WordNet
- mark with a scar; "The skin disease scarred his face permanently" (同)mark, pock, pit
- a mark left (usually on the skin) by the healing of injured tissue (同)cicatrix, cicatrice
PrepTutorEJDIC
- (皮膚の)『傷跡』;(物の表面の)傷跡 / 心の傷跡,痛手;(名誉などを傷つける)汚点 / (植物の茎などに残る)葉印,葉痕(ようこん) / …‘に'傷跡を残す / 〈傷などが〉傷跡を残す《+『over』》
- 瘢痕(はんこん)(傷を修復して再生した新しい組織)
Wikipedia preview
出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2012/10/24 18:53:42」(JST)
wiki en
This article is about scar tissue. For other uses, see Scar (disambiguation).
"Scarring" redirects here. For the act of inflicting scars, see Scarification.
"Scarred" redirects here. For other uses, see Scarred (disambiguation).
"Scars" redirects here. For the 1998 video game, see S.C.A.R.S. (video game).
| It has been suggested that Subcision be merged into this article or section. (Discuss) Proposed since April 2011. |
| Scar | |
|---|---|
| Classification and external resources | |
A minor scar from a cut to the forearm, approx. one year since the wound. |
|
| ICD-10 | L90.5 |
| MeSH | D002921 |
Scars are areas of fibrous tissue (fibrosis) that replace normal skin after injury. A scar results from the biological process of wound repair in the skin and other tissues of the body. Thus, scarring is a natural part of the healing process. With the exception of very minor lesions, every wound (e.g. after accident, disease, or surgery) results in some degree of scarring. An exception to this is animals with regeneration, which do not form scars and the tissue will grow back exactly as before.
Scar tissue is the same protein (collagen) as the tissue that it replaces,[1] but the fiber composition of the protein is different; instead of a random basketweave formation of the collagen fibers found in normal tissue,[1] in fibrosis the collagen cross-links and forms a pronounced alignment in a single direction.[1] This collagen scar tissue alignment is usually of inferior functional quality to the normal collagen randomised alignment. For example, scars in the skin are less resistant to ultraviolet radiation, and sweat glands and hair follicles do not grow back within scar tissue.[2] A myocardial infarction, commonly known as a heart attack, causes scar formation in the heart muscle, which leads to loss of muscular power and possibly heart failure. However, there are some tissues (e.g. bone) that can heal without any structural or functional deterioration.
Heart bypass patient with almost invisible residual scarring
Contents
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Etymology
First attested in English in late 14th century, the word scar derives from Old French escharre, from Late Latin eschara,[3] which is the latinisation of the Greek ἐσχάρα (eskhara), meaning "hearth, fireplace", but in medicine "scab, eschar on a wound caused by burning or otherwise".[4][5]
Types
All scarring is composed of the same collagen as the tissue it has replaced, but the composition of the scar tissue, compared to the normal tissue, is different.[1] Scars differ from other scars in the amounts of collagen overexpressed. Labels have been applied to the differences in overexpression. Two of the most common types are hypertrophic and keloid scarring,[6] both of which experience excessive stiff collagen bundled growth overextending the tissue, blocking off regeneration of tissues. Another form is atrophic scarring (sunken scarring), which also has an overexpression of collagen blocking regeneration. This scar type is sunken, because the collagen bundles do not overextend the tissue. Stretch marks (striae) are regarded as scars by some.
Hypertrophic
Hypertrophic scars occur when the body overproduces collagen, which causes the scar to be raised above the surrounding skin. Hypertrophic scars take the form of a red raised lump on the skin. They usually occur within 4 to 8 weeks following wound infection or wound closure with excess tension and/or other traumatic skin injuries.[6]
Keloid
Keloid scarring on the back of an enslaved African; people with darker skin pigmentations are more prone to the development of keloids.
Keloid scars are a more serious form of scarring, because they can grow indefinitely into large, tumorous (although benign) neoplasms.[6]
Hypertrophic scars are often distinguished from keloid scars by their lack of growth outside the original wound area, but this commonly taught distinction can lead to confusion.[6] All keloid scars are hypertrophic,[6] but "only a small percentage of large scars" are keloid.[6] Phenotypic differences exist between keloid scars and other hypertrophic scars.[6] Keloid scars can occur on anyone, but they are most common in dark-skinned people.[7] They can be caused by surgery, accident, acne or, sometimes, body piercings. In some people, keloid scars form spontaneously. Although they can be a cosmetic problem, keloid scars are only inert masses of collagen and therefore completely harmless and not cancerous. However, they can be itchy or painful in some individuals. They tend to be most common on the shoulders and chest. Hypertrophic scars and its subset keloids tend to be more common in wounds closed by secondary intention.[8]
Atrophic
An atrophic scar takes the form of a sunken recess in the skin, which has a pitted appearance. These are caused when underlying structures supporting the skin, such as fat or muscle, are lost. This type of scarring is often associated with acne,[9][10] chickenpox, other diseases [especially Staphylococcus (or MRSA) infection], surgery, or accidents.
Stretch marks
Main article: Stretch marks
Stretch marks (technically called striae) are also a form of scarring. These are caused when the skin is stretched rapidly (for instance during pregnancy,[11] significant weight gain, or adolescent growth spurts),[12] or when skin is put under tension during the healing process, (usually near joints). This type of scar usually improves in appearance after a few years.[11]
Elevated corticosteroid levels are implicated in striae development.[13]
Pathophysiology
| This section may be too technical for most readers to understand. Please help improve this section to make it understandable to non-experts, without removing the technical details. The talk page may contain suggestions. (January 2012) |
Hypertrophic scarring one year after road rash on the right, and the original wound on the left.
If a wound becomes covered with epithelial tissue within two weeks, minimal collagen will be deposited and no scar will form.[14] Generally, if a wound takes longer than three to four weeks to become covered, a scar will form.[14] Deep second-degree burns heal with scarring and hair loss.[2] Sweat glands do not form in scar tissue, which impairs the regulation of body temperature.[15]
The scar is a result of the body's repair mechanism after injury in many tissues.
Any injury does not become a scar until the wound has completely healed; this can take many months, or years in the worst pathological cases, such as keloids. To begin to patch the damage, a clot is created; the clot is the beginning process that results in a provisional matrix. In the process, the first layer is a provisional matrix and is not scar. Over time, the wounded body tissue then overexpresses collagen inside the provisional matrix to create a collagen matrix. This collagen overexpression continues and crosslinks the fiber arrangement inside the collagen matrix, making the collagen dense. This densely packed collagen, morphing into an inelastic whitish collagen[16] scar wall, blocks off cell communication and regeneration; as a result, the new tissue generated will have a different texture and quality than the surrounding unwounded tissue. This prolonged collagen-producing process results in a fortuna scar.
The scarring is created by fibroblast proliferation,[16] a process that begins with a reaction to the clot.[17]
To mend the damage, fibroblasts slowly form the collagen scar. The fibroblast proliferation is circular[18] and cyclically, the fibroblast proliferation lays down thick, whitish collagen[16] inside the provisional and collagen matrix, resulting in the abundant production of packed collagen on the fibers[16][17][19] giving scars their uneven texture. Over time, the fibroblasts continue to crawl around the matrix, adjusting more fibers and, in the process, the scarring settles and becomes stiff.[20] This fibroblast proliferation also contracts the tissue.[18][21] In unwounded tissue, these fibers are not overexpressed with thick collagen and do not contract.
The fibroblast involved in scarring and contraction is the myofibroblast,[22] which is a specialized contractile fibroblast.[23] These cells express a-smooth muscle actin (a-SMA).[24]
The myofibroblasts are absent in the first trimester in the embryonic stage; damage then heals scar free;[25] small incisional or excision wounds less than 2 mm also heal without scarring;[25] and in adult unwounded tissues where the fibroblast in itself is arrested; however, the myofibroblast is found in massive numbers in adult wound healing which heals with a scar.[23]
The myofibroblasts make up a high proportion of the fibroblasts proliferating in the postembryonic wound at the onset of healing. In the rat model, for instance, myofibroblasts can constitute up to 70% of the fibroblasts,[22] and is responsible for fibrosis on tissue.[26] Generally, the myofibroblasts disappear from the wound within 30 days,[27] but can stay around in pathological cases in hypertrophy, such as keloids.[23][27]
Prolonged inflammation, as well as the fibroblast proliferation[16] can occur. Redness that often follows an injury to the skin is not a scar, and is generally not permanent (see wound healing). The time it takes for this redness to dissipate may, however, range from a few days to, in some serious and rare cases, a few years.[citation needed]
Scars form differently based on the location of the injury on the body and the age of the person who was injured.[citation needed]
The worse the initial damage is, the worse the scar will generally be.[citation needed]
Skin scars occur when the dermis (the deep, thick layer of skin) is damaged. Most skin scars are flat and leave a trace of the original injury that caused them.[citation needed]
Wounds allowed to heal secondarily tend to scar worse than wounds from primary closure.[8]
Treatments
Early and effective treatment of acne scarring can prevent severe acne and the scarring that often follows.[28] High melanin levels and either African or Asian ancestry may make adverse scarring more noticeable.[29] As of 2004[update] no prescription drugs for the treatment or prevention of scars were available.[30]
Collagen Induction Therapy
Collagen induction therapy (CIT) is an aesthetic medical procedure that involves repeatedly puncturing the skin with tiny, sterile needles. Typically, this is done with a specialized device called a microneedling device. CIT is often referred to as "microneedling" or "skin needling" in media and literature.
Chemical peels
Chemical peels are chemicals which destroy the epidermis in a controlled manner, leading to exfoliation and the alleviation of certain skin conditions, including superficial acne scars.[31] Various chemicals can be used depending upon the depth of the peel, and caution should be used, particularly for dark-skinned individuals and those individuals susceptible to keloid formation or with active infections.[32]
Filler injections
Filler injections of collagen or Artefill can be used to raise atrophic scars to the level of surrounding skin.[33] Risks vary based upon the filler used, and can include temporary improvement, further disfigurement, and allergic reaction.[34]
Dermabrasion
Dermabrasion involves the removal of the surface of the skin with special equipment, and usually involves a local anaesthetic.
Laser treatment
Nonablative lasers, such as the 585 nm pulsed dye laser, 1064 nm and 1320 nm Nd:YAG, or the 1540 nm Er:Glass are used as the standard laser therapy for hypertrophic scars and keloids.[35] This therapy smooths the epidermis via contact cooling. Multiple sessions are usually required for a significant reduction in redness and improvement in the texture and pliability of hypertrophic scars and keloids.
Ablative lasers such as the carbon dioxide laser or Er:YAG offer the best results for atrophic and acne scars.[36] Like dermabrasion, ablative lasers work by destroying the epidermis to a certain depth. Healing times for ablative therapy are much longer and the risk profile is greater compared to nonablative therapy; however, nonablative therapy offers only minor improvements in cosmetic appearance of atrophic and acne scars.[35]
Radiotherapy
Low-dose, superficial radiotherapy is sometimes used to prevent recurrence of severe keloid and hypertrophic scarring. It is thought to be effective despite a lack of clinical trials, but only used in extreme cases due to the perceived risk of long-term side effects.[37]
Semiocclusive ointments and pressure dressing
Silicone scar treatments are commonly used in preventing scar formation and improving existing scar appearance.[38] The effectiveness and safety of silicone sheeting for the treatment and prevention of scars is supported by an abundance of clinical studies.
Semiocclusive, silicone-based ointments [39] are used to speed healing and reduce the appearance of scars, and likely work in a similar manner as silicone scar sheets.
Pressure dressings are commonly used in managing burn and hypertrophic scars, although supporting evidence is lacking.[40] These involve elastic materials or gauze to apply pressure to the area. For large scars and particularly large burns, pressure garments may be worn. They are believed to work by applying constant pressure to surface blood vessels, and eventually causing scars to flatten and become softer.[citation needed] Retrospective and ultrasonic studies since the 1960s have supported their use, but the only randomized clinical trial found no statistically significant difference in wound healing.[40] Care providers commonly report improvements, however, and pressure therapy has been effective in treating ear keloids.[40] The general acceptance of the treatment as effective may prevent it from being further studied in clinical trials.[40]
Steroids
Under medical supervision, a long-term course of corticosteroid injections into the scar may help flatten and soften the appearance of keloid or hypertrophic scars.[41]
The steroid is injected into the scar itself; since very little is absorbed into the blood stream, side effects of this treatment are minor. However, it does cause thinning of the scar tissue so it does carry risks when injected into scars caused by operations into ruptured tendons. This treatment is repeated at four- to six-week intervals.
Topical steroids are ineffective.[42]
Surgery
Scarring caused by acne (left), and photo one day after scar revision surgery: The area around sutures is still swollen from surgery.
Scar revision is a process of cutting the scar tissue out. After the excision, the new wound is usually closed up to heal by primary intention, instead of secondary intention. Deeper cuts need a multilayered closure to heal optimally, otherwise depressed or dented scars can result.[43]
Surgical excision of hypertrophic or keloid scars is often associated to other methods, such as pressotherapy or silicone gel sheeting. Lone excision of keloid scars, however, shows a recurrence rate close to 45%. A clinical study is currently ongoing to assess the benefits of a treatment combining surgery and laser-assisted healing in hypertrophic or keloid scars.
Vitamins
Research shows the use of vitamin E and onion extract (sold as Mederma) as treatments for scars is ineffective.[40] Vitamin E causes contact dermatitis in up to 33% of users and in some cases it may worsen scar appearance.[42] But Vitamin C and some of its esters fade the dark pigment associated with some scars.[44]
Intentional scarring
Main article: Scarification
The permanence of scarring has led to its intentional use as a form of body art within some cultures and subcultures . These forms of ritual and non-ritual scarring practices can be found in many groups and cultures around the world.
Research
An intradermal injection of transforming growth factor beta 3 (TGFβ3) is being tested. The results of three trials already completed were published in the Lancet along with an editorial commentary.[45]
A study implicated the protein ribosomal s6 kinase (RSK) in the formation of scar tissue and found the introduction of a chemical to counteract RSK could halt the formation of cirrhosis. This treatment also has the potential to reduce or even prevent altogether other types of scarring.[46]
Research has also implicated osteopontin in scarring.[47][48]
A research group in South Africa has a combination approach using a microporous tape in addition to Bulbine frutescens for hydration and Centella asiatica for collagen conversion.[49] A small study has shown an improved appearance of scars.[50]
See also
- Scarification
- Self-injury
- Wound healing
- Dueling scars
References
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- ^ a b "Giving Burns the First, Second and Third Degree - Classification of burns". skincareguide.ca. http://www.skincareguide.ca/articles/general_skin_care/gen_skin_care_art_3.html. Retrieved 2012-01-31. "Formation of a thick eschar, slow healing (>1month), Obvious scarring, hair loss."
- ^ eschara, Charlton T. Lewis, Charles Short, A Latin Dictionary, on Perseus
- ^ ἐσχάρα, Henry George Liddell, Robert Scott, A Greek-English Lexicon, on perseus
- ^ Online Etymology Dictionary
- ^ a b c d e f g Gauglitz GG, Korting HC, Pavicic T (January-February). "Hypertrophic Scarring and Keloids: Pathomechanisms and Current and Emerging Treatment Strategies". Mol Med (1-2): 113-125. doi:10.2119/molmed.2009.00153. http://www.molmed.org.
- ^ Martini, Frederic H. (2006). Fundamentals of Anatomy & Physiology, Seventh Edition, p. 171. Benjamin Cummings, San Francisco.
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- ^ a b c d e "Facts about fibroblast: scar tissue formation,". Britannica.com. http://www.britannica.com/facts/5/264152/fibroblast-as-discussed-in-scar-biology. Retrieved 2010-04-19. "As part of the healing process, specialized cells called fibroblasts in adjacent areas of skin produce a fibrous connective tissue made up of collagen. The bundles formed by these whitish, rather inelastic fibres make up the bulk of the scar tissue..."
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- ^ a b Parlange, Mary (2007-12-17). "New mechanical insights into wound healing and scar tissue formation". Ecole Polytechnique Fédérale de Lausanne. eurekalert.org. http://www.eurekalert.org/pub_releases/2007-12/epfd-nmi121707.php. Retrieved 2010-08-28. "In the process, it liberates yet more growth factor that in turn stimulates other fibroblasts to become contractile…"
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- ^ Parlange, Mary (2007-12-17). "New mechanical insights into wound healing and scar tissue formation". Ecole Polytechnique Fédérale de Lausanne. eurekalert.org. http://www.eurekalert.org/pub_releases/2007-12/epfd-nmi121707.php. Retrieved 2010-08-28. "The matrix grows stiffer and, at a certain point, the fibroblasts stop migrating and, like Popeye, change into powerful contractile cells, anchoring themselves to the matrix and pulling the edges of the wound together."
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- ^ a b c "Method of preventing or reducing scarring of human skin". freepatentsonline.com. http://www.freepatentsonline.com/y2005/0054608.html. Retrieved 2010-03-26. "These cells, which differentiate from the unwounded tissue cell type (fibroblasts), are responsible for laying down scar tissue. Indeed myofibroblasts remain present in hypertrophic scars up to four years after the original wounding event. An in vitro assay was accordingly developed to identify actives which prevent or reduce myofibroblast formation and thus identify actives which are effective in reducing and/or preventing scar tissue formation."
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- ^ 'Molecular mechanisms linking wound inflammation and fibrosis: knockdown of osteopontin leads to rapid repair and reduced scarring'
- ^ "Gel 'to speed up wound healing'". BBC News. 2008-01-22. http://news.bbc.co.uk/2/hi/health/7199897.stm. Retrieved 2010-05-23.
- ^ Widgerow AD. (2010). Scar management–marrying the practical with the science. Wound Healing South Africa.
- ^ Widgerow AD, Chait LA, Stals PJ, Stals R, Candy G (July 2009). "Multimodality scar management program". Aesthetic Plast Surg 33 (4): 533–43. doi:10.1007/s00266-008-9276-x. PMID 19048338.
External links
- WebMD.com article
- American Academy of Dermatology: "What is a scar?"
- Ohio State University Medical Center article[dead link]
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UpToDate Contents
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- 1. ケロイドおよび肥厚性瘢痕keloids and hypertrophic scars [show details]… treatment of keloids and hypertrophic scars. Laser therapy for keloids and hypertrophic scars is discussed separately. The management of keloid and hypertrophic scars following burn injuries is also discussed …
- 2. にきびの傷のマネージメントmanagement of acne scars [show details]… determining which patients develop scarring. This concept is supported by an immunohistochemical study of 8 patients not prone to acne scarring and 11 patients prone to acne scarring . Specimens from early lesions …
- 3. 皮膚科手術：合併症の予防と治療skin surgery prevention and treatment of complications [show details]…treat as needed. Scarring is an unavoidable consequence of cutaneous surgery. Although in many cases the resulting scar is cosmetically and functionally acceptable, at times scarring can be extensive and …
- 4. 熱傷後の肥厚性瘢痕やケロイドhypertrophic scarring and keloids following burn injuries [show details]… creation of a scar. Burn wounds can heal by primary or secondary intention (eg, skin grafts) depending on their depth and need for coverage. The two main types of scars are immature and mature scars Typically …
- 5. Chemical peels: Procedures and complicationschemical peels procedures and complications [show details]…keratoses, superficial acne scars, and shallow wrinkles. In deep peels, injury extends from the epidermis into the reticular dermis, contributing to improvement in deeper acne scars and wrinkles. Both the specific …
English Journal
- Robot-assisted excision of branchial cleft cysts using a postauricular facelift approach.
- Song CM1, Ji YB1, Kim KR1, Tae K2.
- Auris, nasus, larynx.Auris Nasus Larynx.2015 Oct;42(5):424-7. doi: 10.1016/j.anl.2015.03.009. Epub 2015 Apr 9.
- Various approaches have been employed to avoid visible scars in the neck, along with the development of robotic and endoscopic techniques. We have employed a technique of robot-assisted excision of branchial cleft cyst (BCC) via a postauricular facelift approach. We present three patients with 2nd B
- PMID 25863642
- Corneal complications of vernal keratoconjunctivitis.
- Solomon A1.
- Current opinion in allergy and clinical immunology.Curr Opin Allergy Clin Immunol.2015 Oct;15(5):489-94. doi: 10.1097/ACI.0000000000000202.
- PURPOSE OF REVIEW: Vernal keratoconjunctivitis (VKC) is a severe bilateral chronic allergic inflammatory disease of the ocular surface. In most of the cases, the disease is limited to the tarsal conjunctiva and to the limbus. However, in the more severe cases, the cornea may be involved, leading to
- PMID 26258926
- Choroidal neovascularisation as an unusual ophthalmic manifestation of cat-scratch disease in an 8-year-old girl.
- Latanza L1, Viscogliosi F, Solimeo A, Calabrò F, De Angelis V, De Rosa P.
- International ophthalmology.Int Ophthalmol.2015 Oct;35(5):709-16. doi: 10.1007/s10792-015-0093-3. Epub 2015 Jul 2.
- To report the first case of choroidal neovascularisation (CNV) that appeared during the primary Bartonella henselae infection in an 8-year-old girl. An 8-year-old girl was referred to our clinic complaining of a central scotoma in the right eye. Fundus examination revealed a bilateral disc oedema an
- PMID 26135983
Japanese Journal
- 瘢痕声帯・声帯溝症に対する音声治療の検討
- 金子 真美,平野 滋,楯谷 一郎,児嶋 剛,水田 匡信,倉智 雅子,城本 修,伊藤 壽一
- 音声言語医学 53(3), 229-235, 2012-07-20
- NAID 10030784972
- Fetal Skin Possesses the Ability to Regenerate Completely: Complete Regeneration of Skin
- Kishi Kazuo,Okabe Keisuke,Shimizu Ruka,Kubota Yoshiaki
- The Keio Journal of Medicine 61(4), 101-108, 2012
- … By strictly comparing the stages before and after the transition from the regeneration of skin to scarring, it will be possible to investigate the mechanisms of cutaneous regeneration. …
- NAID 130003316003
- A CASE REPORT OF COLITIS IN WHICH INTESTINAL SPIROCHETOSIS WAS CONSIDERED TO BE THE CAUSE
- 杉田 光司,片岡 伸一,西岡 伸明,楯 英毅,上野 圭介,奥井 雅憲,西上 隆之
- 日本消化器内視鏡学会雑誌 54(11), 3596-3600, 2012
- … The symptoms remarkably improved with 10 days of metronidazole per os and follow up colonoscopy revealed healing and scarring of the lesion. …
- NAID 130002570686
Related Pictures
★リンクテーブル★
| リンク元 | 「瘢痕」「cicatrix」 |
| 拡張検索 | 「papyrus scarring」 |
「瘢痕」
「cicatrix」