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

hongchingyee
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16.06.2020 Views

Clinical ConsiderationMassage therapy may be a viable modality for attenuating post-burnhypertrophic scar pain, pruritus and scar characteristics such as thickness,melanin deposition, erythema, transdermal water loss and elasticity/tissuemobility (Cho et al. 2014).Keloid scarsSensations of itch and pain are common in keloids. Itch occurs more frequentlyat the periphery of keloids whereas pain occurs more in the center.As is the case with hypertrophic scars, histamine release by mast cells has beenimplicated in contributing to itch; however, antihistamines are shown to belargely ineffective. This suggests other factors may contribute to pruritogenesis.Sensory testing in symptomatic keloids show abnormal findings, suggesting thepresence of small nerve fiber neuropathy possibly related to exaggeratedneurogenic inflammation (Lee et al. 2004, Tey et al. 2012).There appears to be no correlation between innervation density and intensity ofitch or pain, suggesting that such sensations are not exclusively related toneuronal 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 itchtransmittingnerve fibers results in a self-regulated hypoplasia in an attempt tomodulate the intensity and persistence of sensory input (neuroplasticity pruningat work) (Tey et al. 2012). Reduced nerve density in the epidermis, where itchconductingfibers terminate, may therefore be a consequence of chronic pruritus.Although there is reduced neural density in the epidermis, neuronal density isshown to be elevated in the dermis. Fibers appear longer and thinner, possiblydue to compression from thickened or dense collagen fibers and the extensivedeposition of ECM in deeper tissue. An alternate hypothesis suggests that the

compressive effect in the keloidal dermis may contribute to the reducedepidermal nerve density (Hochman et al. 2008, Tey et al. 2012). According toBove, regenerating nerves cannot push through dense fibrous tissue.

compressive effect in the keloidal dermis may contribute to the reduced

epidermal nerve density (Hochman et al. 2008, Tey et al. 2012). According to

Bove, regenerating nerves cannot push through dense fibrous tissue.

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