, Oh GN, Kim JY, et al. Ablative fractional laser treatment for hypertrophic scars: Сomparison between Er:YAG and CO2 fractional lasers. J Dermatolog Treat. 2014;25(4):299–303. doi: 10.3109/09546634.2013.782090Choi J.E., Oh G.N., Kim J.Y., et al. Ablative fractional laser treatment for hypertrophic scars: Comparison between Er:YAG and CO2 fractional lasers // J Dermatolog Treat. 2014. Vol. 25, N 4. P. 299–303. doi: 10.3109/09546634.2013.782090Levine A, De Maria S, Park E, Lawson W. Facial plastic surgery. Springer Science Business Media New York; 2013. doi: 10.1007/978-1-4614-4184-7_12Levine A., De Maria S., Park E., Lawson W. Facial plastic surgery. Springer Science Business Media New York, 2013. doi: 10.1007/978-1-4614-4184-7_12