Hypertrophic scar treatment by polydeoxyribonucleotide intralesional injections in combination with corticosteroid, laser and silicone effects

Hypertrophic scars can lead to significant quality-of-life impairment like an aesthetically displeasing, psychosocial, physiological factors. Invasive and non-invasive methods from evidence-based recommendations are available. The aim of this case report is the evaluation of injectional correction of a permanent linear scar with deoxyribonucleotide polymer (polydeoxyribonucleotide (PDRN)) by its regenerative properties with addition of corticosteroid, laser resurfacing and silicone therapy effects. A woman (33 y.o.), presented with matured, linear, hypertrophic scar in abdominal wall, located along linea alba from the umbilicus till the pubic tubercle. Medical history include bladder aplasia and multiple reconstructive surgeries. After the last and most extensive surgical intervention was performed, an abnormal scar appeared. Wide-spread tissues provoked itching, sense of tension, stiffness, pain, disruption of daily activities and depressed emotional well-being. The course of intralesional injections, CO2 laser procedure, silicone application was implemented. The scar was 19 cm long, 1-3 cm wide, rigid, stiff. Color reddish-brown, pink. The therapy was started with PDRN solution in standard concentration of 5,625 mg/3 ml. For one procedure 3 ml were used once a week (12 weeks). Intralesional corticosteroid injections were started with Triamcinolone in standard concentration of 40 mg/ml, 2 ml once a month (5 months). In the result, tissue softening and relaxation were achieved, but simultaneously color changes and telangiectasias manifested. Scar surface correction was proceed with CO2 laser (1064 nm) 3 times and silicone applications (6 weeks). Intermediate results were fixed by photo-reports every month. The thickness, width, rigidity, soreness decreased, color became pale, no telangiectasias, erythema observed. In case of mature, hypertrophic scar it is possible to improve visual, functional condition predominantly by healing PDRN effects with additional use of well-accepted, evidence-based methods.