Scottsdale – Hypertrophic scarring is best described as a refractory skin disease. Patients with this disease experience major physical deformities, restricted range of motion, pain, and itching where this scarring occurs. Because the basis for hypertrophic scar has not been fully elucidated, the clinical management of these thickened scars remains a problem. A recent article in the journal, Aesthetic Plastic Surgery, demonstrates the efficacy of using botulinum type A, also known as Botox, for the treatment of these thick and unpleasant scars that offers hope for patients.

Nineteen patients were enrolled in the study. All patients had only one lesion, each one had persisted for at least 2 years and had maintained active hypertrophic characteristics.  All patients were treated once a month with intralesional botulinum type A for a total of 3 months. Each lesion was injected until slight blanching was visible. The dosage was adjusted to 2.5 U per cubic centimeter of lesion.

The lesions were found, 3 on the face and neck, 5 on the chest, 6 on the back, 3 on the earlobe, and 2 on the buttocks. Patients and surgeons were allowed to assess the results with an average follow up period at 6 months.

All the lesions had some positive response. In the assessment from the plastic surgeons, improvement was seen in 15 lesions that reached a ‘‘good,’’ rating, including 1 on the face, 2 on the neck, 3 on the chest, 5 on the back, 2 on the earlobe, and 2 on the buttocks. Four lesions reached an ‘‘excellent’’ rating, including 1 on the back, 2 on the chest, and 1 on the earlobe.

The authors speculate that botulinum type A affects the cell cycle distribution of fibroblasts derived from the hypertrophic scars as the most likely explanation for their findings.

I like this study because injection of Botox is simple and safe and the before and after photos of the lesions are quite impressive. However, the study has limitations. First, it did not include a control group and was not double blinded, which may affect the degree of confidence. Additionally, the follow-up period was only six months.

It may be possible to offer Botox to some patients based on this research, but it should be made clear to patients that more research will be needed to see how well this technique works and what the long-term results actually last. Moreover, use if Botox in such cases would be off -label.