Background: Keloids and hypertrophic scars (HTS) are abnormal wound responses. Lack of knowledge about their basic biology had prevented development of a targeted approach to the treatment of keloids and hypertrophic scars.
Aim of the work: The study aimed to evaluate the dermoscopic and histopathological features of keloids and hypertrophic scars before and after different treatment modalities.
Methods: Thirty-two patients with keloids and hypertrophic scars were included in the study for clinical, dermoscopic and histopathological examination.patients receieved tratment in form of Fractional Co2 laser or 5FU or verapamil . Examination of slides stained by H&E and the special stain (Masson trichrome) was performed, also CD31 immunohistochemistry was performed in all cases. The histopathological examination of slides both HTS and keloid before and after treatment was done. The pattern of collagen fibers was determined by hematoxylin and eosin stained sections and Masson Trichrome stained sections. The pattern and extent of vascularity demonstrated by CD31 immunostaining was evaluated.
Results: Vancouver scar scale showed significant improvement in all patients. histopathological improvement (the collagen fibers detected by Masson trichrome in the upper dermis of HTS cases become thinner and the MVD detected by CD31 IHC staining showed increased vascularity after treatment). Hypertrophic scars showed better improvement than keloids in all groups. Arborizing and linear vessels showed significant improvement in group 1&2. Linear vessels showed significant improvement in group 3.
Conclusion: Fractional Co2 laser combined with 5FU is an excellent choice of treatment in keloids and hypertrophic scars.