Abstract
The potential of various biological agents to reduce or prevent excessive scar formation has now been evaluated in numerous in-vitro studies, experimental animal models and preliminary clinical trials, in some cases with particularly promising results. Perhaps prominent among this group of biological agents, and, to some degree, possibly representing marketed compounds already being used ‘off label’ to manage excessive scarring, are the tumor necrosis factor alpha antagonist etanercept, and immune-response modifiers such as IFNα2b and imiquimod. Additional assessment of these novel agents is now justified with a view to reducing or preventing hypertrophic scars, keloid scars and the recurrence of post-excision keloid lesions.
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Berman B, Villa AM, Ramirez CC. Novel opportunities in the treatment and prevention of scarring. J Cutan Med Surg 2004; 8 Suppl. 3: 32–6
Brimhall AK, King LN, Licciardone JC, et al. Safety and efficacy of alefacept, efalizumab, etanercept and infliximab in treating moderate to severe plaque psoriasis: a meta-analysis of randomized controlled trials. Br J Dermatol 2008; 159: 274–85
Berman B, Flores F. The treatment of hypertrophic scars and keloids. Eur J Dermatol 1998; 8: 591–5
Saed GM, Ladin D, Olson J, et al. Analysis of p53 gene mutations in keloids using polymerase chain reaction-based single-strand conformational polymorphism and DNA sequencing. Arch Dermatol 1998; 134: 963–7
Ladin DA, Hou Z, Patel D, et al. p53 and apoptosis alterations in keloids and keloid fibroblasts. Wound Repair Regen 1998; 6: 28–37
Berman B, Patel JK, Perez OA, et al. Evaluating the tolerability and efficacy of etanercept compared to triamcinolone acetonide for the intralesional treatment of keloids. J Drugs Dermatol 2008; 7: 757–61
Calabrese F, Carturan E, Chimenti C, et al. Overexpression of tumor necrosis factor (TNF)alpha and TNFalpha receptor I in human viral myocarditis: clinicopathologic correlations. Mod Pathol 2004; 17: 1108–18
Lundblad LK, Thompson-Figueroa J, Leclair T, et al. Tumor necrosis factoralpha overexpression in lung disease: a single cause behind a complex phenotype. Am J Respir Crit Care Med 2005; 171: 1363–70
Navarro JF, Milena FJ, Mora C, et al. Renal pro-inflammatory cytokine gene expression in diabetic nephropathy: effect of angiotensin-converting enzyme inhibition and pentoxifylline administration. Am J Nephrol 2006; 26: 562–70
Stassi G, De Maria R. Autoimmune thyroid disease: new models of cell death in autoimmunity. Nat Rev Immunol 2002; 2: 195–204
Berman B, Duncan MR. Short-term keloid treatment in vivo with human interferon alfa-2b results in a selective and persistent normalization of keloidal fibroblast collagen, glycosaminoglycan, and collagenase production in vitro. J Am Acad Dermatol 1989; 21: 694–702
Brysk MM, Selvanayagam P, Arany I, et al. Induction of apoptotic nuclei by interferon-gamma and by predesquamin in cultured keratinocytes. J Interferon Cytokine Res 1995; 15: 1029–35
Jacob SE, Berman B, Nassiri M, et al. Topical application of imiquimod 5% cream to keloids alters expression genes associated with apoptosis. Br J Dermatol 2003; 149 Suppl. 66: 62–5
Granstein RD, Rook A, Flotte TJ, et al. A controlled trial of intralesional recombinant interferon-gamma in the treatment of keloidal scarring. Clinical and histologic findings. Arch Dermatol 1990; 126: 1295–302
Larrabee Jr WF, East CA, Jaffe HS, et al. Intralesional interferon gamma treatment for keloids and hypertrophic scars. Arch Otolaryngol Head Neck Surg 1990; 116: 1159–62
Berman B, Flores F. Recurrence rates of excised keloids treated with postoperative triamcinolone acetonide injections or interferon alfa-2b injections. J Am Acad Dermatol 1997; 37: 755–7
Novak N, Yu CF, Bieber T, et al. Toll-like receptor 7 agonists and skin. Drug News Perspect 2008; 21: 158–65
Schon MP, Schon M. Imiquimod: mode of action. Br J Dermatol 2007; 157 Suppl. 2: 8–13
Berman B, Kaufman J. Pilot study of the effect of postoperative imiquimod 5% cream on the recurrence rate of excised keloids. J Am Acad Dermatol 2002; 47 (4 Suppl.): S209–11
Chuangsuwanich A, Gunjittisomram S. The efficacy of 5% imiquimod cream in the prevention of recurrence of excised keloids. J Med Assoc Thai 2007; 90: 1363–7
Stashower ME. Successful treatment of earlobe keloids with imiquimod after tangential shave excision. Dermatol Surg 2006; 32: 380–6
Berman B, Viera MH, Amini S, et al. Prevention and management of hypertrophic scars and keloids after burns in children. J Craniofac Surg 2008; 19: 989–1006
Ferguson MW, O’Kane S. Scar-free healing: from embryonic mechanisms to adult therapeutic intervention. Philos Trans R Soc Lond B Biol Sci 2004; 359: 839–50
Durani P, Occleston N, O’Kane S, et al. Avotermin: a novel antiscarring agent. Intint J Low Extrem Wounds 2008; 7: 160–8
Gordon A, Kozin ED, Keswani SG, et al. Permissive environment in postnatal wounds induced by adenoviral-mediated overexpression of the anti-inflammatory cytokine interleukin-10 prevents scar formation. Wound Repair Regen 2008; 16: 70–9
Peranteau WH, Zhang L, Muvarak N, et al. IL-10 overexpression decreases inflammatory mediators and promotes regenerative healing in an adult model of scar formation. J Invest Dermatol 2008; 128: 1852–60
Renovo. Prevascar® phase II results. Renovo announces positive phase II efficacy trial results for Prevascar® [Press release 17 Apr 2007]. [cited 2009 March 29]; Available from: http://www.renovo.com/itemdetails.asp?c_id=31&news_id=29
Kim A, DiCarlo J, Cohen C, et al. Are keloids really “gli-loids”?: High-level expression of gli-1 oncogene in keloids. J Am Acad Dermatol 2001; 45: 707–11
Macaron NC, Cohen C, Chen SC, et al. gli-1 Oncogene is highly expressed in granulomatous skin disorders, including sarcoidosis, granuloma annulare, and necrobiosis lipoidica diabeticorum. Arch Dermatol 2005; 141: 259–62
Berman B, Poochareon V, Villa AM. An open-label pilot study to evaluate the safety and tolerability of tacrolimus ointment 0.1% for the treatment of keloids. Cosm Dermatol 2005; 18: 399–404
Acknowledgments
Editorial assistance for the preparation of this manuscript was provided by Stephanie Blick of inScience Communications. This assistance was funded by Pfizer. Dr Berman did not receive any financial support for the preparation of this manuscript. Dr Berman received honoraria as a monitor of the speakers’ bureau of Graceway, Sanofi-Aventis and Astrellas and he acted as an investigator for Amgen.
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Berman, B. Biological Agents for Controlling Excessive Scarring. AM J Clin Dermatol 11 (Suppl 1), 31–34 (2010). https://doi.org/10.2165/1153419-S0-000000000-00000
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DOI: https://doi.org/10.2165/1153419-S0-000000000-00000