Medical Needling: Effect on Skin Erythema of Hypertrophic Burn Scars

Abstract

Background Burn scars frequently tend to have pathological discolorations, which is manifested in the development of persistent erythema. Affected people suffer from psychological and physiological issues when they are restricted or rejected in their daily life. In this context, medical needling seems to be an efficient therapy for erythematous scars with a relatively low-risk rate of postoperative complications. Study research has already shown significant improvements in the scar quality with reference to the parameters "moisture and transepidermal water loss." Clinical data is up-to-date and provides an innovative therapy outcome of scar treatment with medical needling. Objective The aim of our study was to examine the influence of medical needling on the pathological and persistent erythema of hypertrophic burn scars. By means of reliable measurement methods, we were able to prove positive and sustainable outcomes for normal and healthy skin. The patient cohort included 20 patients with an average age of 34.63 years. Our examinations involved scars that were at least two years old and had healed by secondary intent. Every scar showed the pathological values of persistent erythema according to the participation requirements. Methods For the practical implementation of medical needling or percutaneous collagen induction (PCI), we used a roller covered with needles of 3 mm length. The needling device is rolled over the scar alternatively in a vertical, horizontal, and diagonal orientation. Multiple micro-wounds at a close distance cause intradermal bleeding, which evokes modified skin regeneration provoked by the effects of medical needling. Every patient has been followed up for 12 months postoperatively. Further on, valid results have been evaluated objectively as well as subjectively by the patient and observer. Results Our study has shown that persistent erythema of hypertrophic scars can be considered as an indication of PCI. The needling procedure influences vascularization by stimulating angiogenesis in the post-needling wound healing cascade. As the method is based on percutaneous collagen induction, the synthesis of collagen improves the vital thickness of the epidermis, which is directly associated with less transparency. Examined scars showed a significant reduction of erythema and were less reddened after treatment. Based on the outcomes of objective measurements, medical needling achieves a normalization of the skin color and an adjustment to healthy skin after repetitive treatments. Conclusion Medical needling seems to be a suitable therapy approach for treating erythematous, hypertrophic burn scars.

Keywords: epidermal thickness; hypertrophic burn scars; medical needling; pathological persistent erythema; vascularization.

Figure 1. Roller device for medical needling

Figure 2. Measurement principle of the Mexameter

Image source: Courage-Khazaka GmbH, Cologne, Germany

Figure 3. Patient ratings for "color" and "overall opinion" preoperatively and at last follow-up

Patient ratings: 1 = as normal skin, 10 = very different from normal skin Box displays lower and upper quartiles, median value is indicated by the horizontal line, endpoints of the upper and lower whisker display minimum and maximum values.

Figure 4. Observer ratings for "vascularization" and "relief" preoperatively and at last follow-up

Patient ratings: 1 = as normal skin, 10 = very different from normal skin (Box displays lower and upper quartiles, median value is indicated by the horizontal line, the endpoints of the upper and lower whisker display minimum and maximum values)

Figure 5. Case 1, frontal shot, preoperatively (left) and one year postoperatively after needling (right). Areas treated: face perilabial, chin, neck

Figure 6. Case 2, frontal shot, preoperatively (left) and one year postoperatively after needling (right). Areas treated: entire face

Figure 7. Erythema, pathological scars treated by medical needling and healthy skin pre- and one year postoperatively

Box displays lower and upper quartiles, median value is indicated by the horizontal line, endpoints of upper and lower whisker display minimum and maximum values

Figure 8. Difference in the erythema index for treated scars and healthy skin preoperatively and one year later

Box displays lower and upper quartiles, median value is indicated by the horizontal line, endpoints of the upper and lower whisker display minimum and maximum values.

Figure 9. Erythema, untreated scars and healthy reference pre- and one year postoperatively

Box displays lower and upper quartiles, median value is indicated by the horizontal line, endpoints of the upper and lower whisker display minimum and maximum values.

Figure 10. Difference of the pre- and postoperative measured erythema index dependent on the amount of treatments

Box displays lower and upper quartiles, median value is indicated by the horizontal line, endpoints of the upper and lower whisker display minimum and maximum values.