SCARS

Why does wound healing almost always result in scarring? In theory, it does not have to.

Wound healing in adult skin, a complex process involving many cell types and processes such as epidermal, fibroblastic and endothelial cell proliferation, cell migration, matrix synthesis and wound contraction, almost invariably results in scar tissue formation and wound induration in adult skin. However, it is worth noting that wound healing in embryonic skin involves repair processes that results in essentially perfect regeneration of the damaged tissue (Martin P. Wound healing – aiming for perfect skin regeneration. Science 1997;276:75-81). 

Scarring is associated with inflammation, resulting in the secretion of inflammatory cytokines, and growth factors. It is believed that transforming growth factor-beta (TGFβ), which stimulates the conversion of fibroblasts into myofibroblasts, is predominantly responsible for scarring following injury such as burns and surgical trauma. Wound tension and infections, which increase the secretion of TGFβ, are also associated with increased scarring. It is of interest that embryos, with immature inflammatory cells, are incapable of producing TGFβ.

Injurious processes including burns and surgical trauma trigger wound healing processes through activation of transcription activators, such as nuclear factor kappa B (NF-kB). NF-kB is a family of related dimers, which bind to a common sequence on the DNA, the kB site. In the non-activated state these dimers (p50/p65) are located in the cytoplasm. When activated by injurious stimuli, the activated p50/p65 dimers translocate to the nucleus, where they bind to the DNA, resulting in the transcription of over 200 genes involved in the processes of wound healing.

Curcumin, the active ingredient in turmeric, is a potent inhibitor of NF-kB activation. The process of activating NF-kB dimers in the cytoplasm involves the removal of an inhibitory protein (IkBα) by phosphorylation of its kinase (IkBα) kinase. This is achieved through phosphorylation of IkBαkinase at its serine/threonine sites by phosphorylase kinase (PhK). Curcumin gel, a potent inhibitor of PhK (Heng MCY. Drug induced suppression of phosphorylase kinase correlates with resolution of psoriasis as shown by clinical, histological and immunohistochemical parameters. British Journal of Dermatology 2000;143:937-949), may thus be used as an anti-scarring topical agent, through inhibition of NF-kB-dependent inflammatory processes, including the secretion of TGFβ, responsible for scarring following burns and surgical wounds.  

Madalene C.Y. Heng MD, FRACP, FACD, FAAD

Professor of Medicine/Dermatology

UCLA School of Medicine 

RECOMMENDED PRODUCT: For Severe Burns & Scars, we recommend the Psoria-Gold Scar Serum. Apply 2-3 times daily and once in the evening until faded. For surgical scars, application of Scar Serum may begin once stitches have been removed. 

Although results vary, it is common that appearance of newer injuries have more improvement than older injuries. Psoria-Gold® does not replace your doctor's prescribed skin regimen, and does not guarantee skin will not develop unwanted appearance. IT IS RECOMMENDED TO AVOID UNNECESSARY CONTACT OR EXPOSURE TO THE SUN, UVA AND UVB LIGHT AS MUCH AS POSSIBLE.