Topische Externa zur Prävention und Therapie hypertropher Narben und Keloide: Eine Literaturrecherche

S. Fischer; H. R. Ernst; D. Drücke; Y. Diehm; M. Lehnhardt; A. Daigeler

doi:10.1055/s-0035-1549919

Handchirurgie · Mikrochirurgie · Plastische Chirurgie, Inhaltsverzeichnis

Handchir Mikrochir Plast Chir 2015; 47(04): 253-267
DOI: 10.1055/s-0035-1549919

Übersichtsarbeit

Topische Externa zur Prävention und Therapie hypertropher Narben und Keloide: Eine Literaturrecherche

Topical Preparations for Prevention and Treatment of Hypertrophic Scars and Keloids: A Literature Review

S. Fischer

¹Klinik Für Hand, Plastische und Rekonstruktive Chirurgie, Plastische Chirurgie der Universität Heidelberg, Schwerbrandverletztenzentrum, BG Klinik Ludwigshafen, Ludwigshafen

,

H. R. Ernst

²Klinik für Plastische Chirurgie und Schwerbrandverletzte, Handchirurgiezentrum, Operatives Referenzzentrum für Gliedmaßentumoren, BG-Universitätsklinikum Bergmannsheil, Bochum

,

D. Drücke

³Abteilung für Plastische Chirurgie, Klinik für Unfallchirurgie, Campus Kiel, Universitätsklinikum Schleswig-Holstein, Kiel

,

Y. Diehm

¹Klinik Für Hand, Plastische und Rekonstruktive Chirurgie, Plastische Chirurgie der Universität Heidelberg, Schwerbrandverletztenzentrum, BG Klinik Ludwigshafen, Ludwigshafen

,

M. Lehnhardt

²Klinik für Plastische Chirurgie und Schwerbrandverletzte, Handchirurgiezentrum, Operatives Referenzzentrum für Gliedmaßentumoren, BG-Universitätsklinikum Bergmannsheil, Bochum

,

A. Daigeler

²Klinik für Plastische Chirurgie und Schwerbrandverletzte, Handchirurgiezentrum, Operatives Referenzzentrum für Gliedmaßentumoren, BG-Universitätsklinikum Bergmannsheil, Bochum

› Institutsangaben

Abstract

Zusammenfassung

Hintergrund: Die Prävention und Therapie von hypertrophen Narben und Keloiden stellt eine besondere Herausforderung für den plastischen Chirurgen dar. Topische Externa sind aufgrund ihrer einfachen, nicht invasiven und schmerzfreien Anwendung eine attraktive Therapieoption. Von Seiten der Patienten kommt dabei regelmäßig die Frage nach der Wirksamkeit topischer Externa auf, deren Klärung Gegenstand der vorliegenden Arbeit ist.

Material und Methoden: Es wurde eine systematische Literaturrecherche in den Datenbanken Medline, Medline Plus, Oldmedline und Cochrane Library durchgeführt. Eingeschlossen und gegenübergestellt wurden sämtliche randomisierten kontrollierten Studien, Meta-analysen, systematische Übersichtsarbeiten, Anwendungsbeobachtungen und Fallbeispiele aus der deutschen und englischen Literatur, die sich mit im deutschsprachigen Raum zugelassenen Narbentopika befassen.

Ergebnisse: Es konnten 14 topische Externa identifiziert werden. Es existieren jedoch wenige Daten bezüglich ihrer Wirksamkeit im Vergleich untereinander, mit anderen Therapieoptionen oder unbehandelten Kontrollen. Lediglich zu 6 Präparaten existierten Studien mit hohem Evidenzgrad. Contractubex zeigt dabei in der Prävention pathologischer Narben die besten Ergebnisse.

Schlussfolgerung: Obwohl bei aktueller Datenlage Contractubex präventive Wirkung zeigt und empfohlen werden kann, sind weitere Studien notwendig, um die Evidenzlage zu stärken und vor allem auch die therapeutische Wirksamkeit topischer Externa zu belegen.

Abstract

Background: The treatment and prevention of hypertrophic scars and keloids represents a special challenge particularly in plastic surgery. Given their simple, non-invasive and painless application, topical preparations are an attractive therapeutic option. On the part of the patients, the efficacy in prevention of and therapy for hypertrophic scars and keloids of these topical preparations is regularly questioned. The clarification of this issue is subject of this review.

Material and Methods: A systematic literature research on the databases Medline, Medline Plus, Oldmedline and Cochrane Library was conducted. All randomised controlled trials, meta-analyses, systematic reviews, case series and case studies from the German and English literature, dealing with topical preparations approved in the German speaking area, were included.

Results: In this research, 14 topical preparations were identified. However, there is limited data regarding their efficacy as compared to each other, to other treatment options or untreated controls. Only for 6 topical preparations studies with high evidence level exist. Contractubex showed best results in the prevention of pathological scars.

Conclusion: Even though Contractubex shows preventive effects and can be recommended based on current data, further studies are needed to strengthen the body of evidence and to prove the therapeutic efficacy of topical preparations in general.

Schlüsselwörter

Wundheilung - Haut - hypertrophe Narbe - Keloid - topische Externa

Key words

wound healing - skin - hypertrophic scars - keloid - topical preparations

Volltext

Referenzen

Literatur
1 Ketchum LD, Cohen IK, Masters FW. Hypertrophic scars and keloids. A collective review. Plastic and reconstructive surgery 1974; 53: 140-154
2 Scrimali L, Lomeo G, Tamburino S et al. Laser CO2 versus radiotherapy in treatment of keloid scars. Journal of cosmetic and laser therapy: official publication of the European Society for Laser Dermatology 2012; 14: 94-97
3 Shaffer JJ, Taylor SC, Cook-Bolden F. Keloidal scars: a review with a critical look at therapeutic options. Journal of the American Academy of Dermatology 2002; 46: S63-S97
4 Hackert I, Aschoff R, Sebastian G. Keloide und ihre Therapie. Hautarzt 2003; 54: 1003-1017
5 Koc E, Arca E, Surucu B et al. An open, randomized, controlled, comparative study of the combined effect of intralesional triamcinolone acetonide and onion extract gel and intralesional triamcinolone acetonide alone in the treatment of hypertrophic scars and keloids. Dermatologic surgery: official publication for American Society for Dermatologic Surgery [et al.] 2008; 34: 1507-1514
6 Pellard S. Epidemiology, aetiology and management of abnormal scarring: a review of the literature. Journal of wound care 2006; 15: 44-48
7 Mustoe TA, Cooter RD, Gold MH et al. International clinical recommendations on scar management. Plastic and reconstructive surgery 2002; 110: 560-571
8 Williams CC, De Groote S. Clinical inquiry: What treatment is best for hypertrophic scars and keloids?. J Fam Pract 2011; 60: 757-758
9 Willital GH, Simon J. Efficacy of early initiation of a gel containing extractum cepae, heparin, and allantoin for scar treatment: an observational, noninterventional study of daily practice. J Drugs Dermatol 2013; 12: 38-42
10 Gauglitz GG, Pavicic T. Emerging strategies for the prevention and therapy of excessive scars. MMW Fortschr Med 2012; 154: 55-58
11 Lang B, Antes G, Bast C et al. http://www.cochrane.de (17.12.2014). Deutsches Cochrane Zentrum
12 Jenwitheesuk K, Surakunprapha P, Jenwitheesuk K et al. Role of silicone derivative plus onion extract gel in presternal hypertrophic scar protection: a prospective randomized, double blinded, controlled trial. Int Wound J 2012; 9: 397-402
13 Tarvady S, Anguli VC, Pichappa CV. Effect of heparin on wound healing. J Biosci 1987; 12: 33-40
14 Araújo LU, Grabe-Guimarães A, Mosqueira VCF et al. Profile of wound healing process induced by allantoin. Acta Cir Bras 2010; 25: 460-466
15 Kleijnen J. Evening primrose oil. BMJ: British Medical Journal 1994; 309: 824-825
16 Bamford JT, Ray S, Musekiwa A et al. Oral evening primrose oil and borage oil for eczema. The Cochrane database of systematic reviews 2013; 4: Cd004416
17 Ebner F, Heller A, Rippke F et al. Topical use of dexpanthenol in skin disorders. Am J Clin Dermatol 2002; 3: 427-433
18 Gehring W. Nicotinic acid/niacinamide and the skin. Journal of Cosmetic Dermatology 2004; 3: 88-93
19 Pfirrmann RW, Wicki O. Method and composition for the treatment of scars. In: Google Patents 1980
20 Scuderi N, Dessy LA, Buccheri EM et al. Phase 2 cross-over multicenter trial on the efficacy and safety of topical cyanoacrylates compared with topical silicone gel in the prevention of pathologic scars. Aesthetic plastic surgery 2011; 35: 373-381
21 Holder HG, Mackay EM. The Application of Carbamide (Urea) Therapy in Wound Healing. Annals of surgery 1939; 110: 94-99
22 Raghad QM. Prophylactic effect for the sesame oil and camphor oil on the infected burn skin of mice. Tikrit Journal of Pure Science 2012; 17: 26-33
23 Sticher O. Triterpene einschließlich Steroide. Pharmakognosie – Phytopharmazie 2010; 9: 885-886
24 Pietramaggiori G, Yang H-J, Scherer SS et al. Effects of poly-N-acetyl glucosamine (pGlcNAc) patch on wound healing in db/db mouse. J Trauma 2008; 64: 803-808
25 Grinnell F. Fibronectin and wound healing. J Cell Biochem 1984; 26: 107-116
26 Zurada JM, Kriegel D, Davis IC. Topical treatments for hypertrophic scars. Journal of the American Academy of Dermatology 2006; 55: 1024-1031
27 Chithra P, Sajithlal GB, Chandrakasan G. Influence of Aloe vera on collagen characteristics in healing dermal wounds in rats. Mol Cell Biochem 1998; 181: 71-76
28 Oryan A, Mohammadalipour A, Moshiri A et al. Topical Application of Aloe vera Accelerated Wound Healing, Modeling, and Remodeling: An Experimental Study With Significant Clinical Value. Annals of plastic surgery 2014;
29 Ghadially R, Halkier-Sorensen L, Elias PM. Effects of petrolatum on stratum corneum structure and function. Journal of the American Academy of Dermatology 1992; 26: 387-396
30 Rosa AdS, Bandeira LG, Monte-Alto-Costa A et al. Supplementation with olive oil, but not fish oil, improves cutaneous wound healing in stressed mice. Wound Repair Regen 2014; 22: 537-547
31 Maragakis M, Willital GH, Michel G et al. Possibilities of scar treatment after thoracic surgery. Drugs Exp Clin Res 1995; 21: 199-206
32 Willital GH, Heine H. Efficacy of Contractubex gel in the treatment of fresh scars after thoracic surgery in children and adolescents. Int J Clin Pharmacol Res 1994; 14: 193-202
33 Ho WS, Ying SY, Chan PC et al. Use of onion extract, heparin, allantoin gel in prevention of scarring in chinese patients having laser removal of tattoos: a prospective randomized controlled trial. Dermatologic surgery: official publication for American Society for Dermatologic Surgery [et al.] 2006; 32: 891-896
34 Knutti DA. Vergleichende therapeutische Studie zweier Narbencremen in der postoperativen Behandlung von Mammareduktionspalstiken. derm-ch 1991; 6: 14-19
35 Lee DW, Ku SK, Cho HJ et al. Effects of Noscarna™ on hypertrophic scarring in the rabbit ear model: histopathological aspects. Archives of pharmacal research 2012; 35: 1999-2006
36 Morris DE, Wu L, Zhao LL et al. Acute and chronic animal models for excessive dermal scarring: quantitative studies. Plastic and reconstructive surgery 1997; 100: 674-681
37 Sahin MT, Inan S, Ozturkcan S et al. Comparison of the effects of Contractubex® gel in an experimental model of scar formation in rats: an immunohistochemical and ultrastructural study. J Drugs Dermatol 2012; 11: 74-81
38 Ko WJ, Na YC, Suh BS et al. The effects of topical agent (kelo-cote or contractubex) massage on the thickness of post-burn scar tissue formed in rats. Archives of plastic surgery 2013; 40: 697-704
39 Beuth J, Hunzelmann N, Van Leendert R et al. Safety and efficacy of local administration of contractubex to hypertrophic scars in comparison to corticosteroid treatment. Results of a multicenter, comparative epidemiological cohort study in Germany. In Vivo 2006; 20: 277-283
40 Sullivan T, Smith J, Kermode J et al. Rating the burn scar. J Burn Care Rehabil 1990; 11: 256-260
41 Hosnuter M, Payasli C, Isikdemir A et al. The effects of onion extract on hypertrophic and keloid scars. Journal of wound care 2007; 16: 251-254
42 Karagoz H, Yuksel F, Ulkur E et al. Comparison of efficacy of silicone gel, silicone gel sheeting, and topical onion extract including heparin and allantoin for the treatment of postburn hypertrophic scars. Burns 2009; 35: 1097-1103
43 Perez OA, Viera MH, Patel JK et al. A comparative study evaluating the tolerability and efficacy of two topical therapies for the treatment of keloids and hypertrophic scars. Journal of drugs in dermatology: JDD 2010; 9: 514-518
44 Clarke L, Baker B, Trahan C et al. A prospective double-blinded study of Mederma skin care vs. placebo for post-traumatic scar reduction. Cosmetic Dermatol 1999; 12: 19Y22
45 Chung VQ, Kelley L, Marra D et al. Onion Extract Gel Versus Petrolatum Emollient on New Surgical Scars: a Prospective Double-Blinded Study. Dermatologic surgery 2006; 32: 193-197
46 Jackson BA, Shelton AJ. Pilot study evaluating topical onion extract as treatment for postsurgical scars. Dermatologic surgery 1999; 25: 267-269
47 Saulis AS, Mogford JH, Mustoe TA et al. Effect of Mederma on hypertrophic scarring in the rabbit ear model. Plastic and reconstructive surgery 2002; 110: 177-183
48 Mauss HJ. Striae gravidarum–prevention as therapy. Zentralbl Gynakol 1971; 93: 1273-1278
49 Rupp Prophylaxe und Therapie der Striae distensae der Haut schwangerer Frauen. Fortschritte der Medizin 1965; 23: 951-952
50 Hinrichsmeyer D. Striae distensa in pregnancy, possibility and necessity of prevention. Landarzt 1966; 42: 710-713
51 Chernoff WG, Cramer H, Su-Huang S. The efficacy of topical silicone gel elastomers in the treatment of hypertrophic scars, keloid scars, and post-laser exfoliation erythema. Aesthetic plastic surgery 2007; 31: 495-500
52 Murison M, James W. Preliminary evaluation of the efficacy of dermatix silicone gel in the reduction of scar elevation and pigmentation. Journal of plastic, reconstructive & aesthetic surgery: JPRAS 2006; 59: 437-439
53 van der Wal MBA, van Zuijlen PP, van de Ven P et al. Topical silicone gel versus placebo in promoting the maturation of burn scars: a randomized controlled trial. Plastic and reconstructive surgery 2010; 126: 524-531
54 Dobry E. Die Behandlung von frischen Narben. Therapiewoche Schweiz 12: 910-912
55 Friderich H. Hypertrophe Narben und Keloide Konservative Therapiemöglichkeiten. Zeitschrift für Allgemeinmedizin Heft 1985; 30: 1101-1103
56 Pantlen P, Tilkorn H., Schwipper V. Clinical experience with Silgel and Silgel Sheet, containing polysiloxane, in the treatment of hypertrophic scars and their prophylaxis. Forschungsbericht Fachklinik Hornheide Münster AROMANDO MEDIZIN TECHNIK 2000; www.acc.co.nz (15.01.2015)
57 de Santis P. Pilotstudie zur Wirkung von Synchroline Terproline auf verbrennungsbedingte hypertrophe Narben. http://www.synchroline.de/bilder/studien/studienliste.html (15.01.2015)
58 Prado A, Andrades P, Benitez S et al. Scar management after breast surgery: preliminary results of a prospective, randomized, and double-blind clinical study with aldara cream 5% (imiquimod). Plastic and reconstructive surgery 2005; 115: 966-972
59 Stashower ME. Successful treatment of earlobe keloids with imiquimod after tangential shave excision. Dermatologic surgery: official publication for American Society for Dermatologic Surgery [et al.] 2006; 32: 380-386
60 Cação FM, Tanaka V, Messina MCdL. Failure of imiquimod 5% cream to prevent recurrence of surgically excised trunk keloids. Dermatologic surgery: official publication for American Society for Dermatologic Surgery [et al.] 2009; 35: 629-633
61 Berman B, Frankel S, Villa AM et al. Double-blind, randomized, placebo-controlled, prospective study evaluating the tolerability and effectiveness of imiquimod applied to postsurgical excisions on scar cosmesis. Dermatologic surgery: official publication for American Society for Dermatologic Surgery [et al.] 2005; 31: 1399-1403
62 de Mesquita CJG, Leite JAD, Fechine FV et al. Effect of imiquimod on partial-thickness burns. Burns 2010; 36: 97-108
63 Morales-Burgos A, Loosemore MP, Goldberg LH. Postoperative wound care after dermatologic procedures: a comparison of 2 commonly used petrolatum-based ointments. J Drugs Dermatol 2013; 12: 163-164
64 Shengxian Jia M, Zhao Y, Law M, Galiano R, Mustoe TA. The Effects of Collagenase Ointment on the Prevention of Hypertrophic Scarring in a Rabbit Ear Scarring Model: A Pilot Study. WOUNDS 2011; 23: 160-165
65 Sawada Y, Sone K. Hydration and occlusion treatment for hypertrophic scars and keloids. Br J Plast Surg 1992; 45: 599-603
66 Kwon SY, Park SD, Park K. Comparative effect of topical silicone gel and topical tretinoin cream for the prevention of hypertrophic scar and keloid formation and the improvement of scars. J Eur Acad Dermatol Venereol 2014; 28: 1025-1033
67 Janssen de Limpens AM. The local treatment of hypertrophic scars and keloids with topical retinoic acid. Br J Dermatol 1980; 103: 319-323
68 Dematte MF, Gemperli R, Salles AG et al. Mechanical evaluation of the resistance and elastance of post-burn scars after topical treatment with tretinoin. Clinics (Sao Paulo) 2011; 66: 1949-1954
69 Aust MC, Fernandes D, Kolokythas P et al. Percutaneous collagen induction therapy: an alternative treatment for scars, wrinkles, and skin laxity. Plastic and reconstructive surgery 2008; 121: 1421-1429
70 Aust MC, Knobloch K, Reimers K et al. Percutaneous collagen induction therapy: an alternative treatment for burn scars. Burns 2010; 36: 836-843
71 Niessen FB, Spauwen PH, Schalkwijk J et al. On the nature of hypertrophic scars and keloids: a review. Plastic and reconstructive surgery 1999; 104: 1435-1458
72 Lawrence WT. In search of the optimal treatment of keloids: report of a series and a review of the literature. Annals of plastic surgery 1991; 27: 164-178
73 Cosman B, Wolff M. Correlation of keloid recurrence with completeness of local excision. A negative report. Plastic and reconstructive surgery 1972; 50: 163-166
74 Hackert I, Aschoff R, Sebastian G. Keloide und ihre Therapie. Hautarzt 2003; 54: 1003-1017
75 Leventhal D, Furr M, Reiter D. Treatment of keloids and hypertrophic scars: a meta-analysis and review of the literature. Arch Facial Plast Surg 2006; 8: 362-368
76 Friedstat JS, Hultman CS. Hypertrophic burn scar management: what does the evidence show? A systematic review of randomized controlled trials. Annals of plastic surgery 2014; 72: S198-S201
77 Kim S-M, Choi J-S, Lee J-H et al. Prevention of postsurgical scars: comparsion of efficacy and convenience between silicone gel sheet and topical silicone gel. J Korean Med Sci 2014; 29 (Suppl. 03) S249-S253
78 Apotheke im Paunsdorf Center Kirsten Fritsch e. K. http://www.apotheke.de (15.01.2015)
79 Adler-Apotheke Aac, Untertor https://www.adlershop.ch (15.01.2015)
80 Martinus-Apotheke F-E-S, http://www.deutscheinternetapotheke.de (15.01.2015)
81 medpex Versandapotheke Stifts-Apotheke e.K. http://www.medpex.de (15.01.2015)
82 besamex LS-, https://www.besamex.de (15.01.2015)
83 Merz Pharma GmbH & Co. Frankfurt, http://www.merz.de (15.01.2015)
84 Opfermann Arzneimittel GmbH Im Internet: http://www.rottapharm-madaus.de (Stand: 15.01.2015)
85 Permamed AGP. http://www.permamed.ch (15.01.2015)
86 Advanced Bio-Technologies Inc Silverdale WUSAViDIPGG, http://www.dermatix.de (15.01.2015)
87 Drossapharm AGB. http://www.drossapharm.ch (15.01.2015)
88 Sandoz Pharmaceuticals GmbH http://www.sandoz.de (15.01.2015)
89 AMT Aromando MGK http://www.amt-med.de (15.01.2015)
90 Dermokosmetika Synchroline. http://synchroline.de (15.01.2015)