Plague

Disease Description (Causes and Symptoms)

• Definition: Fibrous granulation tissue (scar tissue) formed to fill a defect after skin tissue is damaged by trauma, surgery, burns, inflammation, or other causes. Once altered, the skin does not regenerate into completely normal tissue.
• Pathophysiology: During the wound-healing process (inflammation → proliferation (granulation tissue) → remodeling), excessive collagen production or abnormal collagen alignment causes scar formation. Scar maturation usually takes 6 months to 2 years.
• Causes and risk factors: Depth, length, width, and direction of the wound; location (areas with high skin tension, such as joints, the chest, and the back); age (more pronounced in younger people); genetic predisposition (keloid tendency); skin color (more common in darker skin tones); ultraviolet exposure; blood circulation; infection and delayed healing; and other factors.
• Main symptoms: Raised or depressed scars, widening (becoming wider than the original wound), hyperpigmentation (dark red color) or hypopigmentation, itching (pruritus), pain, cosmetic problems, and limited movement (contracture) when located near a joint.
• Types:
  • Keloid: Excessive growth extending beyond the wound boundaries; tends to be red, firm, recurrent, and progressively enlarging. Commonly occurs on the chest, earlobes, and shoulders.
  • Hypertrophic scar: Excessive growth within the wound area; generally responds well to conservative treatment.
  • Contracture scar: Adhesion of surrounding tissues (muscles and tendons) caused by skin loss, resulting in limited movement.

Treatment Methods

• General principles:
  • Observe scar maturation (usually 6–12 months, and up to 2 years in some cases), then decide whether active treatment is needed.
  • In the early stage, if there are no symptomatic or cosmetic problems, conservative management is preferred.
• Conservative treatment:
  • Silicone sheets and gels (e.g., Cica-care) → help improve scar width and color; continued use is required (several weeks to several months).
  • Compression therapy (especially for burn scars, using compression garments) → helps suppress recurrence of hypertrophic scars and keloids.
  • Linear taping (after surgery) → reduces tension on the wound.
  • Topical products (some ointments and scar-improvement aids).
  • Sun protection → prevents hyperpigmentation.
• Medications and procedures:
  • Topical or injection treatment: Intralesional injections of steroids such as triamcinolone (effective for keloids and hypertrophic scars; repeated treatment is necessary). Side effects: skin atrophy and depigmentation.
  • 5-FU, interferon, bleomycin, and other agents may sometimes be tried alone or in combination (at the specialist’s discretion).
  • Compression plus cryotherapy (freezing treatment), or localized cryotherapy (especially for small keloids).
  • Laser: Improvement of vascularity and color (e.g., PDL), and remodeling using lasers (such as fractional lasers).
• Surgical treatment:
  • Scar revision (removal and reclosure/reorientation, Z-plasty, etc.) → for hypertrophic scars and cosmetic purposes. Surgery alone carries a risk of recurrence in keloids.
  • Contracture scars: Skin grafting, flap surgery, or use of a tissue expander (to relieve limited movement).
  • Prevention of recurrence after surgery: Combination of compression, silicone, steroid injections, and, in some cases, radiation therapy.
• Precautions:
  • Keloids may worsen with surgery alone, so conservative or combination treatment should be considered first.
  • The side effects of steroid injections (skin atrophy and pigment abnormalities) should be explained.
  • Anticoagulant use, infection, smoking, and other factors can affect surgery and healing.
• Expected timing:
  • During the first 2–6 months after scar revision, the scar may be more noticeable, but it may gradually improve around 6–12 months.

Outpatient Visit Checklist (Including Sample Questions)

Items and information to prepare:

• List of currently used medications (including anticoagulants, antiplatelet agents, steroids, and others)
• History of previous surgeries, treatments, injections, and laser procedures (when and what treatment was performed)
• When and why the scar developed (trauma, surgery, burns, acne, and so on)
• Progression of changes in the scar (size, color, itching or pain, and whether it is growing rapidly)
• Photos (photos from the time of the initial injury and current photos of the scar) — helpful for comparing changes
• Family history (whether there is a tendency to develop keloids)
• Smoking status and conditions that affect healing, such as diabetes or immunosuppression
• Results of previous biopsies or tests, if any Information to tell the medical staff in advance during the outpatient visit:
• Allergies (especially to topical products or anesthetic medications)
• Whether you are pregnant or breastfeeding (important for laser and medication treatment) Sample questions (items that are useful for patients to write down before the outpatient visit):
• "How can you distinguish whether this scar is a keloid or a hypertrophic scar?"
• "What information is needed to assess whether this scar is growing (expanding)?"
• "Are there any restrictions on procedures because of the medications I am currently taking?"

Examples of General Questions to Ask the Doctor

• "How can I find out whether my scar has fully matured? When is the appropriate time for treatment?"
• "What treatment options do you recommend (conservative treatment, injections, laser treatment, or surgery), and how much improvement can be expected from each?"
• "What are the effects and side effects of triamcinolone injections, such as skin atrophy and pigment changes?"
• "What is the risk of recurrence if I undergo surgery? What additional measures are needed to reduce the risk of recurrence?"
• "How long does treatment generally take, and how many repeat visits or procedures are usually required?"
• "What precautions should I take in daily life (work, exercise, and ultraviolet exposure) during and after treatment?"

Examples of Condition-Specific Questions

• When a keloid is suspected:
  • "Do I have a tendency to develop keloids, and how does my family history affect the treatment plan?"
  • "How likely is it that the condition can be managed with injections, laser treatment, or compression therapy alone instead of surgery? What is the recurrence rate?"
• When there is a contracture scar (joint restriction):
  • "Is skin grafting or flap surgery necessary to improve my limited movement? How likely is improvement with physical therapy or an assistive device (splint)?"