Burn scarring in children.
A new treatment with and old story
Dra. Bárbara Díaz. Plastic Aesthetic & Reconstructive Surgeon
Ricardo Gutierrez Children’s Hospital. Buenos Aires City, Argentina.
Abstract:
Burn scars are always a serious injury in children, in despite of its amount of surface.
Anaesthetics sequelae, pruritus, joints malfunction, new wounds on the scar and pain are common
symptoms. Hypertrophic scars are raised scars confined within the boundaries of the wound and
may cause considerable functional and cosmetic problems leading to limited range of motion and
impaired psychosocial well-being.
Extensive documentations of researching were written by cod liver oil, and other substances
through the medical history, mainly in acute wound healing. In this time, we are talking about
scarring modulation improving the surface, functionality and aesthetician of the scars in a reliable
and simple treatment.
Conflicts of Interest:
The author declares no conflicts of interest regarding the publication of this study.
Background:
In low-income countries, the deficiency of an adequate medical care causes a delate in
suitable treatment, or treatment discontinuation. This generates a lot of disabilities and
discomfortable scars, in a population that shows Fitzpatrick high levels of risk.
Either by distance from the hospital or by lack of human and economic resources, are added
to a poor adult health education, to finally left out the scar’s rehabilitation.
In our Burn Care Unit, we had to find a treatment complementary to the sequelae surgeries,
which is safe and easy to follow by parents, regarding possible treatment’s quitting.
Method:
This is a report about fifteen patients, children, before trauma wounds and post burn scar
treatments, who showed significant changes after the continuous use of CUREFINI, an ointment
composed of Petrolatum, Cod Liver Oil as Active Ingredient, BHT, Chamomilla Recutita
(Chamomile) Oil, Helianthus Annuus (Sunflower) Oil and Prunus Amygdalus Dulcis (Sweet
Almond) Oil.
All patients from 0 to 18 years old with recent burn scars or post-surgery scars recently
healed were included. Scars were all symptomatic hypertrophic tissues. None of usual treatments as
compression or physiotherapy were dismissed. In some cases, graft or z-flaps were performed to
mobility or scar length earning.
Patients who had scars older than a year, stables scars or acutes burn wounds were excluded
from this study.
Ointment was applied to hypertrophic scars resulting from burns. Photographic records were
made at 30, 60, and 90 days of treatment to evaluate scar evolution in terms of scar pigmentation,
itching reduction, and elasticity improvement. Paediatric patient surrogates granted their consent to
participate in this study, per the ethical-legal regulations.
Ointment was spread on the scars twice a day, one of the times had to be at night. That made
easier to use in patients who wore compression garment and increases rate of skin absorption.
Results:
Although between the first 15 to 30 days the patients without compressive treatment showed an
increase in purplish-red scar pigmentation, after 90 days the scars showed less erythema due to a
decrease in the vascular scar component.
A notable decrease was observed in the Vancouver Scar Scale score in the treated patients during
that period. (Table 1)
Although some scars initially showed severe pliability scores, the firmness, pigmentation, itching,
and superficial lesions commonly observed in hypertrophic scars were reduced.
Patients who started topical treatment and required surgical treatment (surgical skin flaps, z-plasty,
new grafts) showed better post-surgical healing of the new scars.
No patient presented any irritation, pruritus, or allergy signs to the ointment used.
Patient Age Scar Compression Graft Start 30D 60D 90D
(yrs.) treat.
ID 2 Ant. Thorax Yes No 8 6 4 3
burn
MM 10 Abdomen Yes No 8 8 7 7
burn
CM 2 Neck burn No Yes 12 8 6 6
AL 16 Neck burn No Yes 12 8 6 4
FJ 6 Hand burn Yes Yes 13 11 8 4
CS 12 Hand burn No No 7 4 4 4
SV 5 Forearm Yes Yes 8 7 5 3
burn
FA 4 Ankle burn No Yes 12 8 6 6
LB 16 Foot burn No Yes 9 8 8 4
ML 2 Ant. Thorax No No 12 10 8 8
burn
RG 9 Hip/Calf Yes Yes 10 6 4 4
burn
FR 2 Elbow burnYes Yes 12 8 6 2
NS 5 Foot burn No No 10 9 6 2
NC 6 Foot burn Yes No 8 6 4 2
MO 2 Hand burn No Yes 8 6 6 6
Discussion:
Pathological scars are caused by an excessive response to the activity of TGF-β1.
Connective tissue growth factors are overexpressed 100- to 150-fold in hypertrophic and keloid
scars, respectively, in response to this cytokine compared with normal fibroblasts.
The concentration of polyunsaturated fatty acids (PUFA, EPA, DHA) influences the
synthesis and activity of proinflammatory cytokines and inhibits the expression of the gene induced
by TGF-β1, inhibiting pro-fibrogenesis.
Those fatty acids may partially inhibit some inflammation processes, such as leukocyte
chemotaxis, adhesion expression molecules and leukocyte interactions with the endothelium, the
production of eicosanoids, such as prostaglandins and leukotrienes, from arachidonic n-6 PUFA,
and T-cell inflammatory cytokine production and reactivity. Eicosapentaenoic acid (EPA)
stimulates the biological activity of arachidonic acid (AA) derivatives and the synthesis of active
mediators of inflammation resolution, such as resolvins and protectins.
Those mediators compete with cyclooxygenases and lipoxygenases and reduce the
expression of COX-2 and 5-lipoxygenase, with a beneficial anti-inflammatory effect of n-3 PUFAs.
Vitamin D significantly reduces IL-6 and TNF-α levels. Using cholecalciferol receptors, it
directly binds to leukocyte DNA, activating the MKP-1 gene and thereby interfering in the
inflammatory cascade.
Conclusion:
Using a topical treatment with minimal risk of adverse effects as a complementary therapy to inhibit
chronic inflammation significantly reduces the number and complexity of scar revision surgeries,
provides better comfort for patients requiring compressive dressings, and produces more elastic and
less visible scars in a shorter time.
Based on our experience, surgery planning may be now different, as the use of Curefini® before
surgery allowed for obtaining more elastic scars and planning flaps with the same grafted skin as
the new scars are easier to conceal.
In paediatric plastic surgery, the topical treatment immediately post-op shortens healing time and
provides satisfying scar results.
Presenting author details
Full name: Bárbara Díaz
Contact number: (54 9) 1144364972
Session name/ number:
Category: Poster presentation
E:
[email protected]
