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When the art of medicine needs art itself, to help it treat an unsightly skin scar

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DIDONA DARIO1, CANTISANI CARMEN1, MARCHETTI FRANCESCO1, BAYAT ARDESHIR2
1. Dermatology Policlinico Umberto I, University “Sapienza” of Rome, Italy
2. Plastic and Reconstructive Surgery Research, Centre for Dermatology Research, Institute of Inflammation & Repair, University of Manchester, United Kingdom

A scar is a likely and inevitable consequence of a cutaneous trauma or inflammatory diseases affecting the adult human dermis. A scar results from a fully healed dermal wound/lesion. Dermal wound healing is a complex yet well-orchestrated process, that involves different overlapping steps. Usually, this process is subdivided into three phases: inflammation, proliferation, and tissue remodeling. Inflammation takes place in the first 48 hours after cutaneous trauma. During this phase, neutrophils and macrophages move into the wound site aiming to prevent infection. The proliferation step is characterized mainly by the dramatic activity of fibroblasts, which produce extracellular matrix molecules (ECM) leading to the closure of the defect. Lastly, the remodeling process that could last up to a year or sometimes longer, leads to a cross-linked arrangement of the ECM as the scar matures. Wound healing is not a perfect process. Indeed, different kinds of pathological scars may develop after any form of trauma to the skin. Pathological scars include hypertrophic scars (HS), keloids, and atrophic scars (AS). HS are raised, usually asymptomatic, pinkish lesions, of various shapes. They a ...