List of inexpensive available analogues of Contractubex

pharmachologic effect

Manufacturer: MERZ PHARMA GMBH AND CO.
(Germany) Release form: gel for external use

Active ingredients: onion bulb extract, heparin, allantoin

Analogues: Dermatix, Imoferase, Fermenkol

Contratubeks is a combined drug with anti-inflammatory, regenerative, fibrinolytic and antithrombotic properties. The medication stimulates cell regeneration without enlargement and inhibits the growth of keloid cell structures.

Description of the drug

The main active ingredients of the drug are sodium heparin, allantoin and onion extract. Contractubex is a water-based gel and has a dark brown color. The combination of active ingredients stimulates the resumption of cell growth without leading to excessive tumors.

The special composition of the drug actively affects the affected skin in a short time.

Onion extract works as an anti-inflammatory agent and is especially effective on fresh tissue damage. Allantoin helps soften and dissolve dead cells.

This is necessary so that the body can get rid of excess connective tissue that appears during the formation of scars. And heparin is a well-known remedy against blood stagnation, thrombosis and edema.

Indications for use of Contratubeks

The medication is indicated for the following conditions:

• contractures of joints and tendons due to injuries;
• scars that occur after injuries, surgical interventions, burns, amputations;
• Dupuytren's contracture (scars and shortening of tendons in the hand area);
• cicatricial changes of an atrophic nature after furunculosis or acne;
• stretch marks on the abdomen after childbirth.

The gel can be used as a prophylactic agent to prevent the development of scars.

Indications and contraindications

The only contraindications can be identified as increased sensitivity to the components of the drug, which will manifest itself in the form of allergic reactions. If unpleasant symptoms appear, you should immediately stop using the medicine, stop the symptoms and change the method of treating scars, scars and other changes in the skin. Indications for the use of Contractubex will be as follows:

• stretch marks that appear after pregnancy and weight changes;
• scars from acne, furunculosis;
• scars resulting from operations, amputations and skin damage;

• replacement of ligament tissue with connective or scar tissue (traumatic tendon contracture);
• fibrous fusion of joints;
• degeneration of tendons into scars, concentrated on the extremities (Dupuytren's contracture).

As a result, they begin to recommend medicine if there are noticeable scars or specific diseases associated with the formation of a large amount of scar tissue. If we talk about removing scars, the drug copes especially well with fresh formations, preventing their growth. The older the scar, the slower the treatment will proceed.

Contratubeks - instructions for use

According to the instructions for use of Contratubes, the drug is applied to the scar area by lightly rubbing 2-3 times a day. The gel consumption is 0.5 cm per lesion area of ​​20–25 square meters. see. The course of treatment for fresh scars lasts for 1 month.

If there are old and dense scar changes, the gel is applied under an occlusive (sealed) bandage at night and treatment measures continue for up to six months. In the presence of Dupuytren's contracture, therapy for scar changes on the hand can last 1 year.

The best cream for scars and scars

The cream is a widely popular anti-scar preparation. Affordable and relatively safe for health. However, continued use is required to achieve results.

5 Clearwin

The product contains plant extracts that have a wound-healing, nourishing effect on the structure of the skin. Regular use of the cream eliminates pigmentation, acne, fresh scars and scars. Users note that the drug helps eliminate dark circles, bags under the eyes, and smooth out the skin. Changes on the face become noticeable due to accelerated metabolism and improved microcirculation in tissues.

The cream has a wound-healing effect in cases where other remedies have not helped. Active moisturizing, softening, and renewal of the epidermis are the main indicators of the high quality of Clearvin. Using the cream does not require much effort or skill. It is enough to apply it 2-3 times a day, and the effect will appear in 5-6 weeks. The product does not react with other facial care products. Recommended for use by women and men regardless of age.

4 Epitonex

Refers to cosmetic skin care products. Well eliminates the effects of acne, boils, scratches, cuts. Recommended for increased pigmentation. The basis of the drug is plant extracts, allantoin and beeswax. All components together effectively eliminate scars, stretch marks, and resolve scars.

The cream has an ideal texture for application. It is recommended to apply to problem areas of the skin until completely absorbed. The effect becomes noticeable with daily application of the cream for 2-3 months. The best time to use the cream is morning and evening; if possible, a third application during the day to cleansed skin is recommended. The cream is well tolerated. Individual intolerance is considered a contraindication. You can purchase the drug at a pharmacy.

3 Scar Esthetique

A good product for improving skin condition. Suitable for the treatment of scars and cicatrices caused by injuries, burns and operations. Can also be used to combat stretch marks. The structure of the cream contains many active substances, including vitamins A and C, silicone, Shea butter, onion extract, bisabolol, chitosan, arnica and others.

It has an active effect on scars of various origins. Softens and smoothes the skin, improves appearance. Recommended for the treatment of adults. Sometimes it can cause side effects, expressed by rashes and redness. This is perhaps the only drawback. Otherwise, reviews about the drug are positive. Many customers trust him.

2 Kelofibrase

The cream is suitable for both prevention and treatment of scars. The German development has sodium heparin, D camphor and urea in its structure. Thanks to these substances, the product perfectly moisturizes the skin, softens rough areas, gives elasticity and improves blood circulation. Beneficial effects also include the ability of the drug to have analgesic and anti-inflammatory effects.

Patients noticed a significant improvement in the condition of their scars after using the cream. Swelling has decreased, the process of scar resorption has accelerated, and protruding areas of the skin have been smoothed out. Kelofibrase rarely causes side effects and can be used in children over one year of age.

1 Scarguard

Compared to others, Scarguard has a thin consistency. The peculiarity of the cream is that after drying it forms a kind of bandage, over which you can apply makeup or sunscreen. Thus, the drug is safe for delicate facial skin. However, it is not recommended for children under 2 years of age.

Created on the basis of vitamin E, silicone and hydrocortisone. Due to these components, the production of collagen is enhanced, which helps accelerate the resorption of scars and soften the surface layer. Buyers love the drug for its effective action and lack of side effects. It does not contain harmful substances. The price for a small bottle of Scarguard is of course high, but it is completely worth it.

Analogs of Contratubeks

The pharmaceutical market is represented by a wide range of Contratubex substitutes for external use. Among them there are analogues of domestic production and foreign companies. These drugs are sold in the pharmacy chain in the form of:

• generics;
• synonyms;
• combined means.

These medications are successfully used in practice, allowing doctors to select with maximum efficiency the appropriate analogue that gives a high therapeutic result.

Table of Contratubeks analogues with price and country of origin.

The price of Contratubeks analogs varies over a wide range. Among the large number of preparations for external use, you can purchase analogues of Contratubex gel cheaper. These medications are not inferior to foreign drugs in terms of treatment effectiveness.

What else can replace Contratubes ointment, what analogues? You can supplement the list of medications with the following medications:

• Clearwin;
• Curiosin;
• Mepiform patch;
• Cicatrix;
• Heparin ointment;
• Dolobene;
• Dermatix ultra;
• Imoferase;
• Venitan.

You can purchase analogues of Contractubex ointment for scars from this list, cheaper or more expensive, depending on the manufacturer. What else can replace Contratubes, which drug in comparison will be the best for the treatment of scars?

The best ointment for scars and scars

In most cases, ointments for scars have a resolving effect. Their main task is to reduce the size of scars and eliminate redness. A distinctive feature is a longer effect (as opposed to a gel or cream) on the damaged area of ​​the body or face.

5 Methyluracil ointment

Recommended for external and local use to activate the process of restoration of damaged epidermis. The main advantages of the ointment include stabilization of nucleic acid metabolism, high regenerative ability, and acceleration of the growth of new tissue cells. It is actively used during the recovery period after burns of various etiologies, ulcers, fractures, and deep cuts. It is recommended by doctors in the presence of bedsores in bedridden patients, when recovering from irradiation of genital tumors. Used for vaginal fusion in girls.

An effective way to apply the ointment is 5-10 g daily to the affected area for 2-4 weeks. For the treatment of late radiation burns of the vaginal mucosa, the use of ointment in tampons is allowed. The course lasts until the wound surface is completely healed. Therapy is allowed for up to 4 months. Systematic use of the ointment guarantees the elimination of inflammation and increased immune protection of damaged tissue. The most effective is considered to be applying the product under a bandage, which is changed 2 times a day. If there is pus in the wound, this is done more often. The dressing is accompanied by treating the injured area with an antiseptic.

4 Rubtsevitis

The ointment is used to increase the rate of tissue regeneration and its nutrition. Effectively fights post-operative scars, scars, relieves stretch marks, acne marks, and chickenpox. Improves the condition of contracture, when flexion and extension of the limb is accompanied by unpleasant sensations. The use of ointment smoothes the skin, nourishes it and makes it more elastic. After a few weeks of use, the formations that rise above the surface level out, stop itching, and the pain syndrome weakens.

It is allowed to restore skin on any part of the human body. Apply the product every day 2-3 times for 30-90 days. The drug is well tolerated by patients and has no age restrictions. Convenient to spread, does not spread, concentrates on the problem area. To get rid of deep, old defects, Rubtsevit must be combined with stronger agents.

3 Solcoseryl

The ointment is in great demand among the Russian population. Sold only in pharmacy chains, available without a prescription. Suitable for treating wet and dry injuries. Has an excellent effect on restoring the skin. Resolves scars well. Produced from the blood of healthy calves. This is how it differs from its analogues.

Users noticed that after using Solcoseryl, small scars smoothed out. The skin brightened, acquired a more even color, and became elastic. Before purchasing, consumers are strongly advised to consult a doctor. The ointment is strong and may cause an allergic reaction. The price is quite affordable, which definitely gives it an advantage.

2 Dexpanthenol

A specialized product that copes well with scars left, for example, by a disease such as chickenpox. The structure of the ointment includes natural ingredients: sea buckthorn oil, petroleum jelly, B vitamins, lanolin, citric acid and other beneficial substances. Thanks to their complex action, rapid restoration of the skin occurs.

Dexpanthenol perfectly performs the tasks stated by the manufacturer. Heals scars, smoothes the epidermis. It is a potent drug, so it must be used strictly according to the instructions. It is not recommended to increase the dosage without consulting a doctor. The ointment is easily excreted from the body and can rarely cause allergic reactions. No side effects were noticed.

1 Madecassol

The highly effective product Madecassol is recommended for the treatment of shallow injuries. It has a strong antibacterial effect and is used against scars caused by burns or surgeries. It is of plant origin, so it is safe for children. The advantage is the presence of Asian centella in the composition. Thanks to it, rapid cell regeneration occurs.

As users note, Madecassol is not just another advertised drug, but a truly effective ointment. Burn scars are completely eliminated. It is difficult to find in Russia; it is better to order it online. The product has a wide spectrum of action. In addition to removing scars, it actively fights varicose veins and dermatitis.

Contratubeks or Dermatix - which is better and more effective?

Manufacturer: MEDA PHARMACEUTICALS SWITZERLAND (Switzerland)
Release form: silicone gel for external use

Active ingredient: mixture of polymeric organosilicon compounds (polysiloxanes)

Both drugs have equivalent indications, but a different mechanism of action. Dermatix gel will be best for scars that have formed recently, especially if they are present on the face. For formed keloid scars, Contratubeks will be more effective, and it is also more affordable.

According to patient reviews, the analogue is well tolerated and does not cause discomfort or side effects. Its use is possible for pregnant women and during lactation.

What to choose from Contractubex analogues?

The described drugs provide an opportunity to choose the best option for most situations and for any budget. The success of their use will depend on compliance with the instructions and recommendations of the doctor. It is possible to remove unaesthetic scars, stretch marks, scars in a relatively short period of time. Thanks to the development of pharmaceuticals, this has become available to everyone who needs it.

You should choose the drug that is most suitable in a particular case. It is necessary to take into account the degree of sensitivity of the skin, the healing time of the wound and the age of the scar tissue. If in doubt you cannot choose a specific option, you can consult a dermatologist or cosmetologist. They will help you find the remedy that will be optimal for each individual case.

Contratubeks or Imoferase - which is better for scars

Manufacturer: PETROVAX PHARM (Russia)
Release form: cosmetic cream

Active ingredient: hyaluronidase

Both medications help the patient get rid of skin defects and scars. This is especially true if they are on the face. Imoferase is a cheaper analogue of Contratubex for scars. Its effectiveness remains at a high level and is no less than the activity of the base drug.

Imoferase copes well with fresh skin defects, which within 1–2 months can be completely eliminated or become less noticeable.

Cheap analogues of Contractubex

The difference between the pharmaceutical product Contractubex is the effective treatment of skin lesions, scars, scars, not only recently formed, but also old ones.

The price of the drug is high (600 rubles). It must be said that in pharmacy kiosks you can find its analogues, similar to it in composition and action. Why overpay if you can find a worthy replacement for the gel.

Cheap analogues of Contractubex are bought at pharmacy kiosks, which also do an excellent job of treating skin defects. But it will not be possible to completely replace this drug, since it has a special composition. The main components are sodium heparin, onion extract and allantoin.

Preparations analogous to Contractubex gel:

1. Gel Camelox.

The product is in no way inferior in effectiveness to Contractubex, since the composition is close to it. The main components of this gel are also onion extract and allantoin. Pharmacy Camelox also has auxiliary ingredients - rosemary oil and aloe, which actively help enhance the restorative effect of the gel.

Using this remedy, it is possible to get rid of the following defects:

• From recently healed wounds on the upper layer of the epithelium;
• Striped stretch marks on the abdomen left after pregnancy;
• Indentations from removed pimples will make them less noticeable.

Price – 250 rubles;

1. Gel Venitan Forte.

Most often, this pharmaceutical product is purchased by people suffering from diseases of the veins located in the lower extremities. In addition to the main function, with the help of the gel, scars quickly resolve and wounds heal quickly. The main components of the medicinal gel are allantoin, regular heparin, and dexpanthenol.

According to user reviews, the drug can relieve the following skin problems:

• The gel-like mass is used to remove marks from old healed wounds or thick sutures after intervention with a scalpel. They become not as noticeable as before;
• The skin will become more tender and the depressions left after removing purulent acne will not be visible;
• For prevention, it is recommended to be used by pregnant women to avoid stretch marks on the chest and abdomen.

Gel price – 300 rubles;

1. Gel Dolobene.

An equally popular and effective analogue of the drug Contractubex is Dolobene gel. It contains dimethyl sulfoxide, due to which the drug has more contraindications for use than other gels. There are also side effects. But thanks to this bipolar aprotic solvent, other components of the gel penetrate the skin better and enhance its effect.

Sodium heparin in the drug is responsible for skin regeneration, and with its help the inflammatory process is more likely to be reduced. The same functions are performed by other components of the gel - essential rosemary oil, dexpanthenol, mountain pine and citronella oil.

The drug is used in the following cases:

• Skin injuries, general injuries;
• Inflammatory processes that cause pain in the joints;
• Postpartum stretch marks on the abdomen and breasts;
• Scars of varying severity.

The effect of the gel components makes the skin softer, inflammatory processes are reduced, and blood circulation improves.

Price – 300 rubles (50g tube).

Contratubeks or Fermenkol - which is better?

Manufacturer: HIGH TECHNOLOGIES (Russia)
Release form: cosmetic gel

Active ingredient: collagenolytic collagenases (proteases)

Fermenkol is a new generation enzyme medicine used in the treatment of skin defects. The use of Contratubeks will be a priority in the postoperative period or after a recent injury. It is more effective because it has an anti-inflammatory, bactericidal effect and prevents vascular thrombosis in the scar area. Such comprehensive care for damaged skin promotes better skin restoration.

A properly selected analogue of Contratubex will not only prevent the formation of scars after injuries and surgical procedures, but also significantly improve the condition of old keloid scars.

Solcoseryl

Manufacturer: Valeant Pharmaceuticals Germany GmbH (Germany)
Release form: gel, ointment for external use

Active ingredient: protein-free extract from the blood of healthy dairy calves

Solcoseryl for external use is a medicine that helps stimulate metabolic, regenerative and trophic processes in tissues. The product helps to increase collagen synthesis. The drug is effective for external injuries, burns, frostbite. This analogue of Contratubex gives a good therapeutic effect for bedsores and trophic ulcers.

Kelo-cote

Manufacturer: ADVANCED BIO-TECHNOLOGIES (USA)
Release form: silicone-based gel

Active ingredient: polysiloxane, silicon dioxide

Kelo-coat gel is used to treat keloid and hypertrophied scars of various origins. They can replace Contratubeks gel, which, when applied to the scar, forms a waterproof and airtight film. Under such a framework, collagen synthesis is normalized, which does not allow the scar to grow. The medication reduces itching, discomfort, the severity of scars, and restores the color of the skin.

Mederma

Manufacturer: Merz Pharma (Germany)
Release form: gel for external use

Active ingredient: cepalin, allantoin

The drug for external use Mederma is a combined biologically active agent with anti-inflammatory and reparative effects. Due to the active substances of the drug, hydrophilicity and tissue softening are stimulated. This process leads to smoothing of the collagen fibers that form the basis of the scar and inhibition of its synthesis processes.

Methyluracil

Manufacturer: JSC BIOSINTEZ (Russia)
Release form: ointment for external use

Active ingredient: dioxomethyltetrahydropyrimidine

Methyluracil belongs to the group of tissue regeneration stimulators. This analogue of Conratubex ointment for scars and scars helps to normalize metabolic processes in cellular structures, accelerates the growth of granulations and the formation of epithelium at the site of the wound surface. The medication inhibits the breakdown of proteins and stimulates the renewal of structural parts of cells.

Camelox

Manufacturer: JSC VERTEKS (Russia)
Release form: gel for external use

Active ingredients: allantoin, sodium heparin, onion extract, bromelain, rosemary essential oil

The Russian analogue of Contratubeks, Camelox gel, can be used to treat any type of scars. Thanks to the combined composition of the active ingredients of the drug, the following occurs:

• stimulation of regenerative processes of the skin;
• softening and increasing its elasticity;
• stimulation of collagen production;
• limiting the proliferation of cellular structures of scar tissue.

The drug can be used at any stage of scar formation, not only for treatment, but also as a prophylactic agent to prevent its formation.

Hypertrophic and keloid scars

Scars are the result of replacement of damaged own tissues with rough connective tissue as a result of surgical interventions and various traumatic factors (mechanical, temperature, chemical, ionizing radiation, deep destructive inflammation, etc.) [1, 2, 3]. Scars, being a pronounced cosmetic defect, often lead to psycho-emotional discomfort, as well as the development of psychosocial maladjustment and a decrease in quality of life.

Scar formation goes through several stages:

1. Stage 1 - inflammation and epithelization on days 7–10 after injury. The edges of the wound are connected by fragile granulation tissue; there is no scar as such yet. This period is very important for the formation of a thin and elastic scar - it is necessary to prevent suppuration and divergence of the edges of the wound.
2. Stage 2 - formation of a young scar. This is 10–30 days after the injury. Collagen and elastin fibers begin to form in the granulation tissue. Increased blood supply to the injury remains - the scar is deep pink in color.
3. Stage 3 - formation of a “mature” scar lasting from 1 to 3 months after injury, blood vessels completely disappear, collagen fibers line up along the lines of greatest tension. The scar becomes light and dense.
4. Stage 4 - final transformation of the scar. Duration 4–12 months after injury.

Scar formation occurs mainly due to the extracellular matrix, in particular with the help of collagen. The extracellular matrix is ​​a supromolecular complex that includes chemical compounds of various types (proteins, polysaccharides, proteoglycans, and others). It can be compared to a gel in which fibrous proteins (collagens and elastin) and viscous proteins (fibronectin, laminin) “float”, ensuring the interaction of molecules with each other and with cell surfaces [2, 9, 14, 17]. Of all proteins, collagens constitute the main component of the extracellular matrix and are the most abundant proteins in the body, accounting for about 1/3 of all its proteins. These are water-insoluble extracellular glycoproteins synthesized by fibroblasts, chondroblasts and osteoblasts. Due to the shape of the protein molecule, collagens are classified as fibrillar proteins [16]. The growth of excess extracellular matrix in the scar occurs as a result of the activity of “wound” fibroblasts. In intact (healthy) skin, fibroblasts are responsible for remodeling the components of the dermis; they destroy old collagen and lay down new one. During wounds, injuries, burns and surgical interventions, myofibroblasts appear in the wounds, which strive to “close the gap” in the tissues, intensively depositing components of the extracellular matrix: collagen, glycosaminoglycans, elastin and other proteins. It is due to the proliferation of fibroblasts and their production of excess extracellular matrix that scar growth occurs [2,19].

The following types of scars can be distinguished: normotrophic, hypertrophic and atrophic. During a normal physiological process, a normotrophic scar is formed. These are flat, light-colored scars with normal or reduced sensitivity and elasticity close to normal tissue. Such scars are optimal. In a typical wound, 6–8 weeks after injury, a balance between anabolic and catabolic processes is established. At this stage, the strength of the wound is approximately 30–40% of the strength of healthy skin. As the scar develops, its tensile strength increases as a result of the progressive bonds of collagen fibers.

When the connective tissue reacts excessively to injury against the background of unfavorable healing conditions (inflammation, scar stretching, etc.), hypertrophic scars are formed. Under conditions of hypoxia and inflammation, fibroblasts are activated by biologically active substances. Undifferentiated, pathological, functionally active cells with a high level of collagen synthesis appear. The formation of collagen prevails over its breakdown due to a decrease in the production of collagenase, a specific enzyme that destroys collagen, as a result of which powerful tissue fibrosis develops in the form of hypertrophic or keloid scars. Hypertrophic scars are often combined into a group with keloid scars due to the fact that both types are characterized by excessive formation of fibrous tissue and arise as a result of inadequate inflammation, the addition of a secondary infection, a decrease in local immunological reactions, etc. However, there are also significant differences, such as: on the basis of which differential diagnosis is carried out between these two types of scars, which will be mentioned below [3].

Atrophic scars result from a decreased response of connective tissue to injury. Not enough collagen is formed. Atrophic scars are located below the level of the surrounding skin (sink). With a small width, they practically do not differ from normotrophic ones. Often, atrophic scars appear in places of former exfoliation (acne) - the so-called “post-acne”.

Keloid (keloidum: Greek kele bulging, swelling + eidos appearance; synonym: Alibera keloid) is a dense growth of connective tissue of the skin, reminiscent of a tumor [2]. Keloid scars develop as a result of a perverted tissue reaction to injury; this is a special, most severe group of scars that differ from others in appearance and pathogenesis. As a rule, keloids form against the background of reduced levels of general and tissue immunity. When examining keloid tissue, extremely active fibroblasts are found, the degree of their activity is 4 times higher than that of cells during the normal healing process [9]. Collagen (mostly immature) is located in the form of wide loose bundles and nodes, elastin is absent. A keloid scar has an elastic consistency, an uneven, slightly wrinkled surface. Keloid is usually classified into true and false. A true (spontaneous) keloid scar occurs spontaneously without any prerequisites, most often on the skin of the chest, along the outer surface of the upper third of the shoulder, and in rare cases throughout the body. A false keloid can develop in any place where there has been previous trauma to the skin (mechanical, burn, etc.). For example, a casuistic case was observed by Chawla B., Agarwal A., Kashyap S. (2007), who diagnosed a keloid formation on the cornea of ​​the eye after surgery. Currently, this classification is relative. Most researchers believe that spontaneous keloid is preceded by microtrauma to the skin and etiologically it is no different from a false one (in pathogenesis and morphology, these scars are absolutely identical) [2]. A keloid at the site of abrasions or scratches is a raised area. The color and intensity of the color depends on the degree of vascularization (bright pink, pale, cyanotic). A keloid scar is characterized by pulsating growth, like the ebb and flow of the tide. Scar tissue in keloids extends beyond the original wound, usually does not regress spontaneously, and tends to recur after excision.

Theoretically, keloid can appear at any age, but most often develops during and after puberty. Young individuals are more likely to be injured, and young skin creates more tension, while older skin is less elastic and more rigid. Collagen synthesis levels are also higher at younger ages. Currently, the average age of patients is 25.8 (22.3 in women and 22.6 in men) [5].

Typically, diagnosing a keloid is not difficult. Gulamhuseinwala N., Mackey S., Meagher P. (2008), who conducted a retrospective study of 568 patients with keloids, found that the clinical diagnosis coincided with the histological diagnosis in 94% of cases. However, when scars begin to appear, the question of differential diagnosis between hypertrophic scar and keloid arises. As mentioned above, there are significant differences between these types of scars. The growth of a hypertrophic scar begins immediately after healing and is characterized by the formation of “plus tissue”, an area equal to the wound surface, while the boundaries of the keloid always extend beyond the damaged area. With a hypertrophic scar, subjective sensations are absent or insignificant. Keloid formations cause various subjective sensations (itching, pain, feeling of skin tightness, parasthesia, etc.). The change in color of a hypertrophic scar from pink to whitish occurs at the same time as in normotrophic scars, and over time they noticeably flatten. The keloid remains deep in color and does not regress spontaneously. Typically, one patient has several keloid formations. Keloid scars are most common in people aged 10–30 years, while hypertrophic scars can occur at any age. The morphological picture also has significant differences. It is known that collagen synthesis in keloids is approximately 8 times higher than in hypertrophic scars, which explains the lower quantitative content of collagen fibers in hypertrophic scars, and therefore the mass of the scar. In hypertrophic scars there are fewer fibroplastic cells than in keloids, and there are no giant, immature forms of the “growth zone” [1, 7, 8, 9, 12, 21].

Researchers have noted an unequal frequency of localization of keloid formation in individuals of different races. For example, in white-skinned people, keloids often form on the face (cheek and ear), upper extremities and sternal area; and in Asians the sternal region is almost not affected; in blacks, along with the auricle and neck, the lower extremities are more often affected [5]. This suggested the leading role of heredity in keloid formation. However, to date, no specific gene or set of genes has been identified as being responsible for keloid development [5, 8]. In addition, no significant differences were found between keloid DNA fibroblasts and normal skin DNA fibroblasts. This suggests that what is important in the development of keloid formation is not the increase in the number of fibroblasts producing normal amounts of collagen, but rather that each fibroblast produces more collagen than is necessary for wound repair [13].

Treatment of keloid and hypertrophic scars

The first rule in the treatment of keloids and hypertrophic scars is their prevention. First, unnecessary cosmetic surgery should be avoided in patients prone to keloid formation and severe scarring. A possible exception would be a disfiguring keloid on the pinna. If surgery cannot be avoided, closure of all surgical wounds should occur with minimal tension along the skin folds whenever possible. It is advisable that the incisions do not pass through the surface of the joints and in the middle part of the chest.

Treatment methods for keloid and hypertrophic scars can be divided into several groups:

• medications (corticosteroids, immunomodulators, drugs affecting collagen formation);
• physical and physiotherapeutic (use of occlusive dressings and compression therapy, excision, cryosurgery, laser therapy, electrophoresis, etc.);
• radiation therapy;
• cosmetic procedures aimed at external correction of the defect.

Medicines

Corticosteroids. Intraruminal steroids remain the mainstay of treatment. Corticosteroids reduce scar formation by reducing the synthesis of collagen, glycosaminoglycans, inflammatory mediators, and fibroblast proliferation during wound healing. The most commonly used corticosteroid is triamcinolone acetate at a concentration of 10–40 mg/mL, administered into the injured area by needle injection at 4–6 week intervals. The effectiveness of such an introduction as a monomodel and as an addition to the scar excision procedure is very high. Topical corticosteroids are also widely used, which are applied daily directly to the formation. Complications of corticosteroid treatment include atrophy, telangiectasias, and pigmentation disorders.

Immunomodulators. A new method in the treatment of keloid and hypertrophic scars is interferon therapy. Interferon injected into the suture line after excision of a keloid scar can prophylactically prevent relapses. It is recommended to administer 0.5–1.0 million IU every other day for 2–3 weeks, then 0.1–0.5 million IU 1–2 times a week for three months.

Drugs that reduce hyperproliferation of connective tissue cells. The classic treatment for scars is hyaluronidase. Hyaluronidase breaks down the main component of the interstitial substance of connective tissue - hyaluronic acid, which is a cementing substance of connective tissue, and thus increases tissue and vascular permeability, facilitates the movement of fluids in the interstitial spaces; reduces tissue swelling, softens and flattens scars, and prevents their formation. Preparations containing hyaluronidase (Lidase and Ronidase) are obtained from the testes of cattle. Lidase solution (1 ml) is administered in these cases near the site of the lesion under the skin or under scar tissue. Injections are made daily or every other day; the course of treatment consists of 6–10–15 or more injections. If necessary, repeat courses are carried out at intervals of 1.5–2 months.

A new enzyme preparation for the treatment of diseases accompanied by the growth of connective tissue is Longidaza. "Longidase" is a chemical compound of hyoluronidase with polyoxidonium. The combination of the enzymatic activity of hyaluronidase with the immunomodulatory, antioxidant and moderate anti-inflammatory properties of polyoxidonium provides a wide range of pharmacological properties. It is most effective to use the drug "Longidaza" by ultraphonophoresis or phonophoresis. For ultraphonophoresis, Longidase 3000 IU is diluted in 2–5 ml of gel for ultrasound therapy. The impact is carried out with a small ultrasonic emitter (1 cm2), with an ultrasound frequency of 1 MHz, intensity 0.2–0.4 W/cm2, in continuous mode, exposure time 5–7 minutes, course of 10–12 procedures daily or every other day . Using the phonophoresis method (1500 Hz), 3000 IU of Longidase is administered daily (total exposure time 5 minutes, course - 10 procedures). It is also possible to administer the drug inside the scar:

1. small keloid and hypertrophic scars: Longidaza 3000 IU once every 7 days for a total course of 10 injections into the scar;
2. keloid and hypertrophic large area of ​​​​the lesion: Longidase 3000 IU 1 time in 7 days inside the scar in a course of 8-10 injections, at the same time intramuscular injection of Longidase 3000 IU No. 10.

A well-known drug that inhibits the proliferation of connective tissue cells and at the same time has an anti-inflammatory effect is Contractubex. For many years, Contractubex has been used in surgery and cosmetology in the treatment of postoperative and post-burn scars, including rough scars that impede movement and keloids, as well as stretch marks (striae) after childbirth or after sudden weight loss.

The enzyme preparation of 9 collagenolytic proteases “Fermenkol” is a fundamentally new proteolytic drug. The anti-scar effect of Fermenkol is based on the reduction of excess extracellular matrix in scar tissue. The effect when using anti-scarring agents is observed approximately 3 weeks after the start of use of the product and the optimal result is usually achieved after 2-3 courses of electrophoresis or phonophoresis, 10-15 sessions or applications for 30-60 days.

Physical and physiotherapeutic methods

Silicone sheets and silicone occlusive dressings have been used with varying degrees of success in the treatment of hypertrophic scars and keloids. When using silicone dressings, the effect is more a result of a combination of pressure and surface hydration than the effect of the silicone itself. Studies show that the effectiveness of such dressings when used 24 hours a day for 12 months was observed in only ≈1/3 of patients [20]. The compression/pressure method achieved with silicone sheets causes thinning of the skin. In one study, applying two plates to the earlobes after keloid removal prevented its recurrence for 8 months to 4 years. A significant discomfort of the method is the need to wear bandages/plates throughout the day, as well as the impossibility of attaching them in some anatomical areas (folds, neck, etc.). Other devices (special compression garments and zinc oxide patches) are also used 12 to 24 hours a day for 8 to 12 months, which is a clear disadvantage of the method. According to various authors, their effectiveness does not exceed 40% [4, 5].

Cryosurgery. Cryosurgical agents, such as liquid nitrogen, attack the microvasculature and cause cell death through the formation of intracellular crystals. Typically, 1–3 freeze-thaw cycles of 10–30 seconds are sufficient to achieve the desired effect. Particular attention should be paid to the short duration of liquid nitrogen applications to avoid the appearance of reversible hypopigmentation. Please note that cryotherapy can be painful and cause depigmentation. A more promising method is the combined effect of cryotherapy and corticosteroids [15]. A simple and effective method of facilitating intraruminal steroid injection is to apply very light cryotherapy prior to injection, a step that will cause tissue swelling and subsequent cellular and collagen destruction. Liquid nitrogen is applied for 5-15 seconds, without allowing the skin to freeze. This technique allows for better distribution of the drug in the keloid tissue and minimizes its penetration into surrounding tissues.

Laser therapy. Argon laser (488 nm) is similar to carbon dioxide laser and can promote collagen contraction through local heating. A pulsed dye laser (585 nm) causes a process of photothermolysis, leading to microvascular thrombosis. In the early 1980s, authors noted that with the use of pulsed dye laser, scars became less erythematous, softer, and less hypertrophic. Laser treatment of keloids and hypertrophic scars using a carbon dioxide laser (10,600 nm) can ablate (can cut and cauterize) the lesion, creating a dry surgical environment with minimal tissue trauma. When carbon dioxide laser is used as a single model, the recurrence rate of keloid is quite high, so it is recommended to combine laser treatment with postoperative steroid administration, which significantly reduces the recurrence rate.

Radiation therapy. The use of radiation therapy to treat keloids remains controversial. One retrospective study found that the use of superficial radiation therapy after scar resection caused recurrence in 53% of patients [18]. Preoperative treatment of scars with a solution of hyaluronidase, followed by surgical removal and then external irradiation, is considered more promising to reduce the likelihood of relapse [6].

X-ray therapy (Bucchi rays) is based on the action of ionizing radiation on connective tissue, causing swelling and destruction of collagen fibers and fibroblasts. X-ray therapy is prescribed up to 6 irradiation sessions with an interval of 6–8 weeks at a single dose of up to 15,000 R. Only the superficial layers of the skin (in particular, the scar) are exposed to ionizing radiation, and the X-ray load on the underlying tissue is insignificant. Contraindications to Bucca therapy are kidney disease, circulatory decompensation, the presence of dermatitis and residual wounds. The idea of ​​using x-ray therapy is very rational, because in the case of destruction of a certain number of fibroblasts, a balance is achieved between the synthesis and degradation of complex collagen, up to a change in its very structure. This idea, in particular, has been implemented using modern laser technology. The total radiation dose to prevent recurrence of a keloid is 15 to 20 Gy. They also recommend one-time irradiation of the wound on the day of suture removal in the same doses - 15–20 Gy. Sometimes this procedure is repeated up to 6 times at intervals of 1.5–2 months.

Excision. It is advisable to avoid surgery, especially if a keloid is present. Excision relapses in 45–100% of cases and should only rarely be used as a standalone model of therapy. After excision, long-term anti-relapse therapy is necessary. Whenever possible, wound pressure bandages and linens are used in the early postoperative period. Reducing relapses is achieved by combining excision with other methods, such as radiation or radiotherapy, interferon or corticosteroids [10].

After surgical interventions or skin injuries, it is necessary to take preventive measures to reduce the risk of keloid formation or hypertrophic sutures. The period of active therapy should begin at the 2nd stage of scar formation, i.e. 10–30 days after injury. According to the authors, there is a proportional dependence on the effectiveness of therapeutic treatment on the age of the scars: scars older than 6 months are less responsive to therapy than younger ones. Most likely, the decrease in the effectiveness of therapeutic measures is associated with a decrease in the number of vessels and compaction of scar tissue, which worsens its trophism [3]. Preventive methods may include: occlusive dressings, compression therapy, external applications or intradermal administration of glucocorticosteroids, Contractubex, Longidase, immunotherapy.

With a formed scar with a duration of up to 12 months, it is possible to carry out therapy with all methods, and with a long-term formation (more than 12 months), only aggressive methods are effective: injection of corticosteroids into the affected area, excision, radiation therapy, Bucca therapy, laser therapy.

Cosmetic procedures aimed at external correction of the defect. The most popular cosmetic procedures (peelings, mesotherapy, dermabrasion) do not serve any therapeutic purpose when affecting scars. The use of these methods contributes to the aesthetic correction of small scars. It is important to know that hypertrophic scars can be resurfaced only after they have reached a calm state. To obtain satisfactory results in the treatment of scars with a duration of more than six months, cosmetic procedures must be combined with 1–2 injections of corticosteroids (Diprospan) [2]. Sandblasting dermabrasion (10–15 sessions with an interval of 10–14 days) with a standard course of treatment provides satisfactory results, but when conducting two courses of 10–15 procedures, the effectiveness of treatment increases [2]. Surgical dermabrasion of hypertrophic scars requires re-operation after six months. Complete epithelization of hypertrophic scars after deep surgical dermabrasion occurs much later than epithelization of normotrophic and hypotrophic scars and lasts for 3–4 weeks, even when using wound healing ointments [2]. O. S. Ozerskaya (2002) performed a transplantation of autologous keratinocytes to prevent recurrence of scars after dermabrasion. Unhindered removal of the bandages is possible on days 7–8; complete epithalization of the scars occurred within up to 14 days. Thus, a significant acceleration of epithalization during dermabrasion of scars with keratinocyte transplantation is obvious. To avoid even greater hypertrophy and hyper- or depigmentation, hypertrophic scars cannot be corrected using aggressive methods, and medium peels can be done only after a course of superficial peels. As for keloid scars, it is better not to expose them to irritating methods, since there is a high probability of provoking their further growth.

Peeling with fruit acids. During peeling, dead skin cells are exfoliated and the regeneration processes of its deep layer are stimulated. Fruit acids gently penetrate the skin without damaging it and stimulate the production of collagen and elastin. Thanks to this, the elasticity of the skin increases, the relief is evened out and hyperpigmentation is reduced, which externally corrects the cosmetic defect of small scars.

Chemical peels. For small, mildly expressed hypertrophic scars, chemical peels are best performed in two stages. At the same time, in daily home care on the 21st day, in order to smooth out scar hypertrophy, a silicone dermatological cream is included, which creates an occlusive film, protecting the skin from moisture loss, relieves inflammation and erythema, and stimulates repair. In parallel with peelings, you can conduct mesotherapy sessions with regenerants and local microcirculation enhancers. Treatment of mildly expressed hypertrophied scars after a course of chemical peels can be continued with topical medications. For severe hypertrophic scars, peelings are carried out six to eight months after excision of the pathological scar or a course of physiotherapy (galvano-, phonophoresis) with hyaluronidase and heparin. The course of chemical peelings is also carried out in two stages: first, several sessions of multi-fruit peels (glycolic, salicylic, lactic, citric acids) once a week, then a complex retinol yellow peeling. Peeling is performed according to an individual scheme in accordance with the parameters of the scar and skin reaction.

In conclusion, it should be noted that the therapy of keloid and hypertrophic scars, with all the variety of treatment methods, requires a strictly individual approach, taking into account the main parameters of the scar: the size and duration of its existence.

For questions regarding literature, please contact the editor.

Yu. A. Gallyamova*, Doctor of Medical Sciences Z. Z. Kardashova** * RMAPO, ** Russian State Scientific Center, Moscow

Key words: hypertrophic scars, keloid scars, keloid disease, keloid, keloid formation, keloid treatment, scar treatment, scar prevention.

Levomekol

Manufacturer: NIZHFARM (Russia)
Release form: ointment for external use

Active ingredient: dioxomethyltetrahydropyrimidine, chloramphenicol

Levomekol is a combination product for external use. The medication has anti-inflammatory, antimicrobial, regenerating effects. A cheap analogue of Contratubes purchased in Russia stimulates regeneration, maturation of granulations and epithelial growth in the wound surface.

The active ingredients of the ointment easily penetrate deep into tissues without damaging biological membranes. The antimicrobial activity of the ointment remains in the presence of pus and the presence of necrotic masses.