熱傷後瘢痕治療の基本[1]

Basic Principles of Post-Burn Scar Treatment: Hypertrophic Scars

はじめに

　熱傷は日常生活や災害時などで頻繁に発生する創傷の1つであり，深達性Ⅱ度以上の熱傷では創傷の治癒に時間を要し，肥厚性瘢痕や瘢痕拘縮といった後遺症を残すことがある。肥厚性瘢痕は，創傷治癒の過程において真皮網状層が障害を受けた際に，過剰な線維芽細胞の活性化やコラーゲンの沈着が持続することで生じる線維増殖性疾患であり，疼痛や瘙痒感を伴うほか，外観上の問題も大きく，患者のQOLを著しく低下させる要因となる。したがって，熱傷治療においては単なる創の閉鎖だけでなく，肥厚性瘢痕の予防と治療までを見据えた包括的なマネジメントが重要である。

　本稿では，熱傷後肥厚性瘢痕の発症機序，予防法，治療法について概説する。

　Burns are classified according to the depth of tissue injury. Deep dermal and full-thickness burns are more likely to result in hypertrophic scar formation. Early wound closure is critical for the prevention of hypertrophic scars. Effective preventive strategies include meticulous wound cleansing, maintenance of a moist wound environment, and the application of basic fibroblast growth factor (bFGF) preparations and topical ointments. Following epithelialization, interventions such as compression therapy, topical corticosteroids, and oral tranilast are used to suppress scar proliferation. The therapeutic options include silicone gel sheets, compression therapy, topical or intralesional corticosteroids, and oral tranilast. Combination therapy is often necessary to achieve optimal outcomes. In cases refractory to conservative management, surgical excision may be indicated.

　A multidisciplinary and comprehensive therapeutic approach has been demonstrated to effectively reduce scar severity.