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Empfehlungen zur Prävention und Therapie hypertropher Narben und Keloide

Recommendations for the prevention and therapy of hypertrophic scars and keloids

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Zusammenfassung

Hypertrophe Narben und Keloide können nach tieferen Verletzungen der Haut in Abhängigkeit von Lokalisation, Ursache, Heilungsverlauf und individueller Disposition auftreten und sind Ausdruck einer pathologisch veränderten Wundheilung mit exzessiver Bildung von Narbengewebe. Sowohl Keloide als auch hypertrophe Narben sind häufig mit Juckreiz, Spannungsgefühl, Schmerzen und sogar Funktionseinschränkungen assoziiert. Trotz intensiver Forschungsaktivität sind die Pathomechanismen der überschießenden Narbenbildung bisher nur unzureichend verstanden und sicher wirksame Behandlungsmöglichkeiten bisher nicht verfügbar. Aufgrund zunehmend soliderer Studienlage werden heute neben bereits seit Jahren angewandten Techniken, wie beispielsweise intraläsionale Kortikosteroide und Kryotherapie, neuere, noch weniger etablierte Verfahren – zum Teil in Kombination – erfolgreich eingesetzt. Für beide Entitäten bleibt jedoch nach wie vor die Prävention ungleich effizienter als die jeweilige Behandlung.

Abstract

Hypertrophic scars and keloids form due to aberrations in the physiologic wound healing cascade characterized by greater and more sustained ECM deposition. Both entities are frequently associated with pain, pruritus and contractures, and are thus significantly affecting the patient’s quality of life. Genetic susceptibility, specific anatomic locations, prolonged inflammation and delayed epithelialization significantly contribute to excessive scar formation. However, despite intensive scientific work in this field the complex mechanisms underlying the processes of scarring and wound contraction remain poorly understood and most therapeutic approaches are clinically unsatisfactory. Nevertheless, based on a rising number of clinical studies next to well-known therapeutic concepts including cryotherapy and intralesional triamcinolone, recent techniques extend the spectrum for treating excessive scars. Nonetheless, prevention of pathologic scarring is undoubtedly more effective than to later attempts to treat it.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: Vortragstätigkeit für die Firmen Merz (Contractubex) und Meda (Dermatix ultra).

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  1. Klinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität München, Frauenlobstr. 9-11, 80337, München, Deutschland

    G.G. Gauglitz MMS & C. Kunte

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Correspondence to G.G. Gauglitz MMS.

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Gauglitz, G., Kunte, C. Empfehlungen zur Prävention und Therapie hypertropher Narben und Keloide. Hautarzt 62, 337–346 (2011). https://doi.org/10.1007/s00105-010-2087-4

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