[libribook.com] Traumatic Scar Tissue Management 1st Edition

Clinical Consideration
Massage therapy may be a viable modality for attenuating post-burn
hypertrophic scar pain, pruritus and scar characteristics such as thickness,
melanin deposition, erythema, transdermal water loss and elasticity/tissue
mobility (Cho et al. 2014).
Keloid scars
Sensations of itch and pain are common in keloids. Itch occurs more frequently
at the periphery of keloids whereas pain occurs more in the center.
As is the case with hypertrophic scars, histamine release by mast cells has been
implicated in contributing to itch; however, antihistamines are shown to be
largely ineffective. This suggests other factors may contribute to pruritogenesis.
Sensory testing in symptomatic keloids show abnormal findings, suggesting the
presence of small nerve fiber neuropathy possibly related to exaggerated
neurogenic inflammation (Lee et al. 2004, Tey et al. 2012).
There appears to be no correlation between innervation density and intensity of
itch or pain, suggesting that such sensations are not exclusively related to
neuronal density, but that there are other factors at play (Tey et al. 2012).
Pruritic keloids tend to display a lower than normal epidermal neural density.
Tey and co-workers suggest a possible hypothesis; chronic stimulation of itchtransmitting
nerve fibers results in a self-regulated hypoplasia in an attempt to
modulate the intensity and persistence of sensory input (neuroplasticity pruning
at work) (Tey et al. 2012). Reduced nerve density in the epidermis, where itchconducting
fibers terminate, may therefore be a consequence of chronic pruritus.
Although there is reduced neural density in the epidermis, neuronal density is
shown to be elevated in the dermis. Fibers appear longer and thinner, possibly
due to compression from thickened or dense collagen fibers and the extensive
deposition of ECM in deeper tissue. An alternate hypothesis suggests that the