David F Butler, MD Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic
David F Butler, MD is a member of the following medical societies: American Medical Association , Alpha Omega Alpha , Association of Military Dermatologists , American Academy of Dermatology , American Society for Dermatologic Surgery , American Society for MOHS Surgery , Phi Beta Kappa
Disclosure: Nothing to disclose.
Indications for intralesional corticosteroid therapy are acute and chronic inflammatory processes [ 4 ], hyperplastic and hypertrophic skin disorders, and conditions that typically have a favorable response to systemic and topical corticosteroids. In addition to anti-inflammatory properties, the atrophogenic side effect of corticosteroids also can be used advantageously when treating hypertrophic types of lesions, including hypertrophic scars and keloids, lichen simplex chronicus, hypertrophic discoid lupus erythematosus, psoriasis, and cutaneous sarcoidosis (ie, lupus pernio).
Meshkinpour et al (2005) examined the safety and effectiveness of the ThermaCool TC radiofrequency system for treatment of hypertrophic and keloid scars and assessed treatment associated collagen changes. Six subjects with hypertrophic and 4 with keloid scars were treated with the ThermaCool device: 1/3 of the scar received no treatment (control), 1/3 received one treatment and 1/3 received 2 treatments (4-week interval). Scars were graded before and then 12 and 24 weeks after treatment on symptoms, pigmentation, vascularity, pliability, and height. Biopsies were taken from 4 subjects with hypertrophic scars and evaluated with hematoxylin and eosin (H & E) staining, multi-photon microscopy, and pro-collagen I and III immunohistochemistry. No adverse treatment effects occurred. Clinical and H & E evaluation revealed no significant differences between control and treatment sites. Differences in collagen morphology were detected in some subjects. Increased collagen production (type III > type I) was observed, appeared to peak between 6 and 10 weeks post-treatment and had not returned to baseline even after 12 weeks. The authors concluded that use of the thermage radiofrequency device on hypertrophic scars resulted in collagen fibril morphology and production changes. ThermaCool alone did not achieve clinical hypertrophic scar or keloid improvement. They noted that the collagen effects of this device should be studied further to optimize its therapeutic potential for all indications.